Ouroboros: Needing Help/Advice - Effexor

January 5

Hi, first of all thank you for this platform. I really need help and do not know where to find it anymore…

I used to be on a high dose of Effexor (300mg) in my 20s for about 5 years. I decided to taper down to came off the drug in 2017. The advice of my doctor was to reduce by 37.5mg every two weeks (if I remember correctly). The physical withdrawals were not too bad but I developed panic attacks after about 6 months and went back on the smallest dose of Effexor (37.5mg).

I was on that dose for 5 years and I had less and less panic attacks over the years, I was really happy. Last year in September 2022 I was ready to stop the drug again to have a baby. I wanted to reduce by removing some beads from the capsules but when I opened it I found only one large bead. The drug I was on is a replica of Effexor called Enlafax-XR which is the funded drug here in New Zealand. I decided to stop completely from 37.5mg to 0mg which is what my doctor recommended.

The physical withdrawals were fine and went away pretty quickly. I had more anxiety then usual, but thought it would go away with time.

Fast forward to July, I took a multivitamin which included multiple B vitamins for a few of days and that combined with a fight with my partner sent me into a spiral of terror. I was shaking when going to bed and would wake up with a racing heart. This lasted for 10 days.

I was good again for a few more months. Then came September - I would get quite anxious after my period and decided to take a supplement of St Johns Wort to see if it would help. I started vomiting and shaking in bed again and spiralling into thoughts of terror.

Since I had no idea what was going on I contacted my doctor which prescribed me again Enlafax-XR at 37.5mg. I took one pill and was completely out of it the next day. My vision was slow and my legs and arm were rigid. Time was going really really slow.

I told my doctor which told me I probably had had an anxiety attack and that I should try again on a full stomach. I tried again a couple of weeks later after spending those two weeks in complete terror, shaking and vomiting. At my second attempt I was able to reintroduce the drug. I became better after 1 week and that lasted for another 3 more weeks. I still had quite a lot of anxiety but the terror was gone and I felt more grounded.

After 1 month of taking Enlafax-XR 37.5mg I had a big fight with my partner (our biggest fight yet in 9 years together). Things went downhill from there. I stopped eating, was vomiting all the time, my vision became slow like I was drunk, my legs and arms were completely stiff and tingly and my chest was burning from the inside. This was really intense for 2 weeks and some of the symptoms slowly went away.

It’s been three months now that I am on the drug and still vomit a lot and have really little appetite. My vision is still slow and I have an inner jitteriness in my whole body. I am also continuously horny when I come of my period and can masturbate multiple times a day (it is really annoying). I do not know what to do anymore, I feel like I am at the end of the rope. I always feel on edge/agitated and nothing feels good anymore.

I have three options:

- Continue taking Enlafax-XR and hope it will get better.

- Stop taking Enlafax-XR cold turkey as it cannot be tapered and see what happens.

- Switch to the real Effexor-XR, see if I can tolerate it and start decreasing the dosage.

I am scared and have really little hope. I do not want to make things worst for myself by choosing the wrong next step…Any advices would be more than welcome.

*I have been on multiple drugs over the years starting at 18 years old. Citalopram, Seroquel, Wellbutrin. I have not been on any of these for 10 years.

Thank you so much.

January 5

Hello, and welcome to SA. We are a volunteer-run community of people who have been or are getting off of psychiatric drugs. If it were me, I would choose option #3. There is a way you can safely and gradually taper off Effexor. I will give you more information further down.

Can you please give us specific information in your signature about your drug history for all drugs and supplements you are on and have been on, especially for the past 18-24 months? Please only give us drug names, dosages, and dates, as best you can remember. Please read the link below for instructions.

How to List Your Drug History in Your Signature

Here is some important information about how these drugs actually work. This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses:

How Psychiatric Drugs Remodel Your Brain

This helps you understand what withdrawal syndrome is:

Video on Recovery from Psych Drugs

Windows and Waves Pattern of Stabilization

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

Why Taper by 10% of my Dosage

Tips for Tapering Effexor

January 6

Thank you so much for getting back to me @getofflex I can’t tell you how much it means to me.

Do you think I should wait until I am

stable at this dose on Enlafax (35.7mg) before switching to Effexor?

