nomemory: Long Term Clonazepam/Lexapro (8+ years) with CT

[nomemory]

I was initially prescribed Clonazepam (1 mg at night; later increased to 1 mg twice per day) and Lexapro (20 mg) in September 2015 (at age 27, now 36) for generalized anxiety disorder, social anxiety disorder, and major depressive disorder.  I had recently gone through an event that kicked my anxiety over the edge and pushed me to finally seek help, but these were undiagnosed issues that I had been dealing with all my life. The drugs wiped away my anxiety almost immediately.  Although I had noticed that my cognitive abilities had slowed some, I felt that I could still do my job (just a little slower) and that eliminating the anxiety I had experienced my whole life was a worthy tradeoff.  My depression also improved for a period of time (not sure how long). I continued both medications without much contemplation and was never warned about their long-term effects.

 

At some point, the cognitive issues (processing, memory, executive function, concentration, recognition, aphantasia, etc.) started very slowly getting worse (maybe started day 1 since I did notice some impairment then?) and my depression began to set back in, which also gradually got worse.  I noticed all of this, but as it was very slow and gradual, I didn't attribute it to the drugs; only in that they weren't as effective anymore, at least for depression. I thought that things would be even worse off of without them since I knew they helped me before.  For the cognitive issues, I just thought I was getting dumber with age and the lifelong depression (which had returned) maybe played a role in that, and maybe my lifestyle did too.  I have had no social life during adulthood (including never being in a relationship) and have long neglected my life outside of work.  The pandemic only made matters worse as I worked from home for multiple years (I now work at the office again) and was almost in total isolation other than time spent with my brother (and work calls), who I live with and have for all of adulthood.  

 

At some point I reached a state of complete anhedonia, and my cognitive issues began to have a significant impact on my abilities at work.  I work a high performing and high stress job as an embedded software engineer and had been able to get by based on what is left of my intelligence (at one point very high) and dedicating what little focus I have on work.  In September of 2023, I ran out of my medications right before a work trip out of the country, which led to me going off of both of them cold turkey.  On the trip I experienced acute withdrawal symptoms and that triggered me for the first time in all these years to look up the drugs I had trusted, for their withdrawal symptoms (started mostly focused on Clonazepam), which was illuminating.

 

I learned about BIND and the long-term effects of benzos (again didn't research Lexapro much yet) and found Benzo Buddies (just browsed and never posted). When I got back, I didn't immediately get back on the drugs as I thought it might be best to stick with it rather than trying to get back on and potentially prolonging this experience.  After a few weeks of too many symptoms, I scheduled an appointment with my prescriber, and they wanted to put me back on the drugs.  I explained that I wanted to get off the Clonazepam after what I read (again still didn't know what effect the Lexapro had and so the blame was focused on the Clonazepam) and so they started me back on just the 1 mg at night and said after a month I could start tapering.  They put me back on my original full dose of Lexapro at 20 mg.  

 

At my next appointment they had seemingly forgotten about the Clonazepam tapering, but after reminding them, they said I should stay at 1 mg for another month, then could drop to 0.5 mg for 1 month, and then 0.25 mg for a month before getting off completely.  I went through with this and definitely dealt with more symptoms (will try to add later, but many of the common ones) as I dropped down in dosage.  After finishing this taper I spoke to my aunt about my situation (the first person I discussed it with besides my brother) and she recommended I seek an integrative psychiatrist (the person I was seeing previously was actually just a nurse practitioner and not a psychiatrist).  The new psychiatrist kept me on the Lexapro and recommended me various supplements in addition to CBT, which I began.  The psychiatrist was focused on treating my depression/anhedonia and didn't seem to be familiar with BIND, withdrawal, and the recovery process I had read about on Benzo Buddies.  This was concerning, but I thought that there were positive things they were suggesting that might help me regardless.  Some of the symptoms went away after a few months (like insomnia and anxiety), but the anhedonia and cognitive decline did not seem to get any better.  

