charl93 Posted January 4 Share Posted January 4 Hi everyone! Good to finally be a member on here - I am so pleased I came across this site. I would really appreciate some thoughts on my SSRI journey to date and where things currently stand, as I am feeling a bit lonely and in that mindset where 'things will never get better' and I'm going to end up a slave to antidepressants and anxiety for the rest of my life. Sorry for the long post but I really want to explain my journey with all of this... and I appreciate you taking the time to read it all. I was first put on on SSRIs (Citalopram) by my GP in March 2015 as I was experiencing strong physical symptoms of anxiety with related depression following a relationship breakdown, and 'fear of the unknown' following graduation at University, getting a job etc. I don't remember much about side effects of Cit when I first started it, but I do remember that after being increased to 20mg it made me feel the happiest and most confident I had felt in a very long time. I considered it a 'magic pill'... Even through a really really tough life event it didn't falter. In March/Apr 2017 I felt that perhaps the Cit was no longer working as it had been - I was feeling quite unmotivated and fatigued. Spoke to my GP who recommended a switch to Sertraline. Again, I don't recall how I was switched - whether it was direct or cross taper, and I don't recall whether there were any substantial side effects. However I don't think there was, as I'm pretty sure I'd remember that. I was stabilised at 100mg. I never considered myself to have any major issues on Sertraline. But, I did start to suffer randomly from panic attacks in 2018 when driving on the motorway and I am not sure what triggered this - and this never went away after it started. In January 2020 me and my husband decided we would like to start trying for a family. I had no knowledge of SSRI withdrawal and because of this, like many people, I naively assumed that I would have no issues coming off them. My GP recommended a taper schedule over a really short period which was about 4 weeks, dropping from 100mg to 0. It was a while back now so I can't remember the exact taper schedule but I do remember it included taking a tablet every other day... I got pregnant pretty much immediately in the Feb, and alongside this Covid and lockdown happened. I never considered that withdrawal had hit me hard - in fact I felt pretty good. However a lot of day to day responsibilities went out the window as we were pretty much confined to our homes during that time, so life wasn't quite how it usually is, with less pressures and being able to work from home etc. Looking back now, I probably did have some withdrawal symptoms but it is difficult to know for sure, as I was pregnant and there are lots of things that come with that too, so it is hard to differentiate. When I was around 7/8 months pregnant I started to have occasional high blood pressure, visual disturbances, locking finger joints etc. Monitoring and tests were done regularly but no adverse effects found, no signs of pre-eclampsia etc. My high BP wasn't high enough/consistent enough to be medicated. I went into spontaneous early labour just over 36 weeks and labour was fine. However post-partum was a rough ride. I didn't feel well pretty much as soon as I left the hospital. Dizzy, nauseous and jittery. I just put it down to having a baby, as I didn't know any different about how you should feel following labour. 3 days later I developed chest pains and when lay in bed felt like what I can only describe as a heavy band across my chest. Tested my BP and it was ridiculously high, around 193/124, which resulted in being re-admitted to hospital and commenced on hypertensive medication. Cue the extreme anxious, panicked state and immediately all I could think was that I needed to go back on Sertraline to stabilise me. Looking back I wish I hadn't made such a rash decision but it was almost as if my mind was eager to get back onto it. I wonder whether this may have been some kind of protracted withdrawal. Tests never found anything and they just put it down to pregnancy-induced hypertension. The crazy part of it was my GP recommenced me straight onto 100mg rather than building me up gradually. He advised 'you were on 100mg before so you'll be fine'. I have never felt so ill in my life. Everything got so much worse. I remember my hospital window overlooked the psychiatric unit and I was convinced I would end up in there. My BP was erratic even with the medication - they couldn't understand