This was a comment I responded to someone with on here and I believe it hits the Incel and mgtow problem on the head.
Casual dating is degenerate, the whole point of dating is to find if you genuinely love the person so their the right person for you then marriage. not so you can find some guy milk as much money out of him as possible then cheat on him. This is the problem with dating.
Also by light harted encounters you mean sexual relationships? Like one right stands and casual sex from time to time relationships? They are objectively looks based you can argue looks don't matter to women but just in sexual relationships are based entirely on looks you cannot argue against this. Casual dating is entirely based off looks. In marriage looks fade so you need personality but in casual dating you just get with the hottest person possible until you find somone hotter who's interested. This is why we have the incel and mgtow problem casual dating causes women to only care about looks since personality doesn't matter because the relationship ends anyway and is ploted to end from the start.
But what if you date them casually then marry because you like their personality? Then only hot, and personality rich people get married and everyone else dies alone.

Hi everyone! Thank you so much for all your feedback on the last version. I haven’t changed too much except for the last blurb paragraph which I think is hookier now and I hope solves the problem of not explaining how the story could have sexual prose. I also removed a paragraph from my first three hundred. I hope this version works better now, but please let me know if not.
Dear [AGENT],
Because you like [personalization], I hope you’ll be interested in PHOEBE, my 85,000 word upmarket women’s novel that explores cultural identity and a complicated friendship between two Vietnamese-Americans as they navigate their first years of womanhood.
When twenty-eight year old Phoebe drops out of grad school and gets arrested for assaulting a police officer, the only person she has left to call is her adoptive sister, Gigi.
Phoebe doesn’t have any other family left. After her father killed himself the morning of her high school graduation, her mother drove her across the country to stay with a family friend in Southern California and disappeared. For years, Phoebe was content following Gigi around, even attending college just to stay near her. But when Gigi decided to move away for dental school in San Francisco, Phoebe’s life began its downward spiral.
The day Gigi comes to pick her up, Phoebe is shocked to discover that Gigi is hiding a pregnancy and eloping with a man Phoebe has never met. Without other options, Phoebe soon finds herself moving in with Gigi, Gigi's rich new husband, and their infant son in the moneyed suburb of Arcadia. But Gigi and her husband are always passive-aggressively arguing, and Gigi’s dissatisfaction with motherhood is clear.
In the court mandated therapy sessions following her arrest, Phoebe is forced to recall the trauma she experienced growing up as an immigrant’s child in the Midwest and confront how her loneliness and need for love wrecked the decisions she’s made. Meanwhile, Gigi uncovers a secret about Phoebe’s mother that could change both of their lives.
With flashback cuts similar to the film Challengers (2024), PHOEBE combines the sexual prose and psychological musings of MILK FED by Melissa Broder with the exploration of generational trauma in BANYAN MOON by Thao Thai.
First 300 (again for context, Phoebe refers to Gigi by her full name, Regina)
Regina says my worst trait is how paranoid and judgemental I am. She thinks that I’m always looking over my shoulder, waiting for the next terrible thing to happen, and that I only see the worst in people. She’s not wrong. But unlike her, I haven’t had the sort of life that begets beauty and easy fortune. Every good thing that has ever happened to me was just another suffering in disguise.
My phone buzzes in my hand, and I don’t have to look down at the screen to know it’s Ishaan. It’s been nearly a year since I last saw him, and the same amount of time since I last responded to him. In some messages, he’s worried about me. In others, he’s saying he wants to clear the air, apologize for what happened between us. We need to talk is the most common sequence of words I get. I know he’ll tell me it was all a misunderstanding, but I’m tired of not knowing who to believe, him or my own eyes.
I don’t have his number saved anymore, but I know all the digits that make it up. If you scrambled up all the numbers in a big bag, I could dig them out and place them in back order. Regina says I should just block him and move on, but how can I? He is the monster that I wrought with my own hands. A meat-eating, prospect destroying, body snatching narcissist who was once a sweet twelve-year old boy I could’ve loved but ruined instead.

Decant Reviews Part II: The Revenge! This batch came to me from the most excellent u/Hype_Moments, who thoughtfully reached out to me to inform me of his services after I expressed dismay at my inability to obtain samples directly from Montagne. The decants arrived promptly and packaged securely enough to withstand a nuclear blast! I also appreciate the attention to detail when it comes to labeling: matching Montagne's font and including the notes makes the sampling process feel very deluxe. Great experience, would order again!
On to the fragrances. Unless stated otherwise, I have not smelled the inspiration fragrances, so I am judging these on their own merit. For your reference, I typically prefer unisex fragrances, but I decided to roll the dice and included three feminine scents this time. I'm 29, and I work in both office and classroom environments. Let's get into it!
Eau Vanille: This one is not for everyone, but it's definitely for me. The rich, deep vanilla combined with the guiac wood and incense smells like going to mass at a grand Cathedral. Sophisticated, solemn, mysterious. I imagine that Notre Dame smells like this on Good Friday. Honestly, it kind of reminds me of my confirmation. I swear, the oil the bishop puts on your (greasy, 13-year-old) forehead smells a lot like this. That said, I love this because it reminds me of a positive moment in my faith formation, but it may evoke complex or negative reactions in others. The incense calms down after a couple of hours, which allows the vanilla to shine. Definitely not too sweet, and reads straightforwardly unisex to me. If you're a vanilla-lover looking for something a bit different with some oomph, this could be for you. Maybe not the best choice for the heat of summer, but I will be looking to purchase the full bottle come autumn. Would wear to my arch-rival's funeral.
Strawberry Milk: The wildcard of the bunch. I did not think I was going to like this because I thought it was going to be extremely juvenile and sickly sweet. I ordered it out of pure curiosity after hearing about the ungodly sums folks were shelling out to get their hands on a bottle. While it's definitely a sweet gourmand, it's not syrupy sweet. It's kind of fruity and powdery and just a bit herbal. There's something in here that comes off a little minty to my nose, which is baffling considering the notes. I'm not getting anything particularly strawberry-like, though. Maybe a hint of something lactonic, like malted milk powder, and a burnt-sugar note that could be caramel. Very wearable if you like sweet scents. Not obtrusive, kind of like if you gave a your-skin-but-better scent some moxie. Certainly not your typical celebrity scent. I could see a lot of women liking this. The longevity wasn't the best on this one, though: I think I got about four hours out of it. I'm not personally in love with it, but I'm glad I tried it.
Pink Rose Exclusif: Good Lord, y'all. This THE hot girl perfume. The most attractive woman you can think of probably wears this. It's a really beautiful, sweet, creamy, powdery rose wrapped in a veil of incense and supported by vanilla and woody notes in the base. There's some fruitiness in there too, particularly in the opening. Despite the powderiness and incense, it's quite edible smelling; like a fruity sponge cake that's also drenched in rose syrup, served immediately after the Confirmation service (callback!). I recognize this scent because I have encountered it in the wild on women wearing Delina Exclusif or its dupes, and it definitely... affects me, shall we say. This will turn heads for sure. It also lasts forever with excellent projection. I put on 3 sprays, wore it all day, went to sleep, and then my pillow and sheets smelled like Pink Rose Exclusif for DAYS, just from coming into contact with my arm. You absolutely do not need much of this. As much as I love it, I'm on the fence about whether to buy it, because I'm not sure how often I would actually wear it. It's a little more femme than my personal style usually calls for, imo. Plus, I'm not sure I want all the attention this would garner. That said, it's a 10/10 frag, I'd go for it today if I were single and ready to mingle. UPDATE: After writing this review, I got the opportunity to test the OG in-store, and I can confirm that this is a 1 to 1 dupe. I don't detect any difference whatsoever. Nice work, Montagne!
Pink Rose: This one humbled me. I had already tried the Exclusif version, and figured this was the more wearable, daytime version. I did my normal application (1 spray each on wrists & inner elbows, 2 sprays on the neck, 1 on the front of my shirt) and then headed to the office. When my coworker told me I smelled good from 6 feet away, I knew I had overdone it. I was smelling this all day long, from the 8:30 AM application until bed time. And not just little whiffs here and there, I'm talking constant presence in my olfactory organ. A little distracting, if I'm honest. Luckily, it's a beautiful fragrance. Florals are hit or miss for me, but I have a soft spot for rose. Whereas the Exclusif smells like rose dessert, this smells like a living rose growing fresh and vibrant in the garden. The litchi and rhubarb bring in a little sharpness, and there's a green accord in there that's really refreshing. This is rose done in a modern, interesting way, and I dig it. Feminine, but in a way that feels manageable for my typical presentation. Despite my initial blunder, I do think it's more every-day wearable than its sister as long as you are conservative with your application. Will buy for sure, and probably sooner rather than later.
Carnal Gray Extrait: In a word: exquisite. This smells like being wealthy, well-traveled, and the hottest person at the function. Charisma in a bottle. Effortlessly sexy without being provocative. It's well blended, but not linear. We start with a spicy, herbaceous opening; you get the cardamom right away, with some sweet green undertones. Then, a beautiful dry down. It becomes more powdery with a bit sweetness thanks to iris, tonka, and vanilla. The woodiness from cedar and sandalwood and earthiness from vetiver and patchouli keep it from going gourmand, and the result is something deep, dark, and complex. Perfect for special occasions where you want to dress to impress, this would be the ultimate companion to a well-tailored suit or a fancy cocktail dress. Apparently folks are somewhat divided on whether Gris Charnel Extrait leans feminine or masculine, but to me, CGE is perfectly unisex. Great performance; three sprays lasts me all day with moderate projection. This is my favorite fragrance from Montagne so far, and in the running for my favorite fragrance of all time. It's probably not the best choice for the hot, humid summer that's coming my way, but I don't even care, this is going to the top of the queue. 12/10, I am writing in my will that I want this sprayed on me before I go in the casket.
Brooklyn Jazz: At last, a fragrance that I can compare to its inspiration! I have smelled and fallen in love with Maison Margiela's Jazz Club, and was super excited to see how the wallet-friendly version from Montagne stacks up. Indeed, it's a very close match. We have a nice peppery opening that gives way to boozy, rum tobacco heaven. It's not in the notes, but this definitely comes off leathery to my nose. It smells like sitting in a leather armchair, sipping on dark liquor, and smoking... some kind of tobacco product. I want to say a pipe rather than a cigar, but neither is my vice of choice, so I can't be sure. Either way, old school badass. Think Ron Swanson in Duke Silver mode. If anything, there is perhaps more of an herbal accord here that I didn't notice in Jazz Club, but that could be due to the translation from EDT to EDP. Masculine leaning, but still suitable for ladies who appreciate smokey scents. Altogether, a lovely warm and cozy scent. Decent longevity, but the projection could be better (maybe needs maceration). I do like it, but I'm more motivated to get my hands on Carnal Gray Extrait and Eau Vanille, both of which are certainly different, but occupy a similar region of the fragrance family tree. I may pick it up after I make it through the summer.
Thanks for reading my reviews! And special thank-yous to both u/Hype-Moments and u/AyybrahamLmaocoln for supplying this community with decants and saving us from the anxiety of blind-buying. Let me know if you have any recommendations for my next decant order, particularly more masculine scents that are good for summer; I want my collection to have a little of everything. What do y'all think of Afternoon Dive and Torino 2021? That's all, over and out.