 

I had read horror stories about how long it took some people to recover after getting off benzos (if ever?), but with no known active steps to take to speed up the process, this brought me to look more into Lexapro, which led me to this site and other resources.  After realizing that a lot of the same issues I read about with Clonazepam were also present or at least similar with Lexapro, it felt like another gut punch. I didn't know what to do and also didn't trust that my new psychiatrist, while helpful in some ways, would be able to guide me out of this, based on their apparent lack of understanding of the effects of these drugs long-term and the stages of withdrawal.  I didn't know what to do and hadn't decided on anything.  And then, once again, I ran out of Lexapro on a vacation (the first I had taken in my entire time working).  And again I decided to stick with it as the symptoms weren't too far above what I had already been dealing with at first.  The cognitive symptoms showed some very small signs of improvement on some days I think. That was for the first month or two.  

 

After that, I started dealing with insomnia again and lots of anxiety during the day.  My ability to concentrate, already significantly impaired, has gotten a little worse.  After seeing my psychiatrist again about my situation, they didn't seem too concerned with me stopping the Lexapro, but to address my anxiety and insomnia prescribed Sertraline at 25 mg.  After doing research, I have been reluctant in starting the Sertraline as I'm worried it will only make things worse (by kindling?).  After raising that concern, they prescribed Seroquel at 25 mg for the insomnia.  They suggested I stay on it for 2 weeks with improved sleep, then try to stop and see if my body has adjusted to stay asleep on its own.  I decided to try that and I'm still in that 2 week window.  My sleep has been better, but with additional grogginess/sedation during the day.  So I don't actually feel well rested, despite not waking up during the night constantly like before. They also prescribed Ritalin for my trouble with focus in combination with the results of a genetic test.  The test showed that due to increased COMT enzyme activity that I have decreased dopamine in the pre-frontal cortex and decreased working memory.  I later realized the same genetic test suggested that other drugs like Adderall would be more effective and that Ritalin wouldn't be effective, based on my genetics. Despite that, my psychiatrist decided to keep me on Ritalin instead of switching for the time being.

 

Researching Ritalin linked me to ADHD and after reading about ADHD I realized that I had it and it just had never been diagnosed.  I didn't realize the symptoms I had were anything other than things that made me "different."  I believe this had a lot to do with some (not all) of the initial causes for my anxiety and depression throughout my life, but with all the issues I'm dealing with I'm not sure if I can address it right now.

 

To make matters worse, I got into a car crash a couple weeks ago.  Thankfully nobody was hurt, but the accident totaled my car.  This was the first accident I had ever been in.  The accident has only exacerbated the situation as I now have additional anxiety and guilt on top of everything else.

 

I've been struggling for a long time now.  The cognitive symptoms have been really hard to deal with as my cognition continues to be greatly impaired and I almost aways have some level of brain fog.  This makes work extremely challenging (for what is already a challenging job) and the stress/anxiety makes the situation even worse.  Not being able to feel joy in anything for such a long time has also given me very little hope.

 

Any suggestions/advice would be greatly appreciated.  I may add more details/symptoms if anything comes to mind.
 

[Jane318]

Greetings @nomemory and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications and their associated withdrawal syndromes.

 

Thank you for completing your drug signature.  Thank you also for sharing your story with us.  I am so sorry for all you have gone through.  Sadly, many others here have similar stories, as we live in a world where most "healthcare" professionals - and many people seeking help - look to pills to solve all problems.  It is also rare to find a healthcare practitioner that provides informed consent - that is, tells people about all the adverse side effects associated with using these powerful drugs and how difficult it can be to get off of them.   The good news is that it is possible to get off these drugs and to heal!  And it is the purpose of SA to help people who wish to do so.

 

All the symptoms you describe are documented side effects of these drugs and/or withdrawal symptoms.   It seems likely that you are dealing with acute withdrawal from your CT of Lexapro in August 2024.  You can read about withdrawal here:  What is withdrawal syndrome

 

Because your symptoms are so severe right now, you might consider reinstating a reduced dose of Lexapro until you stabilize.  Reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  Reinstatement predictably works up to 3 months after last dose.  We usually suggest a much smaller reinstatement dose than your last dose.  These drugs are strong, and when reinstating it is better to start with a small amount and increase if symptoms remain unbearable. Your system has become sensitized and If you take too much it may be too much for your brain and can cause you become unstable.  Sometimes it can be hard to regain stability after this happens.    

Please read:

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic

It takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain.

How long does it take to stabilize after reinstating or updosing?