I am nervous about switching to the real Effexor brand as I have been told that it sometimes doesn’t work the same for other people. I worry that I might react badly to it. The pharmacist told me that it’s the same thing but that it can feel a bit different for some people. He compared it to two brands of Ketchup - still the same but may taste different.

My partner is going away to the UK for 3 weeks on the 19 of January which makes me even more nervous to do the switch now as I would be on my own for quite a while if things were to go **** up…

I have been reacting badly to B vitamins and St John’s Wort which makes me think I am quite reactive.

What do you think? Should I wait until I am

more stable before making the switch? Will I eventually became more stable on this dose? There are some bad and better days at the moment so I find it hard to say. I am definitely better than I was 2 months ago, but not really stable yet.

Thank you so much for your help.

January 6

I would suggest stopping the B vitamins altogether. These tend to be activating. How long have you been on the St John's Wort? I would suggest you taper off this first. Then, I would hold for a while on your current regimen of venlafaxine until you are more stable, then make the switch to Effexor. When you do, make the switch gradually.

https://www.survivingantidepressants.org/topic/28978-cross-over-from-tablet-to-liquid-or-changing-the-brand/#comment-464916

It sounds like you are having the typical windows and waves pattern.

Here is a link with checklists of common WD symptoms:

Dr Joseph Glenmullen Withdrawal Symptom Checklists

Here are some techniques to cope with symptoms:

Non Drug Ways to Cope with Withdrawal Symptoms

Stability is really important when we are tapering off psych meds. Please read the link about stability:

Keep It Simple, Slow, and Stable

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you.

Magnesium

Omega 3 Fish Oil

January 6

Hi @getofflex,

Perfect that sounds like a good plan. I will stay on Enlafax until I am stable enough to make the switch to Effexor and then reduce VERY slowly when I am ready. Thank you so much for all the information, I will look through it all.

*When you say "Make the switch gradually” what do you mean?

As for the vitamin B, I only took it for a few days back in July. I am not taking it anymore. Same for St John’s Wort, I took it only for a few days back in September.

I am now only taking Magnesium and Cod Liver Oil.

January 6

15 minutes ago, Ouroboros said:

*When you say "Make the switch gradually” what do you mean?

Please check out the link right below that, It explains everything in detail.

January 6

Hi @getofflex,

I have looked at the link for cross tapering when switching. My issue is that Enlafax-XR (Substitute Venlafaxine brand here in New Zealand) cannot be tapered. Inside the capsule there is only one large hard bead which I don’t think can be cut… Does this make sense?

January 6

Ah yes, this makes sense. I suppose you will need to make a direct switch then. Just be sure that you stick with the same dose.

January 26

Hi everyone, I have a question regarding some side effects I am now having with Venlafaxine and I am wondering if anybody has had a similar experience.

I’ve reinstated Venlafaxine about 3-4 months ago after trying to stop for the second time (for a period of 13 months this time). My current dose is 37.5mg.

I am now experiencing weird symptoms when I get my period, which I never had before. Around the 3rd day of my period I start getting pretty agitated with waves of pins and needles in my arms. I also get diarrhoea multiple times a day and vomiting (although it’s more like retching as nothing comes out).

This lasted for about 3 days I think before it got better during my last period and I am waiting to see how long it will last this time.

It also happened for 1 day I presume during my ovulation.

I have read that estrogen increase the serotonin level in the brain. And since estrogen kicks in a few days into your period, I am now wondering if I am getting some light serotonin syndrome symptoms.

Has anybody experienced this? And if so, has it got better for you?

Thank you!

January 28

Welcome back @Ouroboros,

I've moved your new post back here to your thread. It's best to keep everything relating to yourself in one spot.

Have you seen the list of possible WD symptoms: Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) I note that the things you mention are on the list.

As a guy, I don't have any personal experience with the specific question you have asked. That said, I have read on this site that women can experience heightened WD symptoms based on their cycle.

May I ask if your signature is up to date? You don't take St John's Wort, right? Was it just a once-off back in September 2023?

January 28

Hi @Emonda, thank you so much for getting back to me.