Introduction
While “No Man’s Land” is considered a desert frontier by most, it has been the home of a native population for centuries: The neksut nomads. The neksut travel from oasis to oasis, riding horses and herding sheep and other animals. Though some Neksut have fearsome reputations as warriors, the neksut way of life is under threat from foreign settlers, most of whom see the as unsophisticated.
Recreation
Though outsiders will confidently claim the neksut have no arts to speak of (or even no culture at all), in truth the desert riders have rich musical and storytelling traditions. The neksut are great lovers of song, specializing in throaty chants. Singing is often heard while the tribe is on horseback or around the camp at night, and is typically collaborative, with a lead singer being echoed by several others. The most famous songs are epic historical and mythical tales, such as The Stone Men, Ballad of the Besieger, and Death of Pulcros. Musical instruments include string and woodwind devices, carved from wood and richly decorated.
However perhaps the greatest neksut art is quicksmithing itself. Manipulating quicksteel is vital to the nomads’ way of life, allowing them to effortlessly convert carts into temporary dwellings and back again. But with excess metal, neksut quicksmiths (called shapers in their language) often create temporary sculptures that will be deconstructed when the tribe moves on. Such sculptures are very abstract, often embodying the mood or state of the tribe at the time of construction. To the neksut, the impermanence of this art represents the transient nature of their way of life and of life itself.
Food
The neksut diet is heavily dictated by their nomadic lifestyle, and is fittingly dominated by the products of domesticated animals, principally horses and sheep. Milk is the most important element, and is drank as well as made into cheese, yogurt, or a dry powder. These dairy products are paired with meat from either domestic sheep or from hunted jackalopes or roastritches. Contrary to popular belief, the neksut do not eat their horses, save in rare cases when an animal dies or is too old to keep up with the tribe. Such animals are far too valuable as mounts and sources of milk to be consumed, and in fact an idiom meaning “eating one’s horse” is a neksut expression for one who has not thought things through.
Vegetables and spices (save for salt) are relatively scarce in much of the central desert and thus are scarce in the neksut diet as well. However the nomads make great use of what ingredients they have in a wide variety of dairy and meat meals. Seasoned jackalope jerky with cheese, shredded mutton over yogurt, and roastritch stew are typical. These meals are supplemented with redleaf, roastritch eggs, and whatever foreign ingredients can be traded for. While their cuisine is typically somewhat plain on account of their transient nature, the neksut can put on impressive feasts for special occasions, such as weddings or celebrations. In these cases the traditional meal is the so-called “yogurt table,” in which each participant is given a bowl of yogurt to pair with dozens of small dishes which are passed amongst the tribe.
Gender and Marriage
The neksut are relatively egalitarian in terms of gender. Two reasons for this may be due to their heavy reliance on horses and quicksmithing for their way of life; Mares are actually far superior mounts to stallions (due to their smaller size and milk), and the necessity for quicksmithing to set up camps and carts means that female quicksmiths cannot be disregarded, as all hands are needed. Thus neksut women can be warriors, chieftains, and shamans, with Salaris the Sandstorm and Mist-Eyes being prominent examples. However outside of these important roles, their still is a gendered division of labor in most tribes. Neksut often marry outside the tribe, with young men and women being sent to other tribes as dictated by shamans.
Government
Neksut governance is divided between chieftains and shamans. Chieftains lead tribes from one oasis to another, ultimately ending their journey at a religious site. Shamans oversee religious sites and help select the next route taken by the passing tribes, coordinating movements between different tribes so that resources are given time to replenish. The balance of power between these two roles has varied over time, though currently shamans seemingly hold the dominant role. Shamans serve an important logistical purpose in organizing the travels of tribes and arranging marriages, but they also act as culture repositories, with the shared language, history, and customs of the neksut likely owing to the shamans’ influence. Thus the Neksut are considered one culture and not a dozen.
Religion
Though their mythology purports to explain the origins of humanity, the first mentions of the neksut in the historical record dates to the aftermath of the Great Dying. Some scholars have suggested that the neksut might share common ancestry with some of the people of Tolmika, noting common elements between neksut religion and the Faith of the Heeders.
Neksut religion is centered around the earth and the sky. According to their mythology, the desert was originally a paradise that was the birthplace of the first humans, the Stone Men, who were the children of the earth and the sky. These children crafted a vast civilization from the abundant resources, living like gods for centuries. But over time they forgot their place, abusing the land and ignoring the sky. Eventually, the parents punished their offspring; The earth sent forth earthquakes and eruptions, while the sky whipped up duststorms and withheld the rain. The paradise transformed into the great desert, and most of the children died or fled, leaving their civilization to crumble. But one child, “Neksut”, remained and resolved to repent by living off the land even in these harsh conditions, slaying his fellow stone men. The neksut trace their origins to this figure. They see their own lifestyle as a continuation of that repentance, and view other civilizations as a recreation of their ancestor’s mistakes.

This is an expansion of a recent post and also incorporates some ideas from this theory (by u/ndependent-Design17). Throughout the series the reader is repeatedly reminded that "only death can pay for life" — that magic, especially powerful magic, comes at great cost.

"Only death can pay for life, my lord. A great gift requires a great sacrifice.”

Davos, ASOS
This phrase or variations of this phrase are repeated by Melisandre, Mirri, etc. at various points throughout the series. That which follows is a highly speculative theory on the nature of the cost of magic in the series. Specifically, that souls are central to the exercise of magic and can be used as magic currency.

1. establishing the concept of the soul

Oh, to be sure, there is much we do not understand. The years pass in their hundreds and their thousands, and what does any man see of life but a few summers, a few winters? We look at mountains and call them eternal, and so they seem… but in the course of time, mountains rise and fall, rivers change their courses, stars fall from the sky, and great cities sink beneath the sea. Even gods die, we think. Everything changes.

Bran, AGOT
What happens after we die? Is there some part of us that lives on or do we simply cease to exist. These are fundamental questions that are essentially unanswerable in life but not in ASOIAF. The reader is given a point-of-view account of death in the prologue of ADWD. After unsuccessfully attempting to steal the body of Thistle, a wildling spearwife, Varamyr dies and briefly becomes a disembodied consciousness:

The white world turned and fell away. For a moment it was as if he were inside the weirwood, gazing out through carved red eyes as a dying man twitched feebly on the ground and a madwoman danced blind and bloody underneath the moon, weeping red tears and ripping at her clothes. Then both were gone and he was rising, melting, his spirit borne on some cold wind. He was in the snow and in the clouds, he was a sparrow, a squirrel, an oak. A horned owl flew silently between his trees, hunting a hare; Varamyr was inside the owl, inside the hare, inside the trees. Deep below the frozen ground, earthworms burrowed blindly in the dark, and he was them as well. I am the wood, and everything that’s in it, he thought, exulting.

Prologue, ADWD
Afterward his "spirit," or soul, is eventually transferred into a body of wolf and he begins his second life. This event, and the process of skin-changing more generally, appears to involve projection or transfer of a soul from one body into another. The process of projecting or transferring souls to either animal vessels or the weirwoods is central to the magic of the Children of the Forest.

“Someone else was in the raven,” he told Lord Brynden, once he had returned to his own skin. “Some girl. I felt her.”
“A woman, of those who sing the song of earth,” his teacher said. “Long dead, yet a part of her remains, just as a part of you would remain in Summer if your boy’s flesh were to die upon the morrow. A shadow on the soul. She will not harm you.”
"Do all the birds have singers in them?"
“All,” Lord Brynden said.

Bran, ADWD
After death a "shadow on the soul" of the Singers remain in the crows. The soul of Orell is also described as living on in the body of his eagle after his death.
This process appears to take two forms: the soul can be temporarily projected from one body into another (e.g., as happens when Bran skin-changes into Hodor) or can be permanently transferred as is described in the separate examples above.
These transferred souls merge with their recipient, at least to some degree, and may decay over time:

"The wolf is part of you from that day on, and you’re part of him. Both of you will change.”
Other beasts were best left alone, the hunter had declared. Cats were vain and cruel, always ready to turn on you. Elk and deer were prey; wear their skins too long, and even the bravest man became a coward. Bears, boars, badgers, weasels … Haggon did not hold with such. “Some skins you never want to wear, boy. You won’t like what you’d become.” Birds were the worst, to hear him tell it. “Men were not meant to leave the earth. Spend too much time in the clouds and you never want to come back down again.
...
"They say you forget," Haggon had told him, a few weeks before his own death.
"When the man's flesh dies, his spirit lives on inside the beast, but every day his memory fades, and the beast becomes a little less a warg, a little more a wolf, until nothing of the man is left and only the beast remains."

Prologue, ADWD
Bran is provided with similar warnings about the danger of spending too much time in Summer's skin by Jojen.
The Bran that appears to Jon-Ghost in the vision in ACOK is also likely the lingering soul of a non-contemporary Bran, contained in the weirwoods and communicating from the future.

The weirwood had his brother’s face. Had his brother always had three eyes?
Not always, came the silent shout. Not before the crow.
He sniffed at the bark, smelled wolf and tree and boy, but behind that there were other scents, the rich brown smell of warm earth and the hard grey smell of stone and something else, something terrible. Death, he knew. He was smelling death. He cringed back, his hair bristling, and bared his fangs.
"Don’t be afraid, I like it in the dark. No one can see you, but you can see them. But first you have to open your eyes. See? Like this." And the tree reached down and touched him.

Jon, ACOK
There is more information about this in the Time Traveling Bran series. Briefly, the version of Bran in this vision does not appear to be contemporaneous because likes the dark, is able to open Jon's third eye, smells of death, etc. (This is well outside of the scope of this theory however.)

2. shadow magic requires souls

As above the reader is repeatedly reminded throughout the series that "only death can pay for life." What is specifically being sacrificed, though? Is the magic being fueled by the blood of the sacrificed or by something else?
To answer this let us examine one of the most concrete example of magic in the series, the use or exchange of Stannis Baratheon's "life-fire" in order for Melisandre to manifest the shadows used to kill Renly Baratheon and Courtney Penrose.

Shadows only live when given birth by light, and the king's fires burn so low I dare not draw off any more to make another son. It might well kill him."
Melisandre moved closer.
"With another man, though... a man whose flames still burn hot and high... if you truly wish to serve your king's cause, come to my chamber one night. I could give you pleasure such as you have never known, and with your life-fire I could make..."

Davos, ASOS
According to this explanation, the cost of producing these shadow appears to have been part of his "life-fire," or soul. The shadow is specifically described as having the shape Stannis supporting this. Whether this applies to other types of magic — specifically blood magic or fire magic — is less clear but shadow magic very much appears to require the use of souls.
This type of exchange is also directly referenced in the story of the Night's King provided by Old Nan:

A woman was his downfall; a woman glimpsed from atop the Wall, with skin as white as the moon and eyes like blue stars. Fearing nothing, he chased her and caught her and loved her, though her skin was cold as ice, and when he gave his seed to her he gave his soul as well. (Credit to u/DigLost5791 for this reference.)

Bran, ASOS
Stannis is described by Davos afterward as follows:

The look of him was a shock. He seemed ten years older than the man that Davos had left at Storm’s End when he set sail for the Blackwater and the battle that would be their undoing. The king’s close-cropped beard was spiderwebbed with grey hairs, and he had dropped two stone or more of weight. He had never been a fleshy man, but now the bones moved beneath his skin like spears, fighting to cut free. Even his crown seemed too large for his head. His eyes were blue pits lost in deep hollows, and the shape of a skull could be seen beneath his face.

Davos, ASOS
Asha later describes Stannis as appearing life a "man with one foot in the grave."

What little flesh he’d carried on his tall, spare frame at Deepwood Motte had melted away during the march. The shape of his skull could be seen under his skin, and his jaw was clenched so hard Asha feared his teeth might shatter.

Asha, ADWD
These descriptions seem appropriate for a character that has lost part of their "life-fire" or soul.
Throughout the series Stannis is forced to make a series of increasingly difficult decisions. The most significant of these decisions regards the fate of his nephew, Eric Storm. Melisandre repeatedly urges him to "give [her] the boy," presumably to be burned, but is rebuffed by Stannis.

“I know the cost! Last night, gazing into that hearth, I saw things in the flames as well. I saw a king, a crown of fire on his brows, burning… burning, Davos. His own crown consumed his flesh and turned him into ash. Do you think I need Melisandre to tell me what that means? Or you?” The king moved, so his shadow fell upon King’s Landing.
"…what is the life of one bastard boy against a kingdom?”
“Everything,” said Davos, softly.

Davos, ASOS
Is the life of this bastard boy worth the lives of millions that would die if the Others break through the Wall? Making a deal with the devil and literally selling his soul in pursuit of some greater good seems very appropriate for his character, thematically. The description of his flesh turning to ash in this vision is representative also supports this interpretation.

3. blood and fire magic

As opposed to the creation of the shadows described above, we are also provided an example of so-called blood magic in the leech burning ritual.

“Give me the boy, Your Grace. It is the surer way. The better way. Give me the boy and I shall wake the stone dragon.”
...
Melisandre bowed her head stiffly, and said, “As my king commands.” Reaching up her left sleeve with her right hand, she flung a handful of powder into the brazier. The coals roared. As pale flames writhed atop them, the red woman retrieved the silver dish and brought it to the king. Davos watched her lift the lid. Beneath were three large black leeches, fat with blood. The boy’s blood, Davos knew. A king’s blood. Stannis stretched forth a hand, and his fingers closed around one of the leeches.
“Say the name,” Melisandre commanded.

Davos, ASOS
Following this ritual all of the mentioned individuals do die but do so as the part of separate conspiracies (e.g., Robb Stark is betrayed by the Freys and Boltons, Joffrey Baratheon by Littlefinger and the Tyrells, etc.) which were already in place. It is left intentionally ambiguous by the author but it does not appear that the ritual meaningfully contributed to their deaths.
The creation of the shadows is said by Melisandre to have required part of Stannis' "life-fire" or soul. Could it be that the leech burning ritual was unsuccessful because blood alone is not sufficient as a sacrifice?
These forms of magic are frequently described in the community as "shadow magic" and "blood magic." These concepts — "fire and blood" and "flame and shadow" — are highly associated with one another in the text:

“Shadow?" Davos felt his flesh prickling. "A shadow is a thing of darkness."
”You are more ignorant than a child, ser knight. There are no shadows in the dark. Shadows are the servants of light, the children of fire. The brightest flame casts the darkest shadows."

Davos, ACOK
I speculate that these are different expressions of the same concept; that all of these fall under the general umbrella of fire magic and share common principles. "Fire consumes and in the end there's nothing left."

4. dancing shadows

The tent was aglow with the light of braziers within. Through the blood-spattered sandsilk, she glimpsed shadows moving.
Mirri Maz Duur was dancing, and not alone.
...
No, Dany wanted to say, no, not that, you mustn’t, but when she opened her mouth, a long wail of pain escaped, and the sweat broke over her skin. What was wrong with them, couldn’t they see?
Inside the tent the shapes were dancing, circling the brazier and the bloody bath, dark against the sandsilk, and some did not look human. She glimpsed the shadow of a great wolf, and another like a man wreathed in flames.
“The Lamb Woman knows the secrets of the birthing bed,” Irri said. “She said so, I heard her.”
“Yes,” Doreah agreed, “I heard her too.”
No, she shouted, or perhaps she only thought it, for no whisper of sound escaped her lips. She was being carried. Her eyes opened to gaze up at a flat dead sky, black and bleak and starless. Please, no. The sound of Mirri Maz Duur’s voice grew louder, until it filled the world. The shapes! She screamed. The dancers!
Ser Jorah carried her inside the tent.