Hypersensitivity and kindling

 

Let us know if you decide to reinstate Lexapro and would like our input on dosage.  Then, once you've stabilized on that dosage of the Lexapro, which can take several months, you can begin a slow taper down to zero.  Here at SA, we recommend the hyperbolic taper method for getting off these drugs, which you can read about here:  Why taper by 10% of my dosage?

 

We would have advised against starting the Seroquel.  Since you have been on it such a short time and seems like it is not helping you anyway, you might consider stopping it.  There are multitude of non-drug resources to address sleep issues.

 

We have many threads on how to cope with symptoms – I encourage you to check out the various forums / links on the SA.org home page.

 

This is your introduction topic.  Each member gets one intro topic- please post updates and questions here, in this thread.

 

Do explore the rest of the forum – there is a lot of great information here.  Be sure to read “About SurvivingAntidepressants.org,” which has good information about how to use / search the site: https://www.survivingantidepressants.org/forums/topic/54-about-survivingantidepressantsorg  

 

Also, feel free to read and comment on the intro threads of other members.  This is how you build a community of people who understand what you are dealing with.   It is so helpful to connect with others who are experiencing the same things.

 

Again, I am so sorry for your suffering.  I am grateful no one was hurt in the car accident.  I had similar experience a couple years ago, and it is traumatizing all by itself, much less on top of the stress of withdrawal.  Please do not lose hope.  Our bodies are designed to heal.  It will not be fast, but you can get through this.  The important thing is to trust your body, that it knows how to heal and never give up Trust Your Body: Learning to Heal

 

We look forward to following your journey, and helping out in any way we can.

 

Best wishes.

[nomemory]

Hi Jane,

 

Thanks for the feedback and well wishes. I'd like to try the reinstatement of Lexapro.  What would you suggest for the dosage?  Also, would Sertraline (Zoloft) be an option?  I have that already prescribed but am out of Lexapro, so would need a new prescription.  My sleep is awful right now.  I can't stay asleep very long without waking up in a panic.  The Seroquel was helping (with side effects), but now it doesn't appear to be anymore.  And I'm feeling completely overwhelmed at work and with life itself, which I'm sure is making things worse.  Also, you mentioned the reinstatement only predictably works 3 months after last dose.  I'm just outside of that, which worries me.  Thanks again!

[Jane318]

21 minutes ago, nomemory said:

I'd like to try the reinstatement of Lexapro.  What would you suggest for the dosage?  Also, would Sertraline (Zoloft) be an option?  I have that already prescribed but am out of Lexapro, so would need a new prescription.  My sleep is awful right now.  I can't stay asleep very long without waking up in a panic.  The Seroquel was helping (with side effects), but now it doesn't appear to be anymore.  And I'm feeling completely overwhelmed at work and with life itself, which I'm sure is making things worse.  Also, you mentioned the reinstatement only predictably works 3 months after last dose.  I'm just outside of that, which worries me.  Thanks again!

Given that it has been a bit more than three months since you CT'd Lexapro, I would recommend reinstating at 2 mg Lexapro.  Wait 4 -7 days - if symptoms improve, stay here as long as it takes to stabilize.  If not, increase to 3 mg and repeat.

 

Don't worry that it has been a few months since you CT'd - reinstatement will likely still work.  It has been effective for people further out than this.  But now that you have decided, get your Lexapro prescription refilled so you can begin as soon as you are able,

 

We would not recommend reinstating with a different drug (Zoloft).

 

If Seroquel isn't helping and since you have not been taking it that long, just stop.  Otherwise, this will be just another drug you will have to taper off of.

 

Best wishes and keep us posted please.

[Yesyes123]

On 11/10/2024 at 7:49 PM, nomemory said:

They also prescribed Ritalin for my trouble with focus in combination with the results of a genetic test.  The test showed that due to increased COMT enzyme activity that I have decreased dopamine in the pre-frontal cortex and decreased working memory.

 

I would never trust the results of a test that aims to measure quantities or qualities of a neurotransmitter. Contemporary science simply isn't ready to touch at these. I once had someone insist they took a Serotonin test and they had low serotonin and that's why they needed an SSRI antidepressant forever. Whenever someone mentions this type of evaluation I always feel it is what their doctor told them, the doctor might be convinced by it even, when in reality there is no trustworthy way to submit a patient to such test.