why it would randomly jump back up. I was discharged and readmitted 2 to 3 times because of it. I developed insomnia, I had burning/tingling feelings in my arms and chest. My pupils were so dilated. No appetite and chronic diarrhoea. I developed neck and shoulder pains, shortness of breath. My throat would sometimes feel like it was closing up and like I couldn't swallow properly. My arms felt heavy. I felt in a permanent state of fight or flight. Visual disturbances and tinnitus. I had never experienced anything like it in my life. Everyone kept telling me it was my anxiety even though I knew it wasn't - it was nothing like the anxiety I had experienced before starting antidepressants. At the time I was convinced it was side effects from the BP meds and that they had sent me crazy. I was so desperate to come off them to feel better. I was eventually off the BP meds by end of December 2020, as following home monitoring and a weaning schedule it was felt my BP had stabilised to normal levels. During all of this time I went through the 'windows and waves' of feeling OK and then not so good. And some symptoms persisted despite being off the BP meds. I thought the meds had messed up my nervous system even though I was on them for a pretty short space of time. I never questioned it being Sertraline because I'd never had any issues with it previously, it never came into my mind. After stabilising on Sertraline (which I feel took a hell of a long time this time round - at least a year), my anxiety has been OK, aside from some panic attacks now and then - again whilst driving. However I have always felt 'off' since what happened - I do not feel like I used to (pre-pregnancy). I have gained weight and struggled to lose it despite efforts to eat well and exercise regularly. Like my metabolism is non-existent. My hair is thin and limp. Fatigue. I suffer with tinnitus so much. Cracking and aching joints during exercise, which I would assume is sign of inflammation. Shooting pains in my arms and side. Intolerance to alcohol which I never used to get (high heart rate and feeling jittery/anxious). High heart rate and anxiety in situations that do not warrant this response and would have never generated this bodily response previously. I also get bad white coat syndrome but appreciate this may just be something I have got to deal with, after what happened. I have had some scans, blood tests etc and nothing has been found other than a B12 deficiency, for which I received some injections but did not notice any improvements. Again, people just put it down to my 'GAD' but this is not how my GAD used to present before all of this. Up until now I had never really registered any of these issues perhaps being related to Sertraline. Indeed they may not be. But fast forward to where I am now, I am starting to question some things. In July 2023 I approached my GP to advise that I wanted to try for a 2nd child and wanted to wean off my Sertraline, as I didn't feel like I had any issues doing that before... I was weaned down over 8 weeks from 100mg to 0 (50% cut from 100mg to 50mg which I stayed at for 4 weeks, and then 50% cut again to 25mg which I stayed at for another 4 weeks before discontinuation). I experienced mood changes and unusual angry episodes. Groin and leg pains. Some slight insomnia. Had the burning/tingling once or twice. But I did feel more energised, my tinnitus seemed to improve, I was more motivated and less tired. I went on to have 2 consecutive miscarriages, one month after the other. After the 2nd miscarriage I was nearly 8 weeks off sertraline. My anxiety went through the roof. I googled the crap out of why I'd been unfortunate enough to have 2 recurrent miscarriages. I convinced myself I'd got some kind of blood clotting disorder. I was anxious and jittery and yet again my mind returned to recommencing Sertraline, thinking it would save me. I started back on 50mg on 30th October 2023 after being med-free for 8.5 weeks. After a couple of days my anxiety intensified. The insomnia started, the burning feelings, flushed cheeks, erratic heart rate, tinnitus, visual disturbances. Feeling wired, ruminating/OCD thoughts, no appetite, diarrhoea. It took me back to how I felt when I went back on Sertraline in 2020. I then considered that what I had experienced before was not from the BP meds, it was from the Sert. However this time I had a new experience thrown in - suicidal ideations (but not the will to act on them). After 4 weeks of windows and waves, I looked back on everything over the past few years