Daenerys, AGOT
The introduction of shadow magic in the series is provided above with Mirri Max Duur. Following this ritual Drogo is described as a lifeless husk:

"He seems to like the warmth, Princess," Ser Jorah said. "His eyes follow the sun, though he does not see it. He can walk after a fashion. He will go where you lead him, but no farther. He will eat if you put food in his mouth, drink if you dribble water on his lips."

Daenerys, AGOT
It has previously been speculated that Mirri "reverse skin-changed" Drogo (e.g., "strength of the mount go into the rider, strength of the beast go into the man."). The description provided is less consistent with a horse soul inhabiting a human body than it is with the complete or near-complete absence of a soul. It appears more likely in retrospect that Mirri sacrificed part of Drogo's soul to summon the shadows and likely as a means to kill Daenerys' unborn child.

“The stallion who mounts the world will burn no cities now. His khalasar shall trample no nations into dust."

Daenerys, AGOT

5. reanimation

If "only death can pay for life" and souls are used as a form of magical currency how does one explain the reanimation or resurrection process?
There is a paucity of information on the reanimation of the dead in the series. The resurrection of Beric Dondarrion, for example, appears to be different in fundamental ways from that of the wights or Cold Hands. (We are potentially given a point-of-view account of this process if you accept that Victarion died in ADWD.)

“Thoros, how many times have you brought me back now?”
The red priest bowed his head. “It is R’hllor who brings you back, my lord. The Lord of Light. I am only his instrument.”
“How many times?” Lord Beric insisted.
“Six,” Thoros said reluctantly.
“And each time is harder. You have grown reckless, my lord. Is death so very sweet?”
Arya, ASOS

There is no immediately identifiable magical cost for these "kisses of life," at least at first glance. Thoros later tells us that he breathed part of his "flames" or soul into Beric:

“That first time, his lordship had a hole right through him and blood in his mouth, I knew there was no hope. So when his poor torn chest stopped moving, I gave him the good god's own kiss to send him on his way. I filled my mouth with fire and breathed the flames inside him, down his throat to lungs and heart and soul. The last kiss it is called, and many a time I saw the old priests bestow it on the Lord's servants as they died." (Credit to u/watchersontheweb for providing this quote in the initial thread.)

Arya, ASOS
Thoros is also described as appearing very different after performing this ritual several times in a way that is not entirely dissimilar to the changes in Stannis’ appearance referenced above.

“Here’s the wizard, skinny squirrel. You’ll get your answers now.”
He pointed toward the fire, where Tom Sevenstrings stood talking to a tall thin man with oddments of old armor buckled on over his ratty pink robes. That can’t be Thoros of Myr. Arya remembered the red priest as fat, with a smooth face and a shiny bald head. This man had a droopy face and a full head of shaggy grey hair.
...
“Thoros of Myr. You used to shave your head.”
“To betoken a humble heart, but in truth my heart was vain. Besides, I lost my razor in the woods.” The priest slapped his belly. “I am less than I was, but more. A year in the wild will melt the flesh off a man. Would that I could find a tailor to take in my skin. I might look young again, and pretty maids would shower me with kisses.”

Arya, ASOS
Thoros attributes these changes to his renewed devotion to the Red God and spending "a year in the wild" as above although he is not exactly forthcoming with Arya about the resurrection process. It is also likely that he does not entirely understand what specifically is being exchanged here.
Later he describes Beric giving the "kiss of life" to the corpse of Catelyn Stark:

“The Freys slashed her throat from ear to ear. When we found her by the river she was three days dead. Harwin begged me to give her the kiss of life, but it had been too long. I would not do it, so Lord Beric put his lips to hers instead, and the flame of life passed from him to her. And… she rose. May the Lord of Light protect us. She rose.”

Brienne, AFFC
Notably, this process produces a reanimated Catelyn (a.k.a. Lady Stoneheart). The soul of Beric, or at least whatever is left of his soul at this point in the series, is consumed in order to resurrect Catelyn and not transferred.

6. cold shadows (wild speculation)

The terms "white shadows," "pale shadows," and "cold shadows" are repeated used to describe the Others. The Others are also highly associated with ghosts — the spirits or souls of the dead bound to the earth. (The forrest in which they are introduced is literally called the Haunted Forrest.)

The Others made no sound.
Will saw movement from the corner of his eye. Pale shapes gliding through the wood. He turned his head, glimpsed a white shadow in the darkness. Then it was gone. Branches stirred gently in the wind, scratching at one another with wooden fingers. Will opened his mouth to call down a warning, and the words seemed to freeze in his throat. Perhaps he was wrong. Perhaps it had only been a bird, a reflection on the snow, some trick of the moonlight. What had he seen, after all?
“Will, where are you?” Ser Waymar called up. “Can you see anything?” He was turning in a slow circle, suddenly wary, his sword in hand. He must have felt them, as Will felt them. There was nothing to see. “Answer me! Why is it so cold?” It was cold.
Shivering, Will clung more tightly to his perch. His face pressed hard against the trunk of the sentinel. He could feel the sweet, sticky sap on his cheek. A shadow emerged from the dark of the wood. It stood in front of Royce. Tall, it was, and gaunt and hard as old bones, with flesh pale as milk. Its armor seemed to change color as it moved; here it was white as new-fallen snow, there black as shadow, everywhere dappled with the deep grey-green of the trees. The patterns ran like moonlight on water with every step it took. Will heard the breath go out of Ser Waymar Royce in a long hiss. ...
The Other slid forward on silent feet. In its hand was a longsword like none that Will had ever seen. No human metal had gone into the forging of that blade. It was alive with moonlight, translucent, a shard of crystal so thin that it seemed almost to vanish when seen edge-on. There was a faint blue shimmer to the thing, a ghost-light that played around its edges, and somehow Will knew it was sharper than any razor.

Prologue, AGOT
This is again highly speculative but it seems reasonable to consider that these cold shadows are not "ice demons" or "ice zombies" but are in fact ghosts, the spirits or souls of men that are bound to the earth through magic by the Children of the Forest. (The textual evidence of the creation of the Others by the Children has previously been discussed at length in the community in separate posts.) "Fire consumes, but cold preserves."
This would explain several of the unusual characteristics of the Others described by Tormund:

“Tormund,” Jon said, as they watched four old women pull a cartful of children toward the gate, “tell me of our foe. I would know all there is to know of the Others.”
The wildling rubbed his mouth. “Not here,” he mumbled, “not this side o’ your Wall.” The old man glanced uneasily toward the trees in their white mantles. “They’re never far, you know. They won’t come out by day, not when that old sun’s shining, but don’t think that means they went away. Shadows never go away. Might be you don’t see them, but they’re always clinging to your heels.”
...
Tormund turned back.
"You know nothing. You killed a dead man, aye, I heard. Mance killed a hundred. A man can fight the dead, but when their masters come, when the white mists rise up… how do you fight a mist, crow? Shadows with teeth … air so cold it hurts to breathe, like a knife inside your chest … you do not know, you cannot know … can your sword cut cold?"

Jon, ADWD
A reasonable interpretation of this information is that the Others are present during the day, at least in some capacity, and are only able to assume corporeal form at night.
The Others are also described as "going lightly upon the snow" which would also supports the idea that they are ghosts:

“The white walkers go lightly on the snow,” the ranger said. “You’ll find no prints to mark their passage.”

Samwell, ASOS

7. conclusions

This highly speculative theory attempts to reconcile several seemingly disparate concepts in the series related to magic, namely the actual nature of magical sacrifice ("only death can pay for life") and shadows or shadow magic. More specifically, I suggest that souls are the primary magical currency and can be consumed using fire magic to summon shadows, create glamours, etc. I also speculate that similar processes took place during Mirri Maz Duur's shadow-binding ritual in AGOT and during the repeated resurrections of Berric Dondarrion in ASOS. I further suggest that the Others are ghosts, the spirits or souls of the dead bound to the earth.
EDIT: edited several times to address formatting issues

This is an expansion of a recent post and also incorporates some ideas from this theory (by u/ndependent-Design17). Throughout the series the reader is repeatedly reminded that "only death can pay for life" — that magic, especially powerful magic, comes at great cost.

"Only death can pay for life, my lord. A great gift requires a great sacrifice.”

Davos, ASOS
This phrase or variations of this phrase are repeated by Melisandre, Mirri, etc. at various points throughout the series. That which follows is a highly speculative theory on the nature of the cost of magic in the series. Specifically, that souls are central to the exercise of magic and can be used as magic currency.

1. establishing the concept of the soul

Oh, to be sure, there is much we do not understand. The years pass in their hundreds and their thousands, and what does any man see of life but a few summers, a few winters? We look at mountains and call them eternal, and so they seem… but in the course of time, mountains rise and fall, rivers change their courses, stars fall from the sky, and great cities sink beneath the sea. Even gods die, we think. Everything changes.

Bran, AGOT
What happens after we die? Is there some part of us that lives on or do we simply cease to exist. These are fundamental questions that are essentially unanswerable in life but not in ASOIAF. The reader is given a point-of-view account of death in the prologue of ADWD. After unsuccessfully attempting to steal the body of Thistle, a wildling spearwife, Varamyr dies and briefly becomes a disembodied consciousness:

The white world turned and fell away. For a moment it was as if he were inside the weirwood, gazing out through carved red eyes as a dying man twitched feebly on the ground and a madwoman danced blind and bloody underneath the moon, weeping red tears and ripping at her clothes. Then both were gone and he was rising, melting, his spirit borne on some cold wind. He was in the snow and in the clouds, he was a sparrow, a squirrel, an oak. A horned owl flew silently between his trees, hunting a hare; Varamyr was inside the owl, inside the hare, inside the trees. Deep below the frozen ground, earthworms burrowed blindly in the dark, and he was them as well. I am the wood, and everything that’s in it, he thought, exulting.

Prologue, ADWD
Afterward his "spirit," or soul, is eventually transferred into a body of wolf and he begins his second life. This event, and the process of skin-changing more generally, appears to involve projection or transfer of a soul from one body into another. The process of projecting or transferring souls to either animal vessels or the weirwoods is central to the magic of the Children of the Forest.

“Someone else was in the raven,” he told Lord Brynden, once he had returned to his own skin. “Some girl. I felt her.”
“A woman, of those who sing the song of earth,” his teacher said. “Long dead, yet a part of her remains, just as a part of you would remain in Summer if your boy’s flesh were to die upon the morrow. A shadow on the soul. She will not harm you.”
"Do all the birds have singers in them?"
“All,” Lord Brynden said.

Bran, ADWD
After death a "shadow on the soul" of the Singers remain in the crows. The soul of Orell is also described as living on in the body of his eagle after his death.
This process appears to take two forms: the soul can be temporarily projected from one body into another (e.g., as happens when Bran skin-changes into Hodor) or can be permanently transferred as is described in the separate examples above.
These transferred souls merge with their recipient, at least to some degree, and may decay over time:

"The wolf is part of you from that day on, and you’re part of him. Both of you will change.”
Other beasts were best left alone, the hunter had declared. Cats were vain and cruel, always ready to turn on you. Elk and deer were prey; wear their skins too long, and even the bravest man became a coward. Bears, boars, badgers, weasels … Haggon did not hold with such. “Some skins you never want to wear, boy. You won’t like what you’d become.” Birds were the worst, to hear him tell it. “Men were not meant to leave the earth. Spend too much time in the clouds and you never want to come back down again.
...
"They say you forget," Haggon had told him, a few weeks before his own death.
"When the man's flesh dies, his spirit lives on inside the beast, but every day his memory fades, and the beast becomes a little less a warg, a little more a wolf, until nothing of the man is left and only the beast remains."

Prologue, ADWD
Bran is provided with similar warnings about the danger of spending too much time in Summer's skin by Jojen.
The Bran that appears to Jon-Ghost in the vision in ACOK is also likely the lingering soul of a non-contemporary Bran, contained in the weirwoods and communicating from the future.

The weirwood had his brother’s face. Had his brother always had three eyes?
Not always, came the silent shout. Not before the crow.
He sniffed at the bark, smelled wolf and tree and boy, but behind that there were other scents, the rich brown smell of warm earth and the hard grey smell of stone and something else, something terrible. Death, he knew. He was smelling death. He cringed back, his hair bristling, and bared his fangs.
"Don’t be afraid, I like it in the dark. No one can see you, but you can see them. But first you have to open your eyes. See? Like this." And the tree reached down and touched him.

Jon, ACOK
There is more information about this in the Time Traveling Bran series. Briefly, the version of Bran in this vision does not appear to be contemporaneous because likes the dark, is able to open Jon's third eye, smells of death, etc. (This is well outside of the scope of this theory however.)

2. shadow magic requires souls

As above the reader is repeatedly reminded throughout the series that "only death can pay for life." What is specifically being sacrificed, though? Is the magic being fueled by the blood of the sacrificed or by something else?
To answer this let us examine one of the most concrete example of magic in the series, the use or exchange of Stannis Baratheon's "life-fire" in order for Melisandre to manifest the shadows used to kill Renly Baratheon and Courtney Penrose.

Shadows only live when given birth by light, and the king's fires burn so low I dare not draw off any more to make another son. It might well kill him."
Melisandre moved closer.
"With another man, though... a man whose flames still burn hot and high... if you truly wish to serve your king's cause, come to my chamber one night. I could give you pleasure such as you have never known, and with your life-fire I could make..."