 

It goes back to the chemical imbalance story.

[Yesyes123]

@nomemory It's great you're here and I'm sorry for what's happening to you. It will get better eventually.

As you have probably gathered from your own research, the benzo withdrawal is sort of known to have extreme symptoms, with many popular cases and doctors being somewhat aware of it.

 

The same can't be said about SSRI and most other classes of antidepressants; they often come with severe long-lasting withdrawal symptoms which can be similar to benzos in some ways.

 

With proper information you will be able to fully heal in time.

[Yesyes123]

Hey @nomemory

Hope you're doing good

[Jane318]

Greetings @nomemory - How are you doing?  Did you decide to try reinstating?

[nomemory]

On 12/10/2024 at 11:22 PM, Jane318 said:

Greetings @nomemory - How are you doing?  Did you decide to try reinstating?

Hi @Jane318, sorry for the delayed reply.  I'm doing pretty similar to how I was before, maybe a little better.  I did try reinstating.  I am up to 10 mg and still haven't fully stabilized.  I still wake up multiple times per night (often with anxiety), struggling to get back to sleep. However, full on panic attacks when I wake up have greatly reduced in frequency.  I still experience anxiety during the day (although I'd say less than before?) and am continuing to struggle with significant cognitive issues (it is very possible this is still from the Clonazepam long term usage/withdrawal).  Thanks for checking on me and continued support.  I will try to be better about replying.  Do you have any further suggestions?

[Jane318]

4 hours ago, nomemory said:

I'm doing pretty similar to how I was before, maybe a little better. 

This is good news - Even small improvements are a positive sign of healing.

 

4 hours ago, nomemory said:

I did try reinstating.  I am up to 10 mg and still haven't fully stabilized.  I still wake up multiple times per night (often with anxiety), struggling to get back to sleep. However, full on panic attacks when I wake up have greatly reduced in frequency.  I still experience anxiety during the day (although I'd say less than before?)

I would not increase dose further if I were you.  The goal is to find the minimum dose at which you *start* to see improvement.  You won't stablize immediately - It will take time, likely months, to fully stabilize.  It seems you are seeing some improvement, so I encourage you to hold where you are. Increasing too much increases the risk of kindling.

 

Once you stabilize, you will want to begin a slow, hyperbolic taper to zero.

4 hours ago, nomemory said:

am continuing to struggle with significant cognitive issues (it is very possible this is still from the Clonazepam long term usage/withdrawal).

Cognitive issues are common in withdrawal.  This too will improve with time.  

 

4 hours ago, nomemory said:

Thanks for checking on me and continued support. 

You are welcome - we support each other!

 

4 hours ago, nomemory said:

Do you have any further suggestions?

I suggest you start working on some non-drug strategies for coping with the anxiety if you have not already.  We have lots of information on this, as many of us suffer from anxiety.  I encourage you to search the site, and here is one link that may be helpful:

https://www.survivingantidepressants.org/forums/topic/1101-cognitive-behavior-therapy-cbt-for-anxiety-depression-withdrawal-symptoms-insomnia/.

 

Keep us posted - Best wishes and Happy New Year.

[nomemory]

17 hours ago, Jane318 said:

This is good news - Even small improvements are a positive sign of healing.

 

I would not increase dose further if I were you.  The goal is to find the minimum dose at which you *start* to see improvement.  You won't stablize immediately - It will take time, likely months, to fully stabilize.  It seems you are seeing some improvement, so I encourage you to hold where you are. Increasing too much increases the risk of kindling.

 

Once you stabilize, you will want to begin a slow, hyperbolic taper to zero.

How will I know when I've fully stabilized?  Also, the improvements have been very slow, so it's hard for me to tell if I would have eventually seen improvements at a lower dose.  I also don't know how to split into finer grain doses.  I'm just pill cutting currently.

17 hours ago, Jane318 said:

Cognitive issues are common in withdrawal.  This too will improve with time.  

 

You are welcome - we support each other!

I've been dealing with cognitive issues progressively for years now.  They haven't really seen any noticeable improvement from their worst state.  Since these issues seem to be prevalent from both the long-term use and withdrawal of both of the drugs I've taken for a long time (Clonazepam no longer - but only as of March), it's hard for me to know what caused/is still causing them and therefore when/whether improvement is coming.

