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Otter: requisite introduction


Otter

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Hello,

I stumbled on this site as I was searching for information about alternative tapers to the very slow taper advised by my internal medicine doc. I'm a woman in my mid thirties, mother of two boys (one of whom has autism). I am in a doctoral program studying the behavioral determinants of health after switching careers in my early 30s (I have a master's degree in psychology and was previously a social worker, but my temperament and personal struggles make working in that field too difficult for me).

I began antidepressant therapy when I was 19 years old, and since that time I have been on (either alone or in combination) the following medications: Wellbutrin, Lexapro, Amytriptaline, Buspar, lorazepam, diazepam, clonazepam, Abilify, Depakote, Prozac, Atarax and Sertraline. I have also been prescribed sleeping medications in the past (ambien, sonata), and Gapabentin/Neurontin, off label for "nonmigraine pain" and also off label for PTSD.

I've gone on hiatuses from medication for as long as 6 years (mainly during pregnancy and while breastfeeding, although I was able to read the research related to plasma transfer of sertraline into human milk and was satisfied that the concentrations were low enough to not potentially pose a problem to my then 18 month old son.

I went into care at a psychiatric clinic affiliated with the medical system of my university (because I have no copays there with my insurance of course), and experienced increasing pressure to add additional meds to address the breakthrough anxiety and depression I was experiencing while on 200mg sertraline, and was compelled (by the fact that I do research for a living) to look through the FDA Access database to read the original research that was submitted with the FDA application. This eventually led me into the concept of Tardive Dysphoria, which I believe wasn't mentioned in the literature until 2011? 

I literally stood up and walked out of my psychiatrist's office because I was asking for the evidence base so I could see the efficacy of taking 4+ medications for psychiatric conditions. 

A few days later I was able to see my internal medicine physician and explained my plan and rationale, she was supportive but also has a higher degree of respect for my capacity to participate in my own treatment. 

I weaned off of gapapentin completely and am now down to 100 mg/day or sertraline. I am continuing with 50mg atarax (hydroxezine), and I have a limited supply of 0.5 clonazepam available for breakthrough anxiety.

My suspicion of tardive dysphoria will only be confirmed if my symptoms rapidly extinguish with the removal of SSRI. 

After reading the many stories of serotonin withdrawal syndrome, and on the extreme caution of my internal med doc, I initially approached my taper conservatively, but I felt even worse if you can imagine, and I have been having tremendous withdrawal issues. I decided to try a more rapid taper and some of my physical symptoms (nausea and diarrhea) have resolved quickly. I'm still worried of course.

On top of all this, I have to travel next week to a national professional conference in DC to do back to back political advocacy trainings and present some analysis of ongoing advocacy projects that I've been involved in over the past year.

I can't say as I'm dreading it, though, because I feel pretty consistently miserable and have been since February of this year, so I don't know if I even remember what it feels like to not have to use all my energy to cope.

Edited by scallywag
tags added

1999 - Wellbutrin 150 mg ~ 4 months - cold turkey withdrawal (adverse reaction)
2001-2002 - Lexapro 10mg, lorazepam 1mg - cold turkey withdrawal induced a 2 week subacute seizure cluster
2002-2006 - Clonazepam 1mg, Prozac 40mg
2007 - Added Abilify (adverse reaction - hand tremors) 
2007-2008 slow wean off everything
2014 - Zoloft/Sertraline 50mg, increased to 200mg over the course of a year. 
2015 - Added Atarax 50mg
2016 - Added Gabapentin/Neurontin 1200 mg

June 2016: Rapid Gabapentin wean, rapid sertraline taper 200 - 100 mg

Current meds: 100mg/day of sertraline, 50mg atarax. 0.25mg klonazepam as needed (usually every other day or two)

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  • Moderator Emeritus

Welcome to SA Otter!  Thanks for posting your experience tapering off gabapentin.

 

What was your slow taper? What was your more rapid taper?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Link to comment

hello mighty otter!

just wanted to welcome you to the site and wish you smooth sailing and happy healing. everyone here can sympathize with how otterly devastating withdrawal can be at times. fortunately theres plenty of useful information and people here to help ease the load.