and felt I needed to try something different - that maybe some of these issues will go away if I try a different SSRI. My GP recommended Escitalopram and advised I could do a direct switch from one SSRI to another with a similar half-life. So one day I was on Sertraline 50mg, the next day I was on 10mg Escitalopram (6th December 2023). I hadn't noticed any significant side effects after starting the Escitalopram. I didn't feel any worse and my windows seemed to be getting better over the past 4 weeks. I thought that I was well on the road to stabilising. However over the past week my anxiety has crept up a little, and now these past couple of days, everything has ramped up again, similar to when I started on Sert. Ruminating/OCD thoughts, feeling wired. Insomnia 2 nights ago, slept ok last night. Burning feelings in arms. Flushed cheeks. Could I be experiencing withdrawal from Sertraline even though I have switched to Escitalopram? Or would this be a sign that the Escitalopram is not working for me? I feel really lost on what to do next and I am constantly questioning it all. Do I increase my Escitalopram. Do I sit tight and wait to see what happens even though it is so difficult feeling this way... Once again I am sorry for the essay but it is nice to be heard and I am so appreciative of any thoughts and advice anyone can give me on all of this. My eventual aim is to be off SSRIs (as I just feel like they have messed me up and I worry about the long-term impact of taking them - 8 years I feel is already long enough). However right now my priority is to be stable - for myself and for my family. Charlotte 2015 - 2017 Citalopram - 10mg shortly upped to 20mg 2017 - Switched from Cit to Sertraline - 50mg shortly upped to 100mg Jan 2020 - Feb 2020 - quick taper down schedule given by GP for sertraline (to try to conceive) Off SSRI's mid-February 2020 Oct 2020 - reinstatement of Sertraline by GP straight onto 100mg 😵💫 also put on Nifedipine and Labetalol for post-partum BP issues Weaned off BP meds by end of Dec 2020 Fast forward to 2023: Taper schedule from Sertraline (to try to conceive); July 2023 reduced 100mg to 50mg Sertraline - maintained for 4 weeks August 2023 reduced 50mg to 25mg - maintained for 4 weeks 1st September - cessation of Sertraline, cold-turkey from 25mg Reinstatement of Sertraline 30th October 2023 50mg Direct switch from Sertraline 50mg (last tablet 5th December) to Escitalopram 10mg (first tablet 6th December) Link to comment
Administrator Emonda Posted January 5 Administrator Share Posted January 5 Welcome @charl93, You've had a rough trot of late. 5 hours ago, charl93 said: My GP recommended a taper schedule over a really short period which was about 4 weeks, dropping from 100mg to 0. It was a while back now so I can't remember the exact taper schedule but I do remember it included taking a tablet every other day... This is not the approach taken here. Why taper by 10% of my dosage? also Never skip doses to taper 5 hours ago, charl93 said: Looking back now, I probably did have some withdrawal symptoms but it is difficult to know for sure, as I was pregnant and there are lots of things that come with that too, so it is hard to differentiate. I'd be surprised if you didn't have withdrawal symptoms as a result of the rapid taper: Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 5 hours ago, charl93 said: Cue the extreme anxious, panicked state and immediately all I could think was that I needed to go back on Sertraline to stabilise me. 5 hours ago, charl93 said: The crazy part of it was my GP recommenced me straight onto 100mg rather than building me up gradually. He advised 'you were on 100mg before so you'll be fine'. I have never felt so ill in my life. Always best to start low and see how you go...in case you have an unpleasant response like you did. This may have been a Kindling response: 5 hours ago, charl93 said: In July 2023 I approached my GP to advise that I wanted to try for a 2nd child and wanted to wean off my Sertraline, as I didn't feel like I had any issues doing that before... I was weaned down over 8 weeks from 100mg to 0 (50% cut from 100mg to 50mg which I stayed at for 4 weeks, and then 50% cut again to 25mg which I stayed at for another 4 weeks before discontinuation). A repeat of the experience you mentioned above....more WD symptoms would predictably follow. 