Davos, ASOS
According to this explanation, the cost of producing these shadow appears to have been part of his "life-fire," or soul. The shadow is specifically described as having the shape Stannis supporting this. Whether this applies to other types of magic — specifically blood magic or fire magic — is less clear but shadow magic very much appears to require the use of souls.
This type of exchange is also directly referenced in the story of the Night's King provided by Old Nan:

A woman was his downfall; a woman glimpsed from atop the Wall, with skin as white as the moon and eyes like blue stars. Fearing nothing, he chased her and caught her and loved her, though her skin was cold as ice, and when he gave his seed to her he gave his soul as well. (Credit to u/DigLost5791 for this reference.)

Bran, ASOS
Stannis is described by Davos afterward as follows:

The look of him was a shock. He seemed ten years older than the man that Davos had left at Storm’s End when he set sail for the Blackwater and the battle that would be their undoing. The king’s close-cropped beard was spiderwebbed with grey hairs, and he had dropped two stone or more of weight. He had never been a fleshy man, but now the bones moved beneath his skin like spears, fighting to cut free. Even his crown seemed too large for his head. His eyes were blue pits lost in deep hollows, and the shape of a skull could be seen beneath his face.

Davos, ASOS
Asha later describes Stannis as appearing life a "man with one foot in the grave."

What little flesh he’d carried on his tall, spare frame at Deepwood Motte had melted away during the march. The shape of his skull could be seen under his skin, and his jaw was clenched so hard Asha feared his teeth might shatter.

Asha, ADWD
These descriptions seem appropriate for a character that has lost part of their "life-fire" or soul.
Throughout the series Stannis is forced to make a series of increasingly difficult decisions. The most significant of these decisions regards the fate of his nephew, Eric Storm. Melisandre repeatedly urges him to "give [her] the boy," presumably to be burned, but is rebuffed by Stannis.

“I know the cost! Last night, gazing into that hearth, I saw things in the flames as well. I saw a king, a crown of fire on his brows, burning… burning, Davos. His own crown consumed his flesh and turned him into ash. Do you think I need Melisandre to tell me what that means? Or you?” The king moved, so his shadow fell upon King’s Landing.
"…what is the life of one bastard boy against a kingdom?”
“Everything,” said Davos, softly.

Davos, ASOS
Is the life of this bastard boy worth the lives of millions that would die if the Others break through the Wall? Making a deal with the devil and literally selling his soul in pursuit of some greater good seems very appropriate for his character, thematically. The description of his flesh turning to ash in this vision is representative also supports this interpretation.

3. blood and fire magic

As opposed to the creation of the shadows described above, we are also provided an example of so-called blood magic in the leech burning ritual.

“Give me the boy, Your Grace. It is the surer way. The better way. Give me the boy and I shall wake the stone dragon.”
...
Melisandre bowed her head stiffly, and said, “As my king commands.” Reaching up her left sleeve with her right hand, she flung a handful of powder into the brazier. The coals roared. As pale flames writhed atop them, the red woman retrieved the silver dish and brought it to the king. Davos watched her lift the lid. Beneath were three large black leeches, fat with blood. The boy’s blood, Davos knew. A king’s blood. Stannis stretched forth a hand, and his fingers closed around one of the leeches.
“Say the name,” Melisandre commanded.

Davos, ASOS
Following this ritual all of the mentioned individuals do die but do so as the part of separate conspiracies (e.g., Robb Stark is betrayed by the Freys and Boltons, Joffrey Baratheon by Littlefinger and the Tyrells, etc.) which were already in place. It is left intentionally ambiguous by the author but it does not appear that the ritual meaningfully contributed to their deaths.
The creation of the shadows is said by Melisandre to have required part of Stannis' "life-fire" or soul. Could it be that the leech burning ritual was unsuccessful because blood alone is not sufficient as a sacrifice?
These forms of magic are frequently described in the community as "shadow magic" and "blood magic." These concepts — "fire and blood" and "flame and shadow" — are highly associated with one another in the text:

“Shadow?" Davos felt his flesh prickling. "A shadow is a thing of darkness."
”You are more ignorant than a child, ser knight. There are no shadows in the dark. Shadows are the servants of light, the children of fire. The brightest flame casts the darkest shadows."

Davos, ACOK
I speculate that these are different expressions of the same concept; that all of these fall under the general umbrella of fire magic and share common principles. "Fire consumes and in the end there's nothing left."

4. dancing shadows

The tent was aglow with the light of braziers within. Through the blood-spattered sandsilk, she glimpsed shadows moving.
Mirri Maz Duur was dancing, and not alone.
...
No, Dany wanted to say, no, not that, you mustn’t, but when she opened her mouth, a long wail of pain escaped, and the sweat broke over her skin. What was wrong with them, couldn’t they see?
Inside the tent the shapes were dancing, circling the brazier and the bloody bath, dark against the sandsilk, and some did not look human. She glimpsed the shadow of a great wolf, and another like a man wreathed in flames.
“The Lamb Woman knows the secrets of the birthing bed,” Irri said. “She said so, I heard her.”
“Yes,” Doreah agreed, “I heard her too.”
No, she shouted, or perhaps she only thought it, for no whisper of sound escaped her lips. She was being carried. Her eyes opened to gaze up at a flat dead sky, black and bleak and starless. Please, no. The sound of Mirri Maz Duur’s voice grew louder, until it filled the world. The shapes! She screamed. The dancers!
Ser Jorah carried her inside the tent.

Daenerys, AGOT
The introduction of shadow magic in the series is provided above with Mirri Max Duur. Following this ritual Drogo is described as a lifeless husk:

"He seems to like the warmth, Princess," Ser Jorah said. "His eyes follow the sun, though he does not see it. He can walk after a fashion. He will go where you lead him, but no farther. He will eat if you put food in his mouth, drink if you dribble water on his lips."

Daenerys, AGOT
It has previously been speculated that Mirri "reverse skin-changed" Drogo (e.g., "strength of the mount go into the rider, strength of the beast go into the man."). The description provided is less consistent with a horse soul inhabiting a human body than it is with the complete or near-complete absence of a soul. It appears more likely in retrospect that Mirri sacrificed part of Drogo's soul to summon the shadows and likely as a means to kill Daenerys' unborn child.

“The stallion who mounts the world will burn no cities now. His khalasar shall trample no nations into dust."

Daenerys, AGOT

5. reanimation

If "only death can pay for life" and souls are used as a form of magical currency how does one explain the reanimation or resurrection process?
There is a paucity of information on the reanimation of the dead in the series. The resurrection of Beric Dondarrion, for example, appears to be different in fundamental ways from that of the wights or Cold Hands. (We are potentially given a point-of-view account of this process if you accept that Victarion died in ADWD.)

“Thoros, how many times have you brought me back now?”
The red priest bowed his head. “It is R’hllor who brings you back, my lord. The Lord of Light. I am only his instrument.”
“How many times?” Lord Beric insisted.
“Six,” Thoros said reluctantly.
“And each time is harder. You have grown reckless, my lord. Is death so very sweet?”
Arya, ASOS

There is no immediately identifiable magical cost for these "kisses of life," at least at first glance. Thoros later tells us that he breathed part of his "flames" or soul into Beric:

“That first time, his lordship had a hole right through him and blood in his mouth, I knew there was no hope. So when his poor torn chest stopped moving, I gave him the good god's own kiss to send him on his way. I filled my mouth with fire and breathed the flames inside him, down his throat to lungs and heart and soul. The last kiss it is called, and many a time I saw the old priests bestow it on the Lord's servants as they died." (Credit to u/watchersontheweb for providing this quote in the initial thread.)

Arya, ASOS
Thoros is also described as appearing very different after performing this ritual several times in a way that is not entirely dissimilar to the changes in Stannis’ appearance referenced above.

“Here’s the wizard, skinny squirrel. You’ll get your answers now.”
He pointed toward the fire, where Tom Sevenstrings stood talking to a tall thin man with oddments of old armor buckled on over his ratty pink robes. That can’t be Thoros of Myr. Arya remembered the red priest as fat, with a smooth face and a shiny bald head. This man had a droopy face and a full head of shaggy grey hair.
...
“Thoros of Myr. You used to shave your head.”
“To betoken a humble heart, but in truth my heart was vain. Besides, I lost my razor in the woods.” The priest slapped his belly. “I am less than I was, but more. A year in the wild will melt the flesh off a man. Would that I could find a tailor to take in my skin. I might look young again, and pretty maids would shower me with kisses.”

Arya, ASOS
Thoros attributes these changes to his renewed devotion to the Red God and spending "a year in the wild" as above although he is not exactly forthcoming with Arya about the resurrection process. It is also likely that he does not entirely understand what specifically is being exchanged here.
Later he describes Beric giving the "kiss of life" to the corpse of Catelyn Stark:

“The Freys slashed her throat from ear to ear. When we found her by the river she was three days dead. Harwin begged me to give her the kiss of life, but it had been too long. I would not do it, so Lord Beric put his lips to hers instead, and the flame of life passed from him to her. And… she rose. May the Lord of Light protect us. She rose.”

Brienne, AFFC
Notably, this process produces a reanimated Catelyn (a.k.a. Lady Stoneheart). The soul of Beric, or at least whatever is left of his soul at this point in the series, is consumed in order to resurrect Catelyn and not transferred.

6. cold shadows (wild speculation)

The terms "white shadows," "pale shadows," and "cold shadows" are repeated used to describe the Others. The Others are also highly associated with ghosts — the spirits or souls of the dead bound to the earth. (The forrest in which they are introduced is literally called the Haunted Forrest.)

The Others made no sound.
Will saw movement from the corner of his eye. Pale shapes gliding through the wood. He turned his head, glimpsed a white shadow in the darkness. Then it was gone. Branches stirred gently in the wind, scratching at one another with wooden fingers. Will opened his mouth to call down a warning, and the words seemed to freeze in his throat. Perhaps he was wrong. Perhaps it had only been a bird, a reflection on the snow, some trick of the moonlight. What had he seen, after all?
“Will, where are you?” Ser Waymar called up. “Can you see anything?” He was turning in a slow circle, suddenly wary, his sword in hand. He must have felt them, as Will felt them. There was nothing to see. “Answer me! Why is it so cold?” It was cold.
Shivering, Will clung more tightly to his perch. His face pressed hard against the trunk of the sentinel. He could feel the sweet, sticky sap on his cheek. A shadow emerged from the dark of the wood. It stood in front of Royce. Tall, it was, and gaunt and hard as old bones, with flesh pale as milk. Its armor seemed to change color as it moved; here it was white as new-fallen snow, there black as shadow, everywhere dappled with the deep grey-green of the trees. The patterns ran like moonlight on water with every step it took. Will heard the breath go out of Ser Waymar Royce in a long hiss. ...
The Other slid forward on silent feet. In its hand was a longsword like none that Will had ever seen. No human metal had gone into the forging of that blade. It was alive with moonlight, translucent, a shard of crystal so thin that it seemed almost to vanish when seen edge-on. There was a faint blue shimmer to the thing, a ghost-light that played around its edges, and somehow Will knew it was sharper than any razor.

Prologue, AGOT
This is again highly speculative but it seems reasonable to consider that these cold shadows are not "ice demons" or "ice zombies" but are in fact ghosts, the spirits or souls of men that are bound to the earth through magic by the Children of the Forest. (The textual evidence of the creation of the Others by the Children is linked in a separate post here.) "Fire consumes, but cold preserves."
This would explain several of the unusual characteristics of the Others described by Tormund:

“Tormund,” Jon said, as they watched four old women pull a cartful of children toward the gate, “tell me of our foe. I would know all there is to know of the Others.”
The wildling rubbed his mouth. “Not here,” he mumbled, “not this side o’ your Wall.” The old man glanced uneasily toward the trees in their white mantles. “They’re never far, you know. They won’t come out by day, not when that old sun’s shining, but don’t think that means they went away. Shadows never go away. Might be you don’t see them, but they’re always clinging to your heels.”
...
Tormund turned back.
"You know nothing. You killed a dead man, aye, I heard. Mance killed a hundred. A man can fight the dead, but when their masters come, when the white mists rise up… how do you fight a mist, crow? Shadows with teeth … air so cold it hurts to breathe, like a knife inside your chest … you do not know, you cannot know … can your sword cut cold?"

Jon, ADWD
A reasonable interpretation of this information is that the Others are present during the day, at least in some capacity, and are only able to assume corporeal form at night.
The Others are also described as "going lightly upon the snow" which would also supports the idea that they are ghosts:

“The white walkers go lightly on the snow,” the ranger said. “You’ll find no prints to mark their passage.”

Samwell, ASOS

7. conclusions

This highly speculative theory attempts to reconcile several seemingly disparate concepts in the series related to magic, namely the actual nature of magical sacrifice ("only death can pay for life") and shadows or shadow magic. More specifically, I suggest that souls are the primary magical currency and can be consumed using fire magic to summon shadows, create glamours, etc. I also speculate that similar processes took place during Mirri Maz Duur's shadow-binding ritual in AGOT and during the repeated resurrections of Berric Dondarrion in ASOS. I further suggest that the Others are ghosts, the spirits or souls of the dead bound to the earth.
EDIT: edited several times to address formatting issues

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• Cheesecake Factory GC - $10 bonus card when you buy a $50 one - Expires 5/12
  
• Fromm Diner Can - Free after coupon. (It's pet food)
  
• Painterland Sisters Yogurt - Free after rebate. PayPal or Venmo. Whole Foods only.
  