To answer your question, no I do not currently take St-John’s Wort. I was having anxiety during my period back in September and thought I should try an herbal supplement to calm me down… Looking back I think it kick in a kindling reaction. I took the St-John’s Wort supplement for only 3 days. The anxiety got worse which led me to reach out to my doctor which suggested to go back on my small dose of Venlafaxine (37.5mg), which I did. I think this may have made the kindling worse

but I’m not sure.

The vomiting started when I took the St-John’s Wort back in September. Now it’s on and off and it seems to get triggered mainly by my period.

I understand that WD don’t always automatically stop when you go back on your AD. It’s now been 3 1/2 months since I have reinstated. I had quite a lot of good days before my period which made me quite hopeful. I really hope the WD symptoms will stop with time…

In your opinion, do you think these are WD symptoms or do you think they are caused by the AD? I am just a bit confuse because I didn’t have the vomiting before taking the St-John’s Wort and AD… Although other WD symptoms have resolved since starting the AD which were also triggered by the St-John’s Wort (shaking at night, nightmares, pounding heart, fear, insomnia).

Thanks again for your help. I wish I would have found all this information sooner… Hopefully it gets better and I can one day be off this drug.

January 28

On 1/26/2024 at 8:30 PM, Ouroboros said:

Hi everyone, I have a question regarding some side effects I am now having with Venlafaxine and I am wondering if anybody has had a similar experience. (although it’s more like retching as nothing comes out).

Venlafaxine is problematic for many of us.

I get the retching every morning even on 225mg. Didn't have that when I was "actually depressed" or when I started on it...

Good luck. This is a good place for good support and advice.

January 28

Hi @BigCat, so sorry to hear you are dealing with the same thing. I get it all day long during my period, it makes living a normal life very difficult. Have you had this for a long time? And is it every morning or does it come and go?

January 28

Not having a great day today… I’m struggling to figure out if my symptoms are WD or caused my the medication (Venlafaxine).

My current symptoms are:

- Vomiting

- PGAD

- Anxiety

- Lost of appetite

- Inner jitteriness

- Burning sensation in chest and sometimes stomach

- Tingling in arms

Before reinstating I had different WD symptoms some of which have resolved:

- Intense fear

- Tremor

- Vomiting

- Insomnia

- Extreme anxiety

- Lost of Appetite

In the new symptoms the worst ones are vomiting and PGAD.

I am really struggling to know what to do. I’ve reinstated to my previous dose of Venlafaxine (37.5mg) 3 1/2 months ago. The first month was fine, I actually felt much better and thought I was sorted and then I experience a really big crash after having a big fight with my partner. It is only since then that the new WD symptoms have appeared. Some were really bad at the beginning and are now coming on with less intensity.

I wish I had read more about reinstating before actually doing so. I would have tried a much smaller dose than what I am currently on…

Any advices? Should I continue to hold? The WD I had before reinstating were absolutely horrendous, but the new WD are also really hard to deal with…

January 29

What are my chances of ever stabilizing? It is just really hard today, I need hope.

January 29

23 hours ago, Ouroboros said:

To answer your question, no I do not currently take St-John’s Wort.

Good to hear.

23 hours ago, Ouroboros said:

I understand that WD don’t always automatically stop when you go back on your AD. It’s now been 3 1/2 months since I have reinstated. I had quite a lot of good days before my period which made me quite hopeful. I really hope the WD symptoms will stop with time…

Correct. Some take 6 months to stabilise, some less, and some more. Everyone responds differently. The fact that you had "quite a lot of good days" recently is encouraging.

23 hours ago, Ouroboros said:

In your opinion, do you think these are WD symptoms or do you think they are caused by the AD?

If you were having the same symptom each day around the same time, then that might lead you to conclude that it's the AD causing some sort of adverse reaction. But from what you say, that's not what's happening. If I am understanding you correctly, it seems to be something that happens monthly, right?

23 hours ago, Ouroboros said:

other WD symptoms have resolved since starting the AD which were also triggered by the St-John’s Wort (shaking at night, nightmares, pounding heart, fear, insomnia).

This is encouraging.

8 hours ago, Ouroboros said:

I wish I had read more about reinstating before actually doing so. I would have tried a much smaller dose than what I am currently on…

Hindsight....with hindsight, I'd have made lots of different decisions, too. But yes, starting low with reinstating is best.