 

you seem to have a certain air of competency about you along with a strong will so instead of offering advice or links to info you probably already have researched i instead otter you this fun link: http://www.spirit-animals.com/otter/

 

also your intro title is the best on the forum. 

 

hope you feel better otter. feel free to ask any questions you may have right here in your introductory thread.

38 year old male

50mg sertraline for seasonal affective in spring of '13 through spring of '16

began uninformed taper mid march '16 ending 6 weeks later around may 1st

withdrawal symptoms began july 4th '16

reinstatement of sertraline at 25mg on july 7th '16

august '16 - present: many setbacks even more victories

currently holding at 25mg and ill hold there forever if I have to

looking forward to the day I can begin tapering

 

Link to comment

Welcome to SA Otter!  Thanks for posting your experience tapering off gabapentin.

 

What was your slow taper? What was your more rapid taper?

Hullo, and thanks for the welcome.

 

I did a really rapid taper off of the Gabapentin. I was taking it 4 times a day and eliminated a 300mg pill every few days. I'm not sure if this was advisable, or if this was the cause of my most recent episode of dysphoria, but I had a really dark moment on Tuesday. No going back now, though.

 

I'm also seeing an acupuncturist regularly to address some of the side effects of the taper with lots of success. Funny how there is a much stronger evidence base for the therapeutic effects associated with acupuncture than there is for the off label uses of gabapentin! My university has an integrative medicine clinic within the hospital system so my internal med doc actually wrote me a referral. 

 

Funny thing, though, that I was prescribed the gabapentin before the acupuncture. Things that make you go, hmmmm.....

 

I tapered onto zoloft slowly per my own request and I didn't get up to 200mg until September of last year but I have been experiencing what I can only describe as a slow degradation in my coping skills since that time.  

 

I decided to start tapering a month ago. I understand that the forum advises 10% dose reductions at a time at 6-8 week intervals? My doctor told me to reduce my dose by 50 mg at 6-8 week intervals. I was already in a pretty emotionally distressed state. In desperation I started dividing my doses and taking 50 mg 3 times a day rather than once before bed. That seems to have evened things out somewhat.

 

I don't allow myself to take the clonazepam two days in a row and am reserving it for breakthrough panic that results in a PTSD flashback. Which has happened 5 times, which is a 500% increase in flashback episodes for me. 

 

However, I am not longer feeling like there is a deep, dark blanket drawn over my head.

1999 - Wellbutrin 150 mg ~ 4 months - cold turkey withdrawal (adverse reaction)
2001-2002 - Lexapro 10mg, lorazepam 1mg - cold turkey withdrawal induced a 2 week subacute seizure cluster
2002-2006 - Clonazepam 1mg, Prozac 40mg
2007 - Added Abilify (adverse reaction - hand tremors) 
2007-2008 slow wean off everything
2014 - Zoloft/Sertraline 50mg, increased to 200mg over the course of a year. 
2015 - Added Atarax 50mg
2016 - Added Gabapentin/Neurontin 1200 mg

June 2016: Rapid Gabapentin wean, rapid sertraline taper 200 - 100 mg

Current meds: 100mg/day of sertraline, 50mg atarax. 0.25mg klonazepam as needed (usually every other day or two)

Link to comment

hello mighty otter!

just wanted to welcome you to the site and wish you smooth sailing and happy healing. everyone here can sympathize with how otterly devastating withdrawal can be at times. fortunately theres plenty of useful information and people here to help ease the load.

 

you seem to have a certain air of competency about you along with a strong will so instead of offering advice or links to info you probably already have researched i instead otter you this fun link: http://www.spirit-animals.com/otter/

 

also your intro title is the best on the forum. 

 

hope you feel better otter. feel free to ask any questions you may have right here in your introductory thread.

Heya, thanks and LOL at the punniness.

 

Air of competency has a nice ring to it, this may explain why I have been summarily recruited for the face to face parts of my nonprofit organization's advocacy work. It's all a facade, I assure you! LOL.

 

That is a lovely link. I was dubbed otter many years ago.