• Beneful - IB + SK
  
• Suja Protein Shake - Free at Target in-store or online.
  
• Coffee (Any?) - You get a coupon for up to $10 in free coffee when you buy 3 participating special K cereals. I don't see anything mentioned about specific brands, but I also don't quite know how it works. - Expires 5/30/24
  
• Gooey - Free after rebate - Venmo/PayPal - (It says Walmart at the top, but it also says "from any store")
  
• Perfect Bar - One free bar - PayPal, Venmo, Amazon - Rebates are often instant
  
• CHKP - Free after Aisle - Fairway, Whole Foods, ShopRite
  
• Dr Elsey's Cat Litter - Up to $22 back on a bag up to 40 lbs when you purchase at Target, Walmart, or a local business pet store. You need to cut out the barcode and mail it in with the receipt. One rebate per person/household/address. Must submit within 90 days. There's also a handful of $1 coupons on this page.
  
• Free bag of Like Air Puffcorn - Refund via PayPal or Venmo. Must purchase in-store or for curbside pickup. Expiration date unknown.
  
• Kellogg's Promotions - Various stuff ranging from coupons for free products, movie tickets, various merchandise, and more.
  
• Various Sampoll offers
  
• Offers on Aisle Referrals: Halfday Rockstar - Buy 2 get $5 back. No gas purchase needed. Can do every other week. Free HOP Water (using my ref will give me another rebate offer) Pays out via PayPal or Venmo
  
• Various freebies on Ibotta.
  
• Various deals I've done in previous weeks can still be done.
  

 

Afterthoughts

Small haul for a small bonus today. I put together that part of the haul last night, and once I saw the $5 / 10 bonus, I completely forgot to check every other app, haha. Technically a slight profit loss meeting my IB bonus today, but that's okay because I'm making progress towards my bigger bonus. If I were to prorate that bonus, that'd be an extra $4.52, so it's definitely worth it.
 
My Beneful finally stopped resetting, unfortunately. Hopefully the Mac a Roni and butter keep resetting. I was going to get a couple other things too just to work towards my big bonus, but my store was out. I'll be going out of town later this week, so maybe I'll get lucky and find some good deals at stores that aren't around here.
 

Time Spent

I glanced at IB last night for like 5-10 minutes. I was planning to finish planning the haul today, but I didn't need to find any more deals. I was in the store for 50 minutes today, which included my regular shopping as well as browsing through the plants and clearance aisles.
 

Food From Deals

Here's an idea: Mix up a white cheddar Mac a Roni, with your choice of ham, sausage, chicken, pork, or one of the vegan meat alternatives. Add a little soy sauce, and some green peas if you wish. You could even add some extra butter and milk (or plant based milk) to make it a bit creamier. Serve with a slice of buttered toast or some Jasmine Rice. Perhaps make a little Banana bread for dessert. (Note: Everything mentioned has Ibotta deals available.)
 
Here's some things I've made in the past: High Protein Tomato Crackers, Hot Sausage Cups, Peanut Butter Fudge & Chocolate Hazelnut Fudge, Chocolate Cherry Pie
 
Do you guys want me to continue showing things I've made using ingredients I got from rebate apps on these posts? Let me know in the comments, or you can vote on this poll if you want to remain anonymous.
 

Mini FAQ

• If you're new or confused - check out the guides near the top of the post. They go into detail about everything.
  
• I'm from the USA and these posts are tailored as such, but this post of mine does list things from other countries that I know about.
  
• My posts are tailored to being money makers to suit this subreddit. There are tons of great deals that aren't money makers but can still save you a lot of money.
  
• A lot of what I get is given away to friends, family or is donated. I do this more as a hobby than anything.
  
• I generally do not share my spreadsheet since the one shown in this post is not the one I actually use (it's put together with a script from my usual spreadsheet) and there are a ton of little things that will give you wrong values if you don't know about them and even then you have to be careful. It's super easy to make a spreadsheet with Google Sheets though.
  

Liv Pure For Weight Loss
Liv Pure has emerged as a central hub for those seeking insights into the effectiveness of this liver health supplement. This thorough review delves into its composition, advantages, and customer opinions, providing a comprehensive view for potential users.

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Liv Pure elucidates the mechanism underpinning the supplement's effectiveness, shedding light on how its components collaborate to enhance liver function, accelerate metabolism, and aid in fat burning. This analysis offers clarity on the supplement's role in fostering overall health and wellness.

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• Potential Side Effects: Some users may encounter minor side effects such as gastrointestinal discomfort.
• Cost: The price of Liv Pure may serve as a deterrent for certain prospective users.

Ingredients

• Milk Thistle: Supports liver health and detoxification processes.
• Artichoke Extract: Assists in digestion and promotes liver function.
• Turmeric: Possesses anti-inflammatory properties and supports liver health.
• Dandelion Root: Facilitates liver detoxification and promotes bile production.
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• Liver Support: Liv Pure aids in detoxification, fostering optimal liver function and overall health.
• Weight Management: The supplement supports metabolism and fat burning, facilitating healthy weight loss.
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Side Effects

Although Liv Pure is generally safe for most users, some individuals may experience minor side effects such as gastrointestinal discomfort. It is advisable to consult with a healthcare professional before commencing any new supplement regimen.

Pricing Structure

• 30-Day Supply: $69 per bottle
• 90-Day Supply: $49 per bottle
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Refund Policy

Liv Pure extends a 60-day money-back guarantee on all purchases, enabling customers to trial the product risk-free.

FAQs

How should I consume Liv Pure?

• The recommended dosage of Liv Pure is [insert dosage instructions here]. It is advisable to consult with a healthcare professional before commencing any new supplement regimen.

Are there any allergens in Liv Pure?

• Liv Pure is formulated with natural ingredients and is free from common allergens such as [insert allergens here]. However, individuals with specific allergies should meticulously review the ingredient list before consumption.

Can I take Liv Pur alongside existing medical conditions?

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Final Thoughts

In summary, Liv Pure furnishes a comprehensive overview of a liver health supplement tailored to promote detoxification and weight loss. Through its detailed analysis and customer testimonials, Liv Pure serves as an invaluable resource for individuals seeking to optimize their liver health naturally.

'Came to this dollar general on 5-12-24, Mothers day. The store manager, Bradley, was arguing with an elderly woman who had bought spoiled milk a few days before and wanted to switch it out for a fresh one. It had not hit the expration date yet. We were in the store for about 10 minutes, and the entire time we could hear this man yelling and snapping at the woman, telling her to leave, that it was store policy not to give it to her, which several other dollar general workers have assured us was not true. I finally just went up to the front of the store to buy this woman another gallon, because he was being so unessicarily rude to this elderly woman on mother's day, no less. At that point, I called him out for his mistreatment of her, which started a fight between Bradly, the woman I was with, and another woman at self checkout. Bradley kept threatening the police on us, and refused to let us walk away and finish shopping and get what we needed. He called the police and had two women criminally trespassed on his store, on mother's day, for buying and elderly lady milk. He is a disgusting, rude, likely abusive man with no compassion and he does not need to have a job. When we went to the other dollar general down the street to finish out shopping, the workers there said several people had come to their store with complaints of the manager, Bradley, yelling at them. Many of the complaints came from elderly women. Someone needs to look into why this man is allowed to verbally abuse old women with no consequences.'
This was the review I left on their Google pages. I know it seems stupid now but the fact that he's allowed to mistreat these old women really just eats me alive. He was so rude to her, on mother's no less, and for no reason. She wasn't causing a scene, she wasn't being rude, she was just a financially struggling woman who wanted what she paid for and he had no reason to be so mean to her. What else can I do? This man needs to be fired.

People keep telling her to clarify and elaborate and explain or show proof of last years supposed miscarriage, she avoids a doing just exactly that. I feel like we know her well enough to know that if she had ever gotten a positive on a pregnancy test or had proof of that she would have immediately slapped it in peoples faces in defense of the idea that she was never pregnant. I know for a fact this girl would have been making tik toks with her pictures of her pregnancy test “of what could have been” I genuinely think she just had a late period and over exaggerated it to her benefit because she knows it would potentially create a trauma bond between her and Christian and he wouldn’t try to leave her again. A lot of people on the internet these days would call me insensitive for assuming or putting this idea out there but if we’re being realistic with girls like this on the internet and all the other ridiculous things she milks for attention on the internet, it just makes sense. There are women out there who endure actual miscarriages and stillbirth infant deaths and it’s real and raw and traumatic and disgusting of someone to sit on the internet and have people feel bad for something she’s simply over exaggerated

Unfortunately, I was one of the women who wasn't able to lose much weight while breastfeeding. Ive read that women who werent able to lose weight while breastfeeding, were able to lose weight once weaned? The last time I nursed my son was on March 10th and I just recently like a few days ago finally dried up. So it took 2 months to actually dry up. Did you start losing weight ONCE your milk dried up all the way? Or once you just stopped nursing? I am working hard to try and lose these last 15 pounds from my pregnancy with lifting weights, getting steps in and tracking macros but I'm hoping that the fact that I was still producing milk and not dried up, could possibly have been the reason.

A lot of people from this subreddit have been asking this question and i got this article together to answer that question. I hope it helps. Cheers.

I honestly have found great help when i started taking Omega 3 in a daily basis, Vitamin B1 B6 B12, enough zinc, magnesium and Vitamin D.
PS : for those who also want to increase their testosterone, improving your mood and lowering Cortisol greatly helps.

Stress Reduction

Our bodies release cortisol when stressed. Cortisol decreases serotonin levels in the body, by increasing serotonin reuptake. Too much cortisol can increase your risk of developing mental health disorders. That is why reducing mental stress can help balance cortisol levels and increase serotonin
Many of the lifestyle changes below can be used to decrease stress.

Mood Improvement

Serotonin impacts our mood, but mood also affects serotonin production. Studies using brain imaging (PET), showed that brains of people who are happy produce more serotonin than brains of people who are sad
Therefore, engaging in activities and doing things that make you happier can help boost serotonin production.
In addition, studies show that social interactions also influence serotonin levels. Spend more time with people who make you feel good in general

Exercise

Fatigue, as a result of exercise, increases the amount of tryptophan that can cross the blood-brain barrier (by decreasing BCAA levels) and thereby boosts serotonin production. Psychological benefits of physical exercise can be more readily achieved with consistent aerobic exercise training
Mice that ran on treadmills had higher levels of serotonin compared to mice that remained inactive. Brain tryptophan remained high even after exercise

Getting More Sun

It has been long known that bright light helps treat seasonal depression. But several studies suggest that light is also an effective treatment for other forms of depression
People have higher serotonin levels in the summer compared to winter
In fact, our modern way of life, in which we spend a lot of time indoors, may be depleting our serotonin levels, thereby making us more vulnerable to mood disorders
Pioneer studies suggest that our skin may produce serotonin when exposed to sunlight
In addition, you need vitamin D to produce serotonin, and sun to produce vitamin D
Therefore, going outside and spending more time in the sun on a regular basis is a great way to boost your serotonin levels.

Yoga and Meditation

A review of over 200 peer-reviewed RCTs, clinical trials, and meta-analyses studying complementary and alternative medicine suggest that yoga and meditation may help uplift mood and improve symptoms of mild, moderate, and treatment-resistant depression
In fact, meditation activates many parts of the brain important for understanding the self, emotions, problem-solving, adaptability, and increasing awareness. Serotonin plays a role in wakefulness, along with other neurotransmitters, which are all raised in meditators
Thirty minutes of yoga and breathing exercises improved mood in a study of 71 healthy adults

Psychotherapy

Psychotherapy or counseling may change brain chemistry and even increase serotonin activity (by increasing serotonin receptors). In a (DB-RCT) study of 23 patients with depression who participated in psychotherapy for 4 months, therapy significantly increased serotonin activity and improved symptoms of depression

Eat to Increase Serotonin

Tryptophan is the amino acid building block for serotonin. Tryptophan is not produced by the body, so it must be taken in through diet.
Current research shows that unlike purified tryptophan, consuming tryptophan-rich foods does not necessarily increase brain serotonin. That’s because tryptophan-rich foods, such as meat, dairy, fruits, and vegetables, also contain many other amino acids. Tryptophan has to compete with these other amino acids for transport across the blood-brain barrier
On the other hand, lack of dietary tryptophan (compared to other amino acids) may lead to lower blood and brain tryptophan levels, decreasing serotonin production. Increased BCAAs also lower tryptophan and serotonin, as well as dopamine in the brain. This may be especially problematic for people who take protein powders to enhance exercise performance

Carbs

Consuming carbs increases serotonin levels by increasing the transport of tryptophan into the brain
However, you should use other methods to boost your serotonin, as increasing carbs in your diet can have a plethora of negative effects.

which Supplements can Increase Serotonin?