Overall, compared to pre-reinstatement, you have seen improvement, right? And the main complaint is vomiting (BigCat mentioned that's common with your AD) and PGAD (I don't believe that's on the WD Symptom checklist, but I have heard of it as a side effect of ADs).

3 hours ago, Ouroboros said:

What are my chances of ever stabilizing?

Have a read of LostInCanada. She had a rough trot after a CT and reinstatement. She's making progress and is an encouragement to read.

One of the other team members may drop past to add their thoughts.

January 29

6 hours ago, Ouroboros said:

What are my chances of ever stabilizing? It is just really hard today, I need hope.

Things will improve. My experience, like many, is a bit tidal- ebb and flow.

My anxiety varies, some mornings nothing at all, and I know that by lunchtime it will usually have diminished.

If I look for my anxiety I will find it, so I don't go looking for it...

More power to you!

January 29

12 hours ago, Ouroboros said:

What are my chances of ever stabilizing?

Lots of people stabilize! Our bodies and brains are always working towards balance and healing. Right now, despite your struggles, so many systems in your body are working together to figure this out and ease what you're feeling. Our bodies are capable of truly astounding levels of healing.

12 hours ago, Ouroboros said:

It is just really hard today, I need hope.

I so feel you, I've been there and posted the same! It absolutely gets better with time. Just so hard to believe when you're in it!

On 1/28/2024 at 2:32 AM, Ouroboros said:

I was having anxiety during my period back in September and thought I should try an herbal supplement to calm me down… Looking back I think it kick in a kindling reaction. I took the St-John’s Wort supplement for only 3 days.

St John's Wort can interact with hormonal birth control and lower it's effectiveness, I'm wondering if it can mess with hormones in other ways as well. Have you ever tried Passionflower for anxiety? I mix it into herbal teas sometimes when I'm very tense, but they make supplements too. Catnip and California Poppy are also sedating (although if you make a tea with Catnip with kitties at home you might get a lot more interest than usual in your mug). I've also gotten a lot of help from acupuncture and taking the herbs/making the lifestyle changes the acupuncturists recommended.

I hope you have relief soon!

January 29

Thank you @Emonda @BigCat and @littlebird, this really helps. Thank you so much. Woke up vomiting again… but hoping for some improvements.

January 29

Hello @Ouroborosim so sorry your going through this vomiting is horrendous I should know because I’m dealing with it as well. If you check my introductory you will see vomiting has been going on since October of last year. I woke up this morning needing/an urge to vomit and actually did. My cycle is approaching in 2-3 days I also have not slept good passed few nights I’m assuming it could be a wave/drop in hormones. Do you feel your vomiting is around your hormone shifts during the month.

January 29

Hi @Jennyy, sorry to hear you are dealing with the vomiting as well… Yes it seems like I start vomiting on the heaviest day of my period and it last for 4-5 days. At least that’s what it was last month. I’m going through it again this month and I am still in the thick of it. I will see how it goes this time around. I’ve only reinstated 3 1/2 months ago so it is hard to say yet if my period is really what is triggering the WD symptoms, but it seems to be. I guess I will have to see how it goes it the next few months. Wishing you luck.

January 30

Hi everyone,

Hope everybody is in a window today... I've not vomited yet today which is a good sign. Do you have any advice on how to speak about all of this to your partner and family. Everything I am experiencing is so out of the ordinary that it is really hard for people to understand. My partner has been trying really hard to be nice and understand what is going on, but I know that it's not easy for him. He used to have a happy and driven girlfriend who would be his rock. We had big dreams together, we bought a section of land here in NZ and are building a tiny home. Now I feel like a shell of myself and he really struggles to understand how this has happened and why it is not getting better. He says that I need to do things for myself to feel better like go for a trip in the campervan, go climb the mountain, go to new places, exercise, see people, etc... Which are all good things that would usually help a normal person, but all of those suggestions makes me feel really overwhelmed. It also makes me feel really down, because I use to love doing those things and now I can barely go to the supermarket and do the washing. I know that he loves me, but I understand that it would be really tricky to be living with a person like myself right now. I often pretend to be happy and that everything is ok in front of him to reassure him, although the vomiting is hard to hide. I feel like most of the activities I do during the day is to show him that I am ok. My family doesn't understand either, my dad keeps telling me that I should increase my medication... which makes me feel really sad and alone. I often get really worried that my partner and I might split up because if this. The worst thing is that we live in New Zealand together, but my family is in Canada so I have nobody else here really. Anyway, hoping for things to get better.