5 hours ago, charl93 said: I started back on 50mg on 30th October 2023 after being med-free for 8.5 weeks. After a couple of days my anxiety intensified. The insomnia started, the burning feelings, flushed cheeks, erratic heart rate, tinnitus, visual disturbances. Feeling wired, ruminating/OCD thoughts, no appetite, diarrhoea Again, we recommend starting low to try and prevent this. 5 hours ago, charl93 said: However this time I had a new experience thrown in - suicidal ideations (but not the will to act on them). After 4 weeks of windows and waves, I looked back on everything over the past few years and felt I needed to try something different - that maybe some of these issues will go away if I try a different SSRI. This site does not generally recommend swapping from one AD to another AD. You can end up feeling worse. You may well have WD symptoms from one AD and maybe a reaction to the new AD. Your body needs stability. Constant changes in AD medication can be very destabilising. 5 hours ago, charl93 said: these past couple of days, everything has ramped up again, similar to when I started on Sert. Ruminating/OCD thoughts, feeling wired. Insomnia I'll ask the team offline for their input on where to from here regarding your current dose. Some helpful links: Windows and waves pattern of stabilization Emotional Spirals Non-drug coping strategies Melatonin for sleep What is withdrawal syndrome. Brain Remodelling We don't suggest many supplements, but two that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. Add one at a time and start with a low dose to see how it affects you. Magnesium Omega 3 Fish Oil Avoid alcohol. Please post any updates here in your thread. It is helpful to keep everything related to your journey in one spot. You are very welcome to jump onto someone else's page and interact with them. The encouragement members give each other on this site is wonderful to see. Sing out with any questions. Once again, welcome to S.A. Emonda. Please don't send me PMs. I am not a doctor. My comments are based on my personal experience with ADs and tapering. Consult your doctor about your own medical decisions. Start of taper: Jan ’22 Vortioxetine 15mg, End year 1: 4.5mg, End year 2: 2.38mg, Year 3: 8 Feb 2.19mg, 21 Mar 1.99mg, 2 May 1.83mg, 13 Jun 1.69mg, 25 Jul 1.50mg, 14 Aug 1.46mg, 3 Sep 1.43mg, 10 Sep 1.40mg, 17 Sep 1.37mg, 16 Oct 1.34mg, 23 Oct 1.32mg, 30 Oct 1.29mg Link to comment
Administrator Emonda Posted January 6 Administrator Share Posted January 6 Hi @charl93, There's no guaranteed right answer. There's been two lines of thought. 1: Hold the dose for another week and monitor / record your symptoms. We can then see if there has been any improvement. 2: Slightly reduce the dose, no more than 10%, and gauge for improvement. On 1/4/2024 at 2:10 PM, charl93 said: right now my priority is to be stable - for myself and for my family. Personally, I'd go with stability of the current dose and hold for another week and reassess. Constant change is unhelpful. Keep us posted on how you are doing. I hope this helps. Please don't send me PMs. I am not a doctor. My comments are based on my personal experience with ADs and tapering. Consult your doctor about your own medical decisions. Start of taper: Jan ’22 Vortioxetine 15mg, End year 1: 4.5mg, End year 2: 2.38mg, Year 3: 8 Feb 2.19mg, 21 Mar 1.99mg, 2 May 1.83mg, 13 Jun 1.69mg, 25 Jul 1.50mg, 14 Aug 1.46mg, 3 Sep 1.43mg, 10 Sep 1.40mg, 17 Sep 1.37mg, 16 Oct 1.34mg, 23 Oct 1.32mg, 30 Oct 1.29mg Link to comment
charl93 Posted January 6 Author Share Posted January 6 Hi @Emonda Thank you for taking the time to respond and advise. Would you say the on/off symptoms I have experienced over the past few years are a result of being kindled/a destabilised central nervous system? The ad-hoc tinnitus, shooting pains, palpitations. The intolerance to alcohol (whenever I drink I immediately get high heart rate and feel jittery, flushed cheeks etc - which never used to be the case. Also I used to get tipsy/drunk after a few drinks whereas on the rare occasion I have drank the same amount over the past few years, my body is instead in overdrive and no sign of getting into that tipsy/drunk feeling). Another example is situations that may usually cause a small amount of adrenaline - e.g. waiting to go on a rollercoaster at a theme park.. I have always loved them and had no issues with them. But since returning on Sertraline postpartum, whenever I have tried or been on a theme park ride, its like my adrenaline is out of whack and my heart rate goes high, I feel light headed and panicky! Anything that would normally cause an increase in adrenaline, my body seems to respond in a hypersensitive way. I had originally thought perhaps these responses were side effects