L-Tryptophan and 5-HTP

In the body, L-tryptophan is used to make 5-HTP from which serotonin is made. Taking L-tryptophan may raise plasma serotonin, improving cognitive, motor, or gut issues in those who are deficient
A protein called alpha-Lactalbumin from milk contains more tryptophan than many other proteins. In a (DB-RCT) study of 18 inpiduals, 12 grams of alpha-Lactalbumin increased the amount of tryptophan in blood plasma by 16% after 90 minutes
In another (DB-RCT) study, 12.32 grams of tryptophan increased blood tryptophan by 43% after 1.5 hours and improved memory in 23 subjects vulnerable to high stress
In a pilot study of 13 female patients experiencing premenstrual syndrome (PMS), 6 grams of L-tryptophan taken daily for 14 days improved mood, irritability, difficulty sleeping, and carbohydrate craving
Tryptophan can be purchased in the form of L-tryptophan supplements. 5-HTP (5-hydroxytryptophan) supplements are also available. It is important to note that 5-HTP is not the same as 5-HT, which is the chemical name for serotonin. 5-HTP freely crosses the blood-brain barrier (serotonin itself does not) to be converted into serotonin

Probiotics

In the digestive tract, probiotics restore the gut microbiome and influence the gut-brain axis. Gut bacteria are important because they can produce tryptophan, from which serotonin is made. Many mental health disorders, such as Parkinson’s disease, are linked to less perse or fewer gut bacteria
In a study (DB-RTC), an 8-week probiotic regimen (2.0 x 109 CFU/g of Lactobacillus helveticus and 2.0 x 109 CFU/g of Bifidobacterium longum) increased tryptophan levels in 110 inpiduals with depression. Increased tryptophan can increase serotonin production
A probiotic (Bifidobacteria infantis) given to rats for 14 days raised levels of blood tryptophan

Vitamin D

Vitamin D helps the body make, release, and use serotonin in the brain. Vitamin D activates an enzyme that converts tryptophan into serotonin. If vitamin D levels are low, our brains make less serotonin. Thus, increasing vitamin D intake increases serotonin levels, reducing the risk of mental health disorders
A cohort study of over 9K subjects demonstrated that taking vitamin D supplements during the first year of life was correlated with a 77% reduced risk of schizophrenia. In other words, preventing low vitamin D levels early in life may reduce the chance of having schizophrenia later in life

Omega-3 Fatty Acids

While vitamin D helps neurons make serotonin, the omega-3 fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), help neurons release serotonin and improve its activity (increasing serotonin receptor sensitivity). Fish, such as salmon or trout, are high in omega-3 fatty acids. The omega 3 fatty acid supplements are also sold as fish oil capsules
Inadequate omega-3 fatty acids intake may increase susceptibility to psychiatric illnesses, including depression
In a (DB-RCT) study of 49 patients that repeatedly self-harm themselves, 1.2 grams of EPA and 0.9 grams of DHA capsules daily for 12 weeks reduced suicidal thinking by 45% and depression by 30%
An observational study of 256,118 Japanese participants, discovered that people who ate fish daily had lower rates of suicidal thoughts compared to people who did not eat fish daily. In another observational study of 1,767 Finnish subjects, consuming fish less than twice a week was associated with a higher risk of depression and suicidal thinking
In rats, low levels of omega-3 fatty acids (specifically alpha linoleic acid) are associated with lower serotonin activity, while DHA deficiency reduces brain serotonin in piglets
Reduced intake of both EPA and DHA by pregnant rats resulted in less production, storage, release, and activity (receptor function) of serotonin in the brains of their offspring. Serotonin was not only reduced in the mothers’ brains but also its availability and production were reduced by (65% and 29%, respectively) in the brains of newborn rats

St. John’s Wort

St. John’s Wort is a popular medicinal plant (Hypericum perforatum) used as an antidepressant for mild depression.
The plant increases serotonin in animals, similar to typical antidepressants, but with fewer side effects
In a review (of 35 studies) of 6,993 patients with depression, St. John’s Wort standalone therapy improved mild to moderate symptoms as well as antidepressants and better than placebo. The typical dose is 300 mg of the extract 3 times per day for at least 4 weeks

S-Adenosyl Methionine (SAMe)

SAMe is needed to produce serotonin
It is a naturally occurring compound that plays a role in methylation, energy breakdown and may help patients with major depressive disorder (MDD) who are not responding to conventional, synthetic antidepressants
In a (DB-RCT) study involving 73 MDD inpiduals unresponsive to drug therapy, 800 mg twice a day improved symptoms of depression compared to the placebo
In a (DB-RCT) study of 144 inpiduals with MDD, 1,600 – 3,200 mg of SAMe daily for 12 weeks significantly improved mood
A review of 132 studies (115 CT and 17 preclinical) concluded that SAMe can be useful not just for depression, but for an array of mental health disorders, such as substance abuse and psychosis

Vitamin B

Lack of vitamin B may be associated with the onset of mental health disorders. The body needs Vitamin B6 to make neurotransmitters like serotonin from 5-HTP (Vitamin B acts as enzyme cofactor)
Vitamin B12 and folate (vitamin B9) are necessary for the folate cycle, which helps convert tryptophan into serotonin (by producing and recycling essential co-factors)
In a cohort study of 549 community-dwelling seniors, those with low vitamin B12 and B9 blood levels were more likely to have irreversible problems with cognition (memory, attention, and thought)
In Rhesus monkeys, a single dose of vitamin B6 increased serotonin production in the brain
In addition, treatment of healthy adult rats with a vitamin B mixture raised serotonin levels in the brain

Vitamin C

Vitamin C supplements over a period of 6 weeks increased brain serotonin levels in rats with drug-induced dementia

Vitamin E

Vitamin E supplementation for 8 weeks increased serotonin in rats suffering from spinal cord injury

Zinc

Zinc can target and activate serotonin receptors
In a meta-analysis of 17 observational studies, blood zinc levels were lower in depressed inpiduals compared to non-depressed inpiduals
In a study (DB-RCT), 25 mg of elemental zinc supplements daily for 12 weeks reduced depressive symptoms in a study of 37 patients with major depressive disorder
Zinc can be increased through diet in foods such as red meat, oysters, and whole grains

Magnesium

Magnesium supplements increase serotonin levels by increasing its availability (reducing reuptake) in the brain. In a (DB-RCT) study, 500 mg of magnesium per day for 8 weeks significantly improved symptoms in 60 patients diagnosed with mild to moderate depression
Magnesium is found in green leafy vegetables, nuts, and legumes

Inositol

Inositol increases the sensitivity of serotonin receptors
In one study of 30 women with a PMS mood disorder, myo-inositol reduced symptoms and improved mood given over 6 menstrual cycles
Inositol decreases depression in rats by binding serotonin receptors

Turmeric

Curcumin is the active component of turmeric. In stressed rats, curcumin extended the length of time serotonin stays active in the brain (by blocking the reuptake of serotonin). It also improved cognition and reduced serum corticosterone, a cortisol equivalent, in rats
In mice, a single dose of curcumin (10 – 80 mg/kg) increased serotonin levels

Velvet Bean

Mucuna pruriens, known as the velvet bean, combats Parkinson’s disease better than the standard treatment (levodopa) in rats. In addition to being a source of dopamine, the long-term use of the powder form of Mucuna pruriens also restored serotonin levels in rat brains

L-Theanine

L-theanine, an amino acid found in tea leaves (e.g. green, black, or oolong tea) and Bay Bolete mushrooms, has relaxing effects on the mind. Green tea has the highest concentration of L-theanine
In a cohort study of over 42K Japanese inpiduals, those who consumed at least 5 cups of green tea a day experiences less psychological distress that is often associated with reduced serotonin
In rat studies, L-theanine raised serotonin levels in the brain

Rhodiola

Rhodiola rosea is a flowering plant that may help improve anxiety and depression. In a (DB-RCT) clinical trial of 89 patients with mild to moderate depression and low serotonin, Rhodiola rosea extracts (340 mg/day and 680 mg/day) for 42 days improved overall depression, including insomnia and emotional instability
In 70 depressive rats suffering from chronic mild stress and serotonin deficiency, Rhodiola extract (1.5, 3, or 6g/kg) for 3 weeks restored normal levels of serotonin

Saffron

Safranal, one of the main active components of saffron (Crocus sativus), increases serotonin availability in the brain (by blocking reuptake)
A meta-analysis (5 RCTs) of 177 participants concluded that 30 mg per day of saffron capsules can improve symptoms of depression in adults with major depressive disorder within 6 to 8 weeks

Psychedelics

Psychedelics are hallucinogenic drugs such as lysergic acid diethylamide (LSD) and psilocybin mushrooms. Psychedelics can stimulate serotonin activity (by directly binding to serotonergic receptors and also increasing their number), raise serotonin levels, and reduce its breakdown
In a recent pilot study (DB-RCT) of 12 patients with anxiety, 200 μg of LSD significantly reduced self-reported anxiety. LSD was given in a safe psychotherapeutic environment with medical supervision to avoid side effects
In a (DB-RCT) study of 17 healthy inpiduals, psilocybin (215 micrograms/kg) enhanced mood, increased goal-directed behavior and decreased recognition of negative facial expressions
Though psychedelics can activate serotonin signaling, unsupervised use may lead to serious psychological consequences. Certain plant hallucinogens, as well as synthetic hallucinogens, can be especially toxic. Using this substance should be under professional supervision.

Magnolia Tree

The bark and seed cones of the Magnolia tree (Magnolia officinalis) appear to have anti-stress, anti-anxiety, and antidepressant effects
20 and 40 mg/kg of honokiol and magnolol, the main components of Magnolia officinalis, restored low levels of serotonin in rats with chronic mild stress
Magnolia bark and ginger rhizome are commonly used to treat mental disorders in traditional Chinese medicine (TCM). 30 mg/kg of a magnolia bark and ginger rhizome mixture increased serotonin in the brains of depressed mice

Essential Oils

Essential oils are commonly used to reduce anxiety, stress, low mood, and other mental health disorders. Smelling the essential oils (inhalation) can activate pathways in the brain to boost serotonin and dopamine production
In a study of aromatherapy in 60 elderly patients with depression (RCT), 5 ml of essential oil mixture (containing lavender, sweet orange, bergamot, and almond oil) increased serotonin levels after application two times a week for 8 weeks
Ylang-ylang essential oils increased serotonin levels in mice brains (hippocampus)
Bitter orange is an essential oil that reduced anxiety and improved mood by boosting serotonin activity in mice after 14 days of use
Lavender oil blocked the breakdown/reuptake of serotonin in cell studies

Valerian

The root of the Valerian plant increases serotonin levels and activity (by decreasing its turnover)
Valerian may help with irritable bowel syndrome. In a rat study, components of the Valeriani root balanced overactive serotonin in the gut (colon) and serum
Valeriana officinalis root extract prevented the breakdown of serotonin in mice exposed to stress

Apigenin

Apigenin is a nutrient in citrus fruits that may improve cognition and behavior as well as symptoms of depression and stress
In mouse models, 20-day treatment with apigenin (10 and 20 mg/kg) increased serotonin levels, and decreased anxious behavior
Apigenin was able to reduce the impact of chronic mild stress in rats by increasing serotonin availability and reducing its breakdown

Berberine

Berberine is a salt derived from plants in the Berberis family (the roots, rhizomes, stems, and barks), including barberry, tree turmeric, Oregon-grape, and others. It blocks the enzyme MAO-A, which breaks down serotonin, thereby raising serotonin levels
A single berberine dose increased levels of serotonin by 47% in the brains of depressed mice. Long-term treatment with berberine (5 mg/kg for 15 days) increased serotonin by 19%
Mice given berberine in a different study had increased serotonin levels in regions of the brain (hippocampus and frontal cortex) important for memory and mood

Acetyl-L-Carnitine

Carnitine may increase serotonin in the cerebral cortex, a region of the brain involved in cognition and memory
Acetyl-L-carnitine (ALCAR) is a modified form of carnitine, a common dietary supplement sold in health food stores. ALCAR protects the brain and may help with depression. In mice, it increased levels of serotonin in the brain when given daily for 25 days

Lithium

Lithium has long been used in the treatment of mental disorders such as bipolar disorder. It works by increasing serotonin activity in the brain

Physical Treatments that Increase Serotonin

Neurofeedback

Neurofeedback allows inpiduals to consciously change their brain activity (EEG waves) and therefore modify their behavior and cognition. Some of its clinical uses are for migraines, ADHD, and PTSD
In a study (RCT), neurofeedback (30 minutes, 5 sessions weekly, 4 weeks) was applied to 40 patients with fibromyalgia syndrome (FMS). FMS patients have lower serotonin and widespread pain in their muscles and bones. After 2 weeks, patients experienced less pain, fatigue, anxiety, and depression

Massage

Massage therapy decreased cortisol and raised serotonin and dopamine in a broad population with stress-related health problems in 3 studies
In one (RCT) study, 24 adults with low back pain were either given two 30 minute massages per week or subjected to standard relaxation procedures over the span of 5 weeks. Urine serotonin levels were higher in inpiduals who received massage therapy

Acupuncture

In a randomized clinical trial, 75 women with fibromyalgia, acupuncture increased levels of serotonin in the serum, compared to placebo
In rats, acupuncture-like stimulation increased serotonin activity in certain regions of the brain

Light Therapy

When sun exposure is not possible, bright light therapy can help increase serotonin levels
Bright light therapy (photobiomodulation) shows promising results for depression based on clinical trials
In a study of 10 women with chronic headaches (observational), 34 seconds daily use of low-level laser therapy (LLLT) significantly increased serotonin levels after just 3 days
In a study of 25 drug-free hospitalized veterans with depression or bipolar disorder, bright white light improved depressive symptoms. However, further testing needs to be done on the negative consequences of long-term light treatment