17 hours ago, Jane318 said:

You are welcome - we support each other!

 

I suggest you start working on some non-drug strategies for coping with the anxiety if you have not already.  We have lots of information on this, as many of us suffer from anxiety.  I encourage you to search the site, and here is one link that may be helpful:

https://www.survivingantidepressants.org/forums/topic/1101-cognitive-behavior-therapy-cbt-for-anxiety-depression-withdrawal-symptoms-insomnia/.

 

Keep us posted - Best wishes and Happy New Year.

I've been seeing a therapist for several months now.  It seems to be helping a little, but I've honestly had trouble keeping up with the suggestions/strategies they've given me.  The cognitive issues and depression have been major obstacles.  One of the recent suggestions was to journal my thoughts and then analyze/reframe them. But I have trouble remembering them later, it's all foggy. Will check out the linked thread.

 

Happy New Year to you as well! And thanks again!

[Jane318]

@nomemory - Just to confirm - you reinstated Lexapro, currently at 10 mg?  Can you please update your signature to reflect this, the date you reinstated?

 

4 hours ago, nomemory said:

How will I know when I've fully stabilized?

Based on my experience, I can just assure you that you will just know. Symptoms will have subsided (though not necessarily or even normally disappeared altogether), and will be more consistent day to day.  You will feel more "settled."  For me, and it seems many others, this seems to take place around five to six months.

 

During this period, it is very normal to have periods where you feel better, and periods where you feel terrible.  This is what we call the windows and waves pattern of stabilization.  This is actually a good sign of healing!  Read more about windows and waves here:   The Windows and Waves Pattern of Stabilization

 

It’s important to keep tabs on your symptoms.  This will help you identify your windows and waves and reveal your progress, You can use the following list of typical withdrawal symptoms to track the severity of your symptoms over time:  Daily Checklist of Antidepressant Withdrawal Symptoms (PDF).  

 

4 hours ago, nomemory said:

Also, the improvements have been very slow, so it's hard for me to tell if I would have eventually seen improvements at a lower dose. 

The guidelines we suggest are as I described here: https://www.survivingantidepressants.org/forums/topic/31843-nomemory-long-term-clonazepamlexapro-8-years-with-ct/#findComment-712482.  i.e., start small, wait a few days to see if symptoms improve.  if so, stop.  If no improvement at all, make another small increase and repeat.  Increasing the dose more doesn't necessarily mean you will stabilize faster, and the risk of kindling increases.  So better to stop at minimum dose where you see improvement.

 

4 hours ago, nomemory said:

I also don't know how to split into finer grain doses.  I'm just pill cutting currently.

Accuracy is very important, especially at low doses.  Use of liquid formulations is best.  Please read these topics, then let us know if you have any questions.

https://www.survivingantidepressants.org/forums/topic/300-important-topics-in-the-tapering-forum-and-faq/

https://www.survivingantidepressants.org/forums/topic/406-tips-for-tapering-off-escitalopram-lexapro/ 

 

4 hours ago, nomemory said:

I've been dealing with cognitive issues progressively for years now.  They haven't really seen any noticeable improvement from their worst state.  Since these issues seem to be prevalent from both the long-term use and withdrawal of both of the drugs I've taken for a long time (Clonazepam no longer - but only as of March), it's hard for me to know what caused/is still causing them and therefore when/whether improvement is coming.

I and others here can relate.  As much as we want to pinpoint a cause and timeline for improvement, this is rarely possible.  Healing does happen, regardless, however - our bodies are designed to heal.  I encourage you to try to rest in the knowledge that your brain / CNS is working hard to restore its balance and not become overly-preoccupied with how, when, and why.  We have no control over the past, but we do have the ability to choose how we move forward.  There are many things we can do to support healing - shunning substances that further degrade our CNS (alcohol, weed, other drugs, etc.), rest (healing uses a lot of energy), and good nutrition - I am a big proponent of plenty of high quality protein and healthy fats.  Try to do activities that engage your mind in different ways - listening to music, reading, listening to podcasts / audible books; manual labor, exercise, crafts, puzzles... anything that engages you in a positive way - to the extent you can for where you are right now - AND will take your mind off your symptoms.  I play piano.  I no longer enjoy it like I used to do, but I try to make myself sit down and play at least one piece per day.  When I do, I know this is engaging my brain in a positive way that promotes healing.  I am trusting that enjoyment will return at some point.  