from Sertraline and so I may not experience these reactions on Escitaloprám. However if it is because I have kindled and my CNS is destabilised - is it likely I will continue to experience this on the Escitaloprám? Will the destabilised CNS/these symptoms only get better when I have successfully tapered off antidepressants and my CNS has recovered to a natural state? I am not in any rush to adjust my current medication dosage and I will begin to keep a daily log of symptoms. I will post them all after a week. I have already cut out caffeine since returning on Sertraline at the end of October. I have had the odd alcoholic drink over Christmas but have decided to cut that out too now. In my current state I have decided to not continue trying for a 2nd baby at the moment. I can't help but feel the back to back miscarriages might have been caused by my unstable CNS. They may have just been an unfortunate coincidence. I doubt that I, or anybody, would know that for sure. I am not sure if there's any research/evidence of it with other antidepressant users/withdrawals. But I don't want to risk going through that again (or if successfully pregnant, a tough pregnancy) with all of this that is going on. If I wanted to ask questions about particular symptoms - would I need to keep posting on this intro thread? Or should I be starting a separate thread under the symptoms page? Again, thank you for your support 🙏 2015 - 2017 Citalopram - 10mg shortly upped to 20mg 2017 - Switched from Cit to Sertraline - 50mg shortly upped to 100mg Jan 2020 - Feb 2020 - quick taper down schedule given by GP for sertraline (to try to conceive) Off SSRI's mid-February 2020 Oct 2020 - reinstatement of Sertraline by GP straight onto 100mg 😵💫 also put on Nifedipine and Labetalol for post-partum BP issues Weaned off BP meds by end of Dec 2020 Fast forward to 2023: Taper schedule from Sertraline (to try to conceive); July 2023 reduced 100mg to 50mg Sertraline - maintained for 4 weeks August 2023 reduced 50mg to 25mg - maintained for 4 weeks 1st September - cessation of Sertraline, cold-turkey from 25mg Reinstatement of Sertraline 30th October 2023 50mg Direct switch from Sertraline 50mg (last tablet 5th December) to Escitalopram 10mg (first tablet 6th December) Link to comment
Administrator Emonda Posted January 6 Administrator Share Posted January 6 6 hours ago, charl93 said: If I wanted to ask questions about particular symptoms - would I need to keep posting on this intro thread? Or should I be starting a separate thread under the symptoms page? Just ask any questions about your situation and symptoms here. 6 hours ago, charl93 said: I have had the odd alcoholic drink over Christmas but have decided to cut that out too now. Good to read that. As to these things: 6 hours ago, charl93 said: The ad-hoc tinnitus, shooting pains, palpitations. 6 hours ago, charl93 said: The intolerance to alcohol 6 hours ago, charl93 said: my adrenaline is out of whack and my heart rate goes high, I feel light headed and panicky! I can relate to all of these things. For me, it's been WD symptoms. 6 hours ago, charl93 said: I am not in any rush to adjust my current medication dosage and I will begin to keep a daily log of symptoms. I will post them all after a week. Sounds like a plan... Hope this helps. Please don't send me PMs. I am not a doctor. My comments are based on my personal experience with ADs and tapering. Consult your doctor about your own medical decisions. Start of taper: Jan ’22 Vortioxetine 15mg, End year 1: 4.5mg, End year 2: 2.38mg, Year 3: 8 Feb 2.19mg, 21 Mar 1.99mg, 2 May 1.83mg, 13 Jun 1.69mg, 25 Jul 1.50mg, 14 Aug 1.46mg, 3 Sep 1.43mg, 10 Sep 1.40mg, 17 Sep 1.37mg, 16 Oct 1.34mg, 23 Oct 1.32mg, 30 Oct 1.29mg Link to comment
charl93 Posted January 23 Author Share Posted January 23 Hi. Sorry I have been a bit quiet on here. It is probably a good thing as I have been relatively stable, with the odd symptom here and there albeit manageable. I haven't been very good at keeping track of my symptoms because I work full-time from home and have found it difficult to log symptoms alongside doing my work. I have tried not to pay much attention to my symptoms either - rather I just accept they are there. So yeah... didn't do my symptom log like I said I would 🤦♀️ still taking 10mg Escitalopram - tomorrow will mark 7 weeks that I have been on this med/dosage. On another note, I am looking at magnesium and Omega 3 supplements. The particular Omega 3 supplement I have been looking at contains: Omega-3 Fish Oil 1082mg EPA 330mg DHA 232mg Vitamin