Vagus Nerve Stimulation

Long-term vagus nerve stimulation (14 days) increased serotonin levels in rat brains
In rats, sustained vagus nerve stimulation for 14 days also increased the action of serotonin

Testing Serotonin

Serotonin that gets released into the blood gets rapidly broken down in the liver and lungs, to inactive metabolites (such as 5-HIAA) that are excreted in urine . That is why normally, blood and urine contain very small amounts of serotonin. Larger quantities of serotonin in the blood/urine can be found in people with serotonin-producing tumors (carcinoid tumors).
Beware of the use of urine serotonin levels to check for “neurotransmitter imbalances”. While the companies providing these tests state that the levels in urine correspond to brain neurotransmitter levels, science has repeatedly shown that this is not the case
Serotonin doesn’t cross the blood-brain barrier. Even if it did, it is released intermittently and influenced by many different stimuli. Furthermore, levels differ within different parts of the brain. And finally, values differ for the same person from one day to another
In addition, companies have been known to intentionally use extremely narrow ranges, without any scientific support whatsoever, in order to sell supplements to their clients
If you do have neurotransmitter imbalances in the brain, more reliable tests of serotonin levels are cerebrospinal fluid tests or measurements of serotonin in blood platelets
A PET scan is the only direct way to detect changes of serotonin production in specific areas of the brain
Serotonin Risks and Safety
Excess serotonin may result in serotonin syndrome, which can be fatal. Usually, though, serotonin syndrome is a result of drug interactions. No cases have been observed just from safe, natural approaches
MDMA, LSD, and other synthetic drugs may cause serotonin syndrome, and should not be taken without medical supervision or outside a psychotherapeutic environment
Most of the studies mentioned above were performed on adults. More research involving children is needed in order to determine safety.
Abnormally heightened levels of serotonin (hyperserotonemia) is a consistent finding in inpiduals with autism. Pregnant women with hyperserotonemia are more likely to give birth to children with autism

Drug Interactions

The use of St. John’s Wort, SAMe, or lithium simultaneously with serotonergic drugs like selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAO-I), and triptans, can increase the risk of serotonin syndrome, a life-threatening and potentially fatal condition

Limitations and Caveats

Some of these studies have fairly small sample sizes. Additionally, many of these natural methods of increasing serotonin in the body have only been tested in animals and need further research in humans through clinical trials.
In addition to the concentration of serotonin, both the number of serotonin receptors and their sensitivity may also play an integral role in determining serotonin activity.
Though serotonin is mostly made, stored, and released in the gut, serotonin acts as an important neurotransmitter in the brain. Some of these natural remedies and supplements need further testing to determine if they are able to cross the blood-brain barrier. Long-term application of these remedies should also be further studied.

Please see the Prescribing Information for IMFINZI and IMJUDO.
IMPORTANT SAFETY INFORMATION
There are no contraindications for IMFINZI^® (durvalumab) or IMJUDO^® (tremelimumab-actl).
Severe and Fatal Immune-Mediated Adverse Reactions
Important immune-mediated adverse reactions listed under Warnings and Precautions may not include all possible severe and fatal immune-mediated reactions. Immune-mediated adverse reactions, which may be severe or fatal, can occur in any organ system or tissue. Immune-mediated adverse reactions can occur at any time after starting treatment or after discontinuation. Monitor patients closely for symptoms and signs that may be clinical manifestations of underlying immune-mediated adverse reactions. Evaluate clinical chemistries including liver enzymes, creatinine, adrenocorticotropic hormone (ACTH) level, and thyroid function at baseline and before each dose. In cases of suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate. Withhold or permanently discontinue IMFINZI and IMJUDO depending on severity. See USPI Dosing and Administration for specific details. In general, if IMFINZI and IMJUDO requires interruption or discontinuation, administer systemic corticosteroid therapy (1 mg to 2 mg/kg/day prednisone or equivalent) until improvement to Grade 1 or less. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immune-mediated adverse reactions are not controlled with corticosteroid therapy.
Immune-Mediated Pneumonitis
IMFINZI and IMJUDO can cause immune-mediated pneumonitis, which may be fatal. The incidence of pneumonitis is higher in patients who have received prior thoracic radiation.

• IMFINZI as a Single Agent
  • In patients who did not receive recent prior radiation, the incidence of immune-mediated pneumonitis was 2.4% (34/1414), including fatal (<0.1%), and Grade 3-4 (0.4%) adverse reactions. In patients who received recent prior radiation, the incidence of pneumonitis (including radiation pneumonitis) in patients with unresectable Stage III NSCLC following definitive chemoradiation within 42 days prior to initiation of IMFINZI in PACIFIC was 18.3% (87/475) in patients receiving IMFINZI and 12.8% (30/234) in patients receiving placebo. Of the patients who received IMFINZI (475), 1.1% were fatal and 2.7% were Grade 3 adverse reactions.
  • The frequency and severity of immune-mediated pneumonitis in patients who did not receive definitive chemoradiation prior to IMFINZI were similar in patients who received IMFINZI as a single agent or with ES-SCLC or BTC when given in combination with chemotherapy.
• IMFINZI with IMJUDO
  • Immune-mediated pneumonitis occurred in 1.3% (5/388) of patients receiving IMFINZI and IMJUDO, including fatal (0.3%) and Grade 3 (0.2%) adverse reactions.
• IMFINZI with IMJUDO and Platinum-Based Chemotherapy
  • Immune-mediated pneumonitis occurred in 3.5% (21/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including fatal (0.5%), and Grade 3 (1%) adverse reactions.

Immune-Mediated Colitis
IMFINZI with IMJUDO and platinum-based chemotherapy can cause immune-mediated colitis, which may be fatal.
IMFINZI and IMJUDO can cause immune-mediated colitis that is frequently associated with diarrhea. Cytomegalovirus (CMV) infection/reactivation has been reported in patients with corticosteroid-refractory immune-mediated colitis. In cases of corticosteroid-refractory colitis, consider repeating infectious workup to exclude alternative etiologies.

• IMFINZI as a Single Agent
  • Immune-mediated colitis occurred in 2% (37/1889) of patients receiving IMFINZI, including Grade 4 (<0.1%) and Grade 3 (0.4%) adverse reactions.
• IMFINZI with IMJUDO
  • Immune-mediated colitis or diarrhea occurred in 6% (23/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (3.6%) adverse reactions. Intestinal perforation has been observed in other studies of IMFINZI and IMJUDO.
• IMFINZI with IMJUDO and Platinum-Based Chemotherapy
  • Immune-mediated colitis occurred in 6.5% (39/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy including fatal (0.2%) and Grade 3 (2.5%) adverse reactions. Intestinal perforation and large intestine perforation were reported in 0.1% of patients.

Immune-Mediated Hepatitis
IMFINZI and IMJUDO can cause immune-mediated hepatitis, which may be fatal.

• IMFINZI as a Single Agent
  • Immune-mediated hepatitis occurred in 2.8% (52/1889) of patients receiving IMFINZI, including fatal (0.2%), Grade 4 (0.3%) and Grade 3 (1.4%) adverse reactions.
• IMFINZI with IMJUDO
  • Immune-mediated hepatitis occurred in 7.5% (29/388) of patients receiving IMFINZI and IMJUDO, including fatal (0.8%), Grade 4 (0.3%) and Grade 3 (4.1%) adverse reactions.
• IMFINZI with IMJUDO and Platinum-Based Chemotherapy
  • Immune-mediated hepatitis occurred in 3.9% (23/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including fatal (0.3%), Grade 4 (0.5%), and Grade 3 (2%) adverse reactions.

Immune-Mediated Endocrinopathies

• Adrenal Insufficiency: IMFINZI and IMJUDO can cause primary or secondary adrenal insufficiency. For Grade 2 or higher adrenal insufficiency, initiate symptomatic treatment, including hormone replacement as clinically indicated.
  • IMFINZI as a Single Agent
    • Immune-mediated adrenal insufficiency occurred in 0.5% (9/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions.
  • IMFINZI with IMJUDO
    • Immune-mediated adrenal insufficiency occurred in 1.5% (6/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (0.3%) adverse reactions.
  • IMFINZI with IMJUDO and Platinum-Based Chemotherapy
    • Immune-mediated adrenal insufficiency occurred in 2.2% (13/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.8%) adverse reactions.
• Hypophysitis: IMFINZI and IMJUDO can cause immune-mediated hypophysitis. Hypophysitis can present with acute symptoms associated with mass effect such as headache, photophobia, or visual field cuts. Hypophysitis can cause hypopituitarism. Initiate symptomatic treatment including hormone replacement as clinically indicated.
  • IMFINZI as a Single Agent
    • Grade 3 hypophysitis/hypopituitarism occurred in <0.1% (1/1889) of patients who received IMFINZI.
  • IMFINZI with IMJUDO
    • Immune-mediated hypophysitis/hypopituitarism occurred in 1% (4/388) of patients receiving IMFINZI and IMJUDO.
  • IMFINZI with IMJUDO and Platinum-Based Chemotherapy
    • Immune-mediated hypophysitis occurred in 1.3% (8/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.5%) adverse reactions.
• Thyroid Disorders (Thyroiditis, Hyperthyroidism, and Hypothyroidism): IMFINZI and IMJUDO can cause immune-mediated thyroid disorders. Thyroiditis can present with or without endocrinopathy. Hypothyroidism can follow hyperthyroidism. Initiate hormone replacement therapy for hypothyroidism or institute medical management of hyperthyroidism as clinically indicated.
  • IMFINZI as a Single Agent
    • Immune-mediated thyroiditis occurred in 0.5% (9/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions.
    • Immune-mediated hyperthyroidism occurred in 2.1% (39/1889) of patients receiving IMFINZI.
    • Immune-mediated hypothyroidism occurred in 8.3% (156/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions.
  • IMFINZI with IMJUDO
    • Immune-mediated thyroiditis occurred in 1.5% (6/388) of patients receiving IMFINZI and IMJUDO.
    • Immune-mediated hyperthyroidism occurred in 4.6% (18/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (0.3%) adverse reactions.
    • Immune-mediated hypothyroidism occurred in 11% (42/388) of patients receiving IMFINZI and IMJUDO.
  • IMFINZI with IMJUDO and Platinum-Based Chemotherapy
    • Immune-mediated thyroiditis occurred in 1.2% (7/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy.
    • Immune-mediated hyperthyroidism occurred in 5% (30/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.2%) adverse reactions.
    • Immune-mediated hypothyroidism occurred in 8.6% (51/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.5%) adverse reactions.
• Type 1 Diabetes Mellitus, which can present with diabetic ketoacidosis: Monitor patients for hyperglycemia or other signs and symptoms of diabetes. Initiate treatment with insulin as clinically indicated.
  • IMFINZI as a Single Agent
    • Grade 3 immune-mediated Type 1 diabetes mellitus occurred in <0.1% (1/1889) of patients receiving IMFINZI.
  • IMFINZI with IMJUDO
    • Two patients (0.5%, 2/388) had events of hyperglycemia requiring insulin therapy that had not resolved at last follow-up.
  • IMFINZI with IMJUDO and Platinum-Based Chemotherapy
    • Immune-mediated Type 1 diabetes mellitus occurred in 0.5% (3/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy including Grade 3 (0.3%) adverse reactions.

Immune-Mediated Nephritis with Renal Dysfunction
IMFINZI and IMJUDO can cause immune-mediated nephritis.

• IMFINZI as a Single Agent
  • Immune-mediated nephritis occurred in 0.5% (10/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions.
• IMFINZI with IMJUDO
  • Immune-mediated nephritis occurred in 1% (4/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (0.5%) adverse reactions.
• IMFINZI with IMJUDO and Platinum-Based Chemotherapy
  • Immune-mediated nephritis occurred in 0.7% (4/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.2%) adverse reactions.

Immune-Mediated Dermatology Reactions
IMFINZI and IMJUDO can cause immune-mediated rash or dermatitis. Exfoliative dermatitis, including Stevens-Johnson Syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS), and toxic epidermal necrolysis (TEN), has occurred with PD-1/L-1 and CTLA-4 blocking antibodies. Topical emollients and/or topical corticosteroids may be adequate to treat mild to moderate non-exfoliative rashes.

• IMFINZI as a Single Agent
  • Immune-mediated rash or dermatitis occurred in 1.8% (34/1889) of patients receiving IMFINZI, including Grade 3 (0.4%) adverse reactions.
• IMFINZI with IMJUDO
  • Immune-mediated rash or dermatitis occurred in 4.9% (19/388) of patients receiving IMFINZI and IMJUDO, including Grade 4 (0.3%) and Grade 3 (1.5%) adverse reactions.
• IMFINZI with IMJUDO and Platinum-Based Chemotherapy
  • Immune-mediated rash or dermatitis occurred in 7.2% (43/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.3%) adverse reactions.

Immune-Mediated Pancreatitis
IMFINZI in combination with IMJUDO can cause immune-mediated pancreatitis. Immune-mediated pancreatitis occurred in 2.3% (9/388) of patients receiving IMFINZI and IMJUDO, including Grade 4 (0.3%) and Grade 3 (1.5%) adverse reactions.
Other Immune-Mediated Adverse Reactions
The following clinically significant, immune-mediated adverse reactions occurred at an incidence of less than 1% each in patients who received IMFINZI and IMJUDO or were reported with the use of other immune-checkpoint inhibitors.