 

4 hours ago, nomemory said:

I've been seeing a therapist for several months now.  It seems to be helping a little, but I've honestly had trouble keeping up with the suggestions/strategies they've given me.  The cognitive issues and depression have been major obstacles.  One of the recent suggestions was to journal my thoughts and then analyze/reframe them. But I have trouble remembering them later, it's all foggy.

It is likely that you will benefit more from therapy when you are not in the midst of severe withdrawal.

[nomemory]

On 12/28/2024 at 3:45 PM, Jane318 said:

@nomemory - Just to confirm - you reinstated Lexapro, currently at 10 mg?  Can you please update your signature to reflect this, the date you reinstated?

 

Based on my experience, I can just assure you that you will just know. Symptoms will have subsided (though not necessarily or even normally disappeared altogether), and will be more consistent day to day.  You will feel more "settled."  For me, and it seems many others, this seems to take place around five to six months.

 

During this period, it is very normal to have periods where you feel better, and periods where you feel terrible.  This is what we call the windows and waves pattern of stabilization.  This is actually a good sign of healing!  Read more about windows and waves here:   The Windows and Waves Pattern of Stabilization
 

It’s important to keep tabs on your symptoms.  This will help you identify your windows and waves and reveal your progress, You can use the following list of typical withdrawal symptoms to track the severity of your symptoms over time:  Daily Checklist of Antidepressant Withdrawal Symptoms (PDF).  

Yes, that's correct.  I updated my signature.

 

I see. Makes sense. The fact that I'm very likely still healing from the benzo also, which has a similar healing pattern and symptoms, I feel makes it complicated to determine what's from what.

 

On 12/28/2024 at 3:45 PM, Jane318 said:

The guidelines we suggest are as I described here: https://www.survivingantidepressants.org/forums/topic/31843-nomemory-long-term-clonazepamlexapro-8-years-with-ct/#findComment-712482.  i.e., start small, wait a few days to see if symptoms improve.  if so, stop.  If no improvement at all, make another small increase and repeat.  Increasing the dose more doesn't necessarily mean you will stabilize faster, and the risk of kindling increases.  So better to stop at minimum dose where you see improvement.

 

Accuracy is very important, especially at low doses.  Use of liquid formulations is best.  Please read these topics, then let us know if you have any questions.

https://www.survivingantidepressants.org/forums/topic/300-important-topics-in-the-tapering-forum-and-faq/

https://www.survivingantidepressants.org/forums/topic/406-tips-for-tapering-off-escitalopram-lexapro/ 

It's likely that I increased more than I needed to due to not knowing about liquid formulations and how to get precise doses.  However, I didn't experience kindling at least.

 

On 12/28/2024 at 3:45 PM, Jane318 said:

I and others here can relate.  As much as we want to pinpoint a cause and timeline for improvement, this is rarely possible.  Healing does happen, regardless, however - our bodies are designed to heal.  I encourage you to try to rest in the knowledge that your brain / CNS is working hard to restore its balance and not become overly-preoccupied with how, when, and why.  We have no control over the past, but we do have the ability to choose how we move forward.  There are many things we can do to support healing - shunning substances that further degrade our CNS (alcohol, weed, other drugs, etc.), rest (healing uses a lot of energy), and good nutrition - I am a big proponent of plenty of high quality protein and healthy fats.  Try to do activities that engage your mind in different ways - listening to music, reading, listening to podcasts / audible books; manual labor, exercise, crafts, puzzles... anything that engages you in a positive way - to the extent you can for where you are right now - AND will take your mind off your symptoms.  I play piano.  I no longer enjoy it like I used to do, but I try to make myself sit down and play at least one piece per day.  When I do, I know this is engaging my brain in a positive way that promotes healing.  I am trusting that enjoyment will return at some point.  

 

It is likely that you will benefit more from therapy when you are not in the midst of severe withdrawal.

 

That's a good way to approach the situation, hopefully I can take it to heart.  And hopefully I can keep my mind engaged.  It's often hard for me outside of work because I usually don't have much energy left.

 

You're probably right about the therapy as well.

 

Thanks again.