E 11mg Am I right in thinking that it is recommended I'd need at least 4 of these capsules within one day? I understand that I need to start off low and not jump straight to this dosage - but in an ideal world, if I can tolerate it, would this be the amount I'd need? Thanks 2015 - 2017 Citalopram - 10mg shortly upped to 20mg 2017 - Switched from Cit to Sertraline - 50mg shortly upped to 100mg Jan 2020 - Feb 2020 - quick taper down schedule given by GP for sertraline (to try to conceive) Off SSRI's mid-February 2020 Oct 2020 - reinstatement of Sertraline by GP straight onto 100mg 😵💫 also put on Nifedipine and Labetalol for post-partum BP issues Weaned off BP meds by end of Dec 2020 Fast forward to 2023: Taper schedule from Sertraline (to try to conceive); July 2023 reduced 100mg to 50mg Sertraline - maintained for 4 weeks August 2023 reduced 50mg to 25mg - maintained for 4 weeks 1st September - cessation of Sertraline, cold-turkey from 25mg Reinstatement of Sertraline 30th October 2023 50mg Direct switch from Sertraline 50mg (last tablet 5th December) to Escitalopram 10mg (first tablet 6th December) Link to comment
charl93 Posted January 30 Author Share Posted January 30 Can anyone give me advice on where to begin with tapering my Escitaloprám? I currently take a 10mg tablet. I want to drop 10%, so 9mg. What would be the best method of making this cut? 2015 - 2017 Citalopram - 10mg shortly upped to 20mg 2017 - Switched from Cit to Sertraline - 50mg shortly upped to 100mg Jan 2020 - Feb 2020 - quick taper down schedule given by GP for sertraline (to try to conceive) Off SSRI's mid-February 2020 Oct 2020 - reinstatement of Sertraline by GP straight onto 100mg 😵💫 also put on Nifedipine and Labetalol for post-partum BP issues Weaned off BP meds by end of Dec 2020 Fast forward to 2023: Taper schedule from Sertraline (to try to conceive); July 2023 reduced 100mg to 50mg Sertraline - maintained for 4 weeks August 2023 reduced 50mg to 25mg - maintained for 4 weeks 1st September - cessation of Sertraline, cold-turkey from 25mg Reinstatement of Sertraline 30th October 2023 50mg Direct switch from Sertraline 50mg (last tablet 5th December) to Escitalopram 10mg (first tablet 6th December) Link to comment
Administrator Emonda Posted January 31 Administrator Share Posted January 31 On 1/24/2024 at 8:27 AM, charl93 said: Sorry I have been a bit quiet on here. It is probably a good thing as I have been relatively stable, with the odd symptom here and there albeit manageable. Good news! On 1/24/2024 at 8:27 AM, charl93 said: Am I right in thinking that it is recommended I'd need at least 4 of these capsules within one day? I understand that I need to start off low and not jump straight to this dosage - but in an ideal world, if I can tolerate it, would this be the amount I'd need? I'd go and have a read of the Omega 3 Fish Oil link again. Start low and see how you go. Please don't send me PMs. I am not a doctor. My comments are based on my personal experience with ADs and tapering. Consult your doctor about your own medical decisions. Start of taper: Jan ’22 Vortioxetine 15mg, End year 1: 4.5mg, End year 2: 2.38mg, Year 3: 8 Feb 2.19mg, 21 Mar 1.99mg, 2 May 1.83mg, 13 Jun 1.69mg, 25 Jul 1.50mg, 14 Aug 1.46mg, 3 Sep 1.43mg, 10 Sep 1.40mg, 17 Sep 1.37mg, 16 Oct 1.34mg, 23 Oct 1.32mg, 30 Oct 1.29mg Link to comment
Administrator Emonda Posted January 31 Administrator Share Posted January 31 9 hours ago, charl93 said: Can anyone give me advice on where to begin with tapering my Escitaloprám? You made quite a few changes not that long ago, so I'd be in no hurry to taper. Before tapering, you need to be confident you are in a good place mentally and feeling stable. That said, when you are ready and stable, many people here use a scale such as the Gemini-20 to weigh their dose. Others use liquid AD to taper, but that's another change that can be destabilising. Transitioning from pills to liquid. Have a read of the 4th post down by Gridley. It's really important to be consistent and accurate with your dose. I hope this helps you. Please don't send me PMs. I am not a doctor. My comments are based on my personal experience with ADs and tapering. Consult your doctor about your own medical decisions. Start of taper: Jan ’22 Vortioxetine 15mg, End year 1: 4.5mg, End year 2: 2.38mg, Year 3: 8 Feb 2.19mg, 21 Mar 1.99mg, 2 May 1.83mg, 13 Jun 1.69mg, 25 Jul 1.50mg, 14 Aug 1.46mg, 3 Sep 1.43mg, 10 Sep 1.40mg, 17 Sep 1.37mg, 16 Oct 1.34mg, 23 Oct 1.32mg, 30 Oct 1.29mg Link to comment
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