Also, question about stabilisation. When we say that we have stabilised, does it mean that the waves have stopped?

January 31

Other question. Sorry I think I’m in a spiral. What is the difference between PWS and PAWS. I’m trying to find the information, but everything I read really scares me.

From my side of things, I had physical withdrawal symptoms when I came of the med for about a week or so. But the worst were the symptoms I got 10 months after stopping (for about 10 days) (shaking, feeling of doom, pounding heart, etc) after taking a multivitamin for 3 days and then again 12 months after stopping (after taking St-John’s Wort for 3 days) which led me to reinstate at 13 months off the drug.

Are PWS and/or PAWS potentially eventually eased by reinstating? I know I’ve reinstated really late which is not recommended, but I hadn’t needed to prior to that.

January 31

12 hours ago, Ouroboros said:

Hope everybody is in a window today... I've not vomited yet today which is a good sign.

Wonderful news.

12 hours ago, Ouroboros said:

Do you have any advice on how to speak about all of this to your partner and family.

I only discuss this journey with my wife and a small number of trusted friends I thought would understand. Realistically, I don't think people can really understand unless they have experienced it.

You could share the WD symptom checklist with your partner so they can gain an appreciation of the challenge you face.

My wife read the Prozac Backlash after I read it. She found it beneficial and eye-opening. Maybe you could read that, then give it to your partner.

12 hours ago, Ouroboros said:

He used to have a happy and driven girlfriend who would be his rock. We had big dreams together, we bought a section of land here in NZ and are building a tiny home.

12 hours ago, Ouroboros said:

It also makes me feel really down, because I use to love doing those things and now I can barely go to the supermarket and do the washing

How you are feeling now is temporary. Better days are certainly ahead.

12 hours ago, Ouroboros said:

my dad keeps telling me that I should increase my medication... which makes me feel really sad and alone

Well-meaning, but uninformed. Again, unless someone has experienced it, it's hard for them to understand.

12 hours ago, Ouroboros said:

I often get really worried that my partner and I might split up because if this. The worst thing is that we live in New Zealand together, but my family is in Canada so I have nobody else here really. Anyway, hoping for things to get better.

Maybe you should have a read of this link: Emotional Spirals

Hope this helps. You will improve with time.

January 31

Thank you so much for your responses @Emonda it helps a lot. How are you doing? Are you in a good place in your journey?

January 31

I'm glad that was helpful.

Sometimes we just need a little encouragement and support to keep us going on the journey. I dive into the success stories when I need a lift.

2 hours ago, Ouroboros said:

How are you doing? Are you in a good place in your journey?

Mostly ok, just mild underlying anxiety/fear at times....thank you for asking 🙂

February 3

Just wanted to leave a positive note today. I had a lovely day today and felt like a normal person. Just wanted to leave a happy note on this thread to remind myself and others that the good days do exist and will come again.

February 6

Question regarding histamines. I’ve just read that the change of hormones during your period and ovulation can trigger histamine release.

"Histamine intolerance is more common in women, and is often worse at ovulation and just before the period."

I think I’ve read that some people get triggered by certain food because of the histamine. Could this be why I feel so bad during my period and ovulation?

Also, does this somehow get better with time? I’ve never had issues with histamine before…

If anybody has info on this, I would love to know.

February 7

Hi again, hope everybody is doing well. Any advice on how to figure out if a specific food is triggering symptoms? I’ve been reading about histamine intolerance and I’m wondering how to spot if I am reacting to high histamine food or not. Would this be very obvious? Would you get symptoms by example straight after drinking a cup of coffee? If anybody has any experience with this I would love to know more about it.

Also, I have read that exercise can be a trigger. How would this look like? Would I get symptoms straight after exercising? Or would it be more of an accumulation or multiple days? I’ve always loved exercising and I don’t know if I should continu or not. I find it really hard to know if it’s triggering symptoms as they always seem to come and go from one day to the next without much correlation with if I’ve exercised or not.