• Cardiac/vascular: Myocarditis, pericarditis, vasculitis.
• Nervous system: Meningitis, encephalitis, myelitis and demyelination, myasthenic syndrome/myasthenia gravis (including exacerbation), Guillain-Barré syndrome, nerve paresis, autoimmune neuropathy.
• Ocular: Uveitis, iritis, and other ocular inflammatory toxicities can occur. Some cases can be associated with retinal detachment. Various grades of visual impairment to include blindness can occur. If uveitis occurs in combination with other immune-mediated adverse reactions, consider a Vogt-Koyanagi-Harada-like syndrome, as this may require treatment with systemic steroids to reduce the risk of permanent vision loss.
• Gastrointestinal: Pancreatitis including increases in serum amylase and lipase levels, gastritis, duodenitis.
• Musculoskeletal and connective tissue disorders: Myositis/polymyositis, rhabdomyolysis and associated sequelae including renal failure, arthritis, polymyalgia rheumatic.
• Endocrine: Hypoparathyroidism.
• Other (hematologic/immune): Hemolytic anemia, aplastic anemia, hemophagocytic lymphohistiocytosis, systemic inflammatory response syndrome, histiocytic necrotizing lymphadenitis (Kikuchi lymphadenitis), sarcoidosis, immune thrombocytopenia, solid organ transplant rejection, other transplant (including corneal graft) rejection.

Infusion-Related Reactions
IMFINZI and IMJUDO can cause severe or life-threatening infusion-related reactions. Monitor for signs and symptoms of infusion-related reactions. Interrupt, slow the rate of, or permanently discontinue IMFINZI and IMJUDO based on the severity. See USPI Dosing and Administration for specific details. For Grade 1 or 2 infusion-related reactions, consider using pre-medications with subsequent doses.

• IMFINZI as a Single Agent
  • Infusion-related reactions occurred in 2.2% (42/1889) of patients receiving IMFINZI, including Grade 3 (0.3%) adverse reactions.
• IMFINZI with IMJUDO
  • Infusion-related reactions occurred in 10 (2.6%) patients receiving IMFINZI and IMJUDO.
• IMFINZI with IMJUDO and Platinum-Based Chemotherapy
  • Infusion-related reactions occurred in 2.9% (17/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.3%) adverse reactions.

Complications of Allogeneic HSCT after IMFINZI
Fatal and other serious complications can occur in patients who receive allogeneic hematopoietic stem cell transplantation (HSCT) before or after being treated with a PD-1/L-1 blocking antibody. Transplant-related complications include hyperacute graft-versus-host-disease (GVHD), acute GVHD, chronic GVHD, hepatic veno-occlusive disease (VOD) after reduced intensity conditioning, and steroid-requiring febrile syndrome (without an identified infectious cause). These complications may occur despite intervening therapy between PD-1/L-1 blockade and allogeneic HSCT. Follow patients closely for evidence of transplant-related complications and intervene promptly. Consider the benefit versus risks of treatment with a PD-1/L-1 blocking antibody prior to or after an allogeneic HSCT.
Embryo-Fetal Toxicity
Based on their mechanism of action and data from animal studies, IMFINZI and IMJUDO can cause fetal harm when administered to a pregnant woman. Advise pregnant women of the potential risk to a fetus. In females of reproductive potential, verify pregnancy status prior to initiating IMFINZI and IMJUDO and advise them to use effective contraception during treatment with IMFINZI and IMJUDO and for 3 months after the last dose of IMFINZI and IMJUDO.
Lactation
There is no information regarding the presence of IMFINZI and IMJUDO in human milk; however, because of the potential for serious adverse reactions in breastfed infants from IMFINZI and IMJUDO, advise women not to breastfeed during treatment and for 3 months after the last dose.
Adverse Reactions

• In patients with Stage III NSCLC in the PACIFIC study receiving IMFINZI (n=475), the most common adverse reactions (≥20%) were cough (40%), fatigue (34%), pneumonitis or radiation pneumonitis (34%), upper respiratory tract infections (26%), dyspnea (25%), and rash (23%). The most common Grade 3 or 4 adverse reactions (≥3%) were pneumonia (7%) and pneumonitis/radiation pneumonitis (3.4%).
• In patients with Stage III NSCLC in the PACIFIC study receiving IMFINZI (n=475), discontinuation due to adverse reactions occurred in 15% of patients in the IMFINZI arm. Serious adverse reactions occurred in 29% of patients receiving IMFINZI. The most frequent serious adverse reactions (≥2%) were pneumonitis or radiation pneumonitis (7%) and pneumonia (6%). Fatal pneumonitis or radiation pneumonitis and fatal pneumonia occurred in <2% of patients and were similar across arms.
• In patients with mNSCLC in the POSEIDON study receiving IMFINZI and IMJUDO plus platinum-based chemotherapy (n=330), the most common adverse reactions (occurring in ≥20% of patients) were nausea (42%), fatigue (36%), musculoskeletal pain (29%), decreased appetite (28%), rash (27%), and diarrhea (22%).
• In patients with mNSCLC in the POSEIDON study receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy (n=330), permanent discontinuation of IMFINZI or IMJUDO due to an adverse reaction occurred in 17% of patients. Serious adverse reactions occurred in 44% of patients, with the most frequent serious adverse reactions reported in at least 2% of patients being pneumonia (11%), anemia (5%), diarrhea (2.4%), thrombocytopenia (2.4%), pyrexia (2.4%), and febrile neutropenia (2.1%). Fatal adverse reactions occurred in a total of 4.2% of patients.
• In patients with extensive-stage SCLC in the CASPIAN study receiving IMFINZI plus chemotherapy (n=265), the most common adverse reactions (≥20%) were nausea (34%), fatigue/asthenia (32%), and alopecia (31%). The most common Grade 3 or 4 adverse reaction (≥3%) was fatigue/asthenia (3.4%).
• In patients with extensive-stage SCLC in the CASPIAN study receiving IMFINZI plus chemotherapy (n=265), IMFINZI was discontinued due to adverse reactions in 7% of the patients receiving IMFINZI plus chemotherapy. Serious adverse reactions occurred in 31% of patients receiving IMFINZI plus chemotherapy. The most frequent serious adverse reactions reported in at least 1% of patients were febrile neutropenia (4.5%), pneumonia (2.3%), anemia (1.9%), pancytopenia (1.5%), pneumonitis (1.1%), and COPD (1.1%). Fatal adverse reactions occurred in 4.9% of patients receiving IMFINZI plus chemotherapy.
• In patients with locally advanced or metastatic BTC in the TOPAZ-1 study receiving IMFINZI (n=338), the most common adverse reactions (occurring in ≥20% of patients) were fatigue (42%), nausea (40%), constipation (32%), decreased appetite (26%), abdominal pain (24%), rash (23%), and pyrexia (20%).
• In patients with locally advanced or metastatic BTC in the TOPAZ-1 study receiving IMFINZI (n=338), discontinuation due to adverse reactions occurred in 6% of the patients receiving IMFINZI plus chemotherapy. Serious adverse reactions occurred in 47% of patients receiving IMFINZI plus chemotherapy. The most frequent serious adverse reactions reported in at least 2% of patients were cholangitis (7%), pyrexia (3.8%), anemia (3.6%), sepsis (3.3%) and acute kidney injury (2.4%). Fatal adverse reactions occurred in 3.6% of patients receiving IMFINZI plus chemotherapy. These include ischemic or hemorrhagic stroke (4 patients), sepsis (2 patients), and upper gastrointestinal hemorrhage (2 patients).
• In patients with unresectable HCC in the HIMALAYA study receiving IMFINZI and IMJUDO (n=388), the most common adverse reactions (occurring in ≥20% of patients) were rash (32%), diarrhea (27%), fatigue (26%), pruritus (23%), musculoskeletal pain (22%), and abdominal pain (20%).
• In patients with unresectable HCC in the HIMALAYA study receiving IMFINZI and IMJUDO (n=388), serious adverse reactions occurred in 41% of patients. Serious adverse reactions in >1% of patients included hemorrhage (6%), diarrhea (4%), sepsis (2.1%), pneumonia (2.1%), rash (1.5%), vomiting (1.3%), acute kidney injury (1.3%), and anemia (1.3%). Fatal adverse reactions occurred in 8% of patients who received IMFINZI and IMJUDO, including death (1%), hemorrhage intracranial (0.5%), cardiac arrest (0.5%), pneumonitis (0.5%), hepatic failure (0.5%), and immune-mediated hepatitis (0.5%). Permanent discontinuation of treatment regimen due to an adverse reaction occurred in 14% of patients.

The safety and effectiveness of IMFINZI and IMJUDO have not been established in pediatric patients.
Indications:
IMFINZI is indicated for the treatment of adult patients with unresectable Stage III non-small cell lung cancer (NSCLC) whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy.
IMFINZI, in combination with IMJUDO and platinum-based chemotherapy, is indicated for the treatment of adult patients with metastatic NSCLC with no sensitizing epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) genomic tumor aberrations.
IMFINZI, in combination with etoposide and either carboplatin or cisplatin, is indicated for the first-line treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC).
IMFINZI, in combination with gemcitabine and cisplatin, is indicated for the treatment of adult patients with locally advanced or metastatic biliary tract cancer (BTC).
IMFINZI in combination with IMJUDO is indicated for the treatment of adult patients with unresectable hepatocellular carcinoma (uHCC).
Please see Full Prescribing Information including Medication Guide for IMFINZI and IMJUDO.
You are encouraged to report negative side effects of AstraZeneca prescription drugs by calling 1-800-236-9933. If you prefer to report these to the FDA, call 1-800-FDA-1088.
IMFINZI and IMJUDO are registered trademarks of the AstraZeneca group of companies.
©2024 AstraZeneca. All rights reserved. US-85388 Last Updated 5/24

If you're looking to boycott Nestle, there are a few things you can do. First, you can choose to not purchase Nestle products. This means being mindful of the brands they own, such as KitKat, Nescafe, and Nestea, among others. You can also spread awareness about the issues you're concerned about, encouraging others to make informed choices. Remember, it's always important to do your own research and make decisions that align with your values. Since the company’s conception in 1867, Nestlé has convinced people its baby formula is better for infants than breast milk — a claim that is categorically false. They placed particular focus on marketing in developing countries in Africa, Latin America and Asia during the 1970s, sending saleswomen dressed as nurses to convince the mothers that their formula was better for their children than their own breast milk.
Many women, struggling to afford the expensive milk touted as better than what their bodies produced for free, diluted the formula with (often unsanitary) water, further reducing its nutritional value. Millions of infants died. Many more grew up nutritionally deficient, dramatically impacting the health and lifespan of swathes of the developing world — one of the worst scandals a corporation has ever publicly faced. Meanwhile, the company pocketed billions in revenue from baby formula and continues to do so. Today, the misconception lives on, and baby formula remains a booming market. Despite global outrage now lasting half a century, as well as tons of new research into the harm caused by Nestlé baby formula and other Nestlé products, infant formula remains an $11.5-billion market — and growing.

Mother's day is a fun day. my husband (28M) believes that women are pathetic to create a day to get gifts and praise when nobody cares about father's day.. if you have a spouse that loves you and take care of you. you are lucky person. go ahead and give them a hug or kiss.
I think my short 4 years of marriage is heading to end. I'm tired and exhausted. overworked. neglected and emotionally abused. I've had some kind of cold with sinus infection for last few days and have had this nasty cough. I've been coughing all day. all night but still managed to work, clean, laundry, take care of our child etc... He hasn't even offered me a cup of water. He purposely ignores that I'm sick and refuse to even recognize it. when he is sick. he acts like he is dying even with the smallest thing.. like sore throat. I still take care of him. I offer him different things. ask him if he needs anything.. but it is sad to see my husband being absolutely indifferent towards me like there isn't single affection left for me. it's heartbreaking.
Today, I was cleaning a milk bottle for our toddler. He wouldn't wash it but he will come check if I cleaned it right. I cleaned our kitchen countertop with dish soap and sponge. he comes to check. asked me if I'm using disinfect. I said no. he still goes ahead and lecture me that if I use the disinfect. I need to wipe it again with water. will he clean the counter top? no. but will he come check on how I cleaned? yes. I did laundry. he comes to check which mode I'm using. he will lecture me for what kind of mode I should be using. will he do the laundry himself? no. but he is 100% willing to come check what I did.
I don't understand this behavior. I've told him multiple times that this is very bizarre and don't know how to take this. He said that he is just letting me know what's the best. does he have OCD? no. he has ADHD and terrible at organizing or even following the tasks. I just can't wrap my head around it. He will always talk about what I did and what I should have done and if I explain to him that I did what I had to do. he will argue and lecture for hours. I'm exhausted. I work full time and he only work part time. while he is great with our toddler and spends a lot of time with him when he comes home from daycare.. I'm the one who is in charge of all the finance, house chores + full time job. he doesn't pay single bill. I do it all. my mental burden has been out of this world and all he does is adding another unnecessary stress on me.
He couldn't even say a single nice word for Mother's day. he asked me if today is Mother days in middle of the day. I said yes. he went silent and went outside in his little man cave shed and hasn't came back in. I'm working to make extra income since everything is expensive while coughing my souls out. I'm just beat and broken. I know that's who I married to and this is what I get. I've been thinking about divorce but he threats me to fight me for half of everything I own and taking our child back to his country. I just feel so stupid.