Finally, would it be possible to change the title of my introduction thread to: My Healing Journey - Effexor. Trying to be a bit more optimistic. I’m not sure if I can change the title myself or not.

Thank you. Best of luck to you all.

March 1

@Ouroboros HI! I just read your topic on reinstating from Jan 31st and was wondering how you feel like you're doing now?

March 2

Hello @ThisIsthestart, I’m doing a bit better. There are some good and bad days and I still don’t totally feel like myself even on the good days but it’s manageable. I’ve not vomited in more than a week so that’s really good news, hopefully this trend continues. I still have diarrhoea everyday, muscle twitching, brain fog and my vision is weird like I’m tipsy. And of course still pretty anxious, especially in the morning. How are you doing?

March 4

@Ouroboros I'm glad to hear it's trending upwards, even if you're still experiencing a lot of discomfort. It's wild how this puts even a day of pretty uncomfortable symptoms into perspective after having days that are almost intolerable. My symptoms are mostly emotional, huge waves of anxiety/depression/fear. Sometimes the waves can be so awful all I can do is sob and feel frozen and it's hard to remember that isn't actually how I feel, and then some days I feel 70% myself, or can at least acknowledge the other times are the wave. Quite the mind f*ck.

March 19

On 2/6/2024 at 9:49 PM, Ouroboros said:

I’ve been reading about histamine intolerance and I’m wondering how to spot if I am reacting to high histamine food or not. Would this be very obvious?

For me, I just don't feel good after having it. When I was drinking, red wine was almost immediately a headache. Aged cheese sometimes makes me feel achey all over, like I'm all inflamed. Have you noticed feeling off after eating certain things? I've been getting a lot of relief from digestive enzymes and probiotics, especially while changing psych med dosages (which seems to affect digestion more than I realized was possible).

On 3/1/2024 at 4:32 PM, Ouroboros said:

I’m doing a bit better. There are some good and bad days and I still don’t totally feel like myself even on the good days but it’s manageable. I’ve not vomited in more than a week so that’s really good news, hopefully this trend continues.

How have you been feeling lately?

March 20

@littlebird

Thank you for your reply regarding the food sensitivities. I don’t think I have food sensitivities since the anxiety and symptoms show up randomly and not straight after I eat something.

Thanks also for checking up on how I’m doing. I’ve had a good couple of weeks. So good that I even climber our local mountain. I have not vomited in about a month which is really good news even though I am sometime still nauseous. The only symptoms I have had these past two weeks was chest tightness on and off and some anxiety although not too bad. Even my IBS symptoms (diarrhoea) had resolved!

But today is a bad day unfortunately… it started yesterday afternoon. I feel weak, shaky, nauseous and the diarrhoea is back. My chest is also tight and I have electricity going down my arms and up my neck on and off. I feel really anxious too. I have just come out of my period yesterday and I think this might be the cause. I always seem to have more trouble around that time, especially after the period. I am wondering if I might need to take iron, but I am very nervous about taking supplements as I have reacted badly to them before (multivitamin and st-John’s worth). In any case, hopefully I will feel better soon.

How are you?

March 20

It's definitely worth getting your iron levels checked ask the doctor for a test.

March 20

17 hours ago, Ouroboros said:

I feel really anxious too. I have just come out of my period yesterday and I think this might be the cause.

That'll do it! Hope you get to feeling better soon.

17 hours ago, Ouroboros said:

I always seem to have more trouble around that time, especially after the period. I am wondering if I might need to take iron, but I am very nervous about taking supplements as I have reacted badly to them before (multivitamin and st-John’s worth).

This would be worth looking into, iron levels can absolutely affect mental health! I'm vegetarian and run into this sometimes. Supplements can absolutely throw you off, might be good to talk to a doctor about which ones they recommend for your digestive issues. Do digestive issues flare up around your period too? I've hard this can be normal and from cramps, but could also be something like endometriosis (especially if your cramps are killer). Just been talking to some friends about this so it's on my mind.

17 hours ago, Ouroboros said:

How are you?

Doing all right! Figuring out meds. I have a good doctor who hears me when I say I feel better on a lower dose and that's incredibly helpful.

Ouroboros: Needing Help/Advice - Effexor

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