 

I've always been a relatively pragmatic rip the bandaid off kind of gal. In my 20s when I was no longer on my parents' insurance I fell into the habit of self medicating with various legal and nonlegal recreational substances. I quit all of those cold turkey, just kind of bumbling through the process and being a generally miserable person to be around for long stretches of time. However, after I had exhausted all my recreational options I was able to pursue mindfulness meditation with more rigor than I had previously been capable of. So there's that. I have just had a lemony snickett's kind of life, so I don't really have high expectations. :P

1999 - Wellbutrin 150 mg ~ 4 months - cold turkey withdrawal (adverse reaction)
2001-2002 - Lexapro 10mg, lorazepam 1mg - cold turkey withdrawal induced a 2 week subacute seizure cluster
2002-2006 - Clonazepam 1mg, Prozac 40mg
2007 - Added Abilify (adverse reaction - hand tremors) 
2007-2008 slow wean off everything
2014 - Zoloft/Sertraline 50mg, increased to 200mg over the course of a year. 
2015 - Added Atarax 50mg
2016 - Added Gabapentin/Neurontin 1200 mg

June 2016: Rapid Gabapentin wean, rapid sertraline taper 200 - 100 mg

Current meds: 100mg/day of sertraline, 50mg atarax. 0.25mg klonazepam as needed (usually every other day or two)

Link to comment

Welcome otter

Gee thats one large dose of zoloft you are on. Was it escalated to cover the gabapentn withdrawal?

Are you taking 3 other drugs as well?

 

My suspicion of tardive dysphoria will only be confirmed if my symptoms rapidly extinguish with the removal of SSRI.

I dont quite follow your logic here. 

My understanding of TD is its also a withdrawal symptom and can last a long time even when off the drug.

In fact withdrawal symptoms are not guaranteed to end the moment one gets off the drug. 'No drug' and 'no withdrawal symptoms' are not necessarily  synonymous terms.

 

So are you tapering at 10% or following the doctors advice?

 

Are you able to do  a drug signature?

 

Glad you found sa.

 

nz11

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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  • Moderator Emeritus

Otter, yep that is a fast taper off gabapentin!
 
You've got the gist of what's been observed as a safe tapering approach.
 
Why taper by 10% of my dosage?  

You may want to have a discussion with your acupuncture therapist about the breakthrough anxiety you experience as part of withdrawal.  Some people find that their acupuncturist will avoid stimulating treatments which can aggravate symptoms such as anxiety and panic.
 
I don't know much about EMDR, Eye Movement Desensitization and Reprocessing, but I have heard and read that it can be effective in reducing PTSD symptoms. For instance the US Veterans' Administration lists it as a treatment for PTSD. It's probably not a good idea to try to address trauma while going through drug tapers and withdrawal.
 
A request:

Would you summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-18 months particularly? Any drugs prior to that can just be listed with start and stop years.

Please put your withdrawal history in signature

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Link to comment

Welcome otter

Gee thats one large dose of zoloft you are on. Was it escalated to cover the gabapentn withdrawal?

Are you taking 3 other drugs as well?

 

My suspicion of tardive dysphoria will only be confirmed if my symptoms rapidly extinguish with the removal of SSRI.

I dont quite follow your logic here. 

My understanding of TD is its also a withdrawal symptom and can last a long time even when off the drug.

In fact withdrawal symptoms are not guaranteed to end the moment one gets off the drug. 'No drug' and 'no withdrawal symptoms' are not necessarily  synonymous terms.

 

So are you tapering at 10% or following the doctors advice?

 

Are you able to do  a drug signature?

 

Glad you found sa.

 

nz11

Hi nz11,

 

I was told that the dose range for sertraline with PTSD was 200mg. I initially had a great benefit from starting the Zoloft, it wore off after about 9 months or so, and the dosage was increased again to what I felt was minimal benefit, and then there followed the a brief stint at various complementary pharmaceutical therapies. This is all in addition to talk therapy, etc as I've gotten into a pretty good self care routine with regard to the consequences of trauma.

 

I have no exposure to the literature related to tardive dysphoria (I use TDp so as not to be confused with tardive dyskinesia, which I always think when I see TD because of my previous career in social work, LOL) as it pertains to SSRI withdrawal. I discovered the term "tardive dysphoria" (which was new to me) in a manuscript examining the role of long term SSRI use in inducing chronic depression (El-Mallakh, Gao & Roberts, 2011). But this piques my interest, so if you have any references I would very much enjoy reading some on this topic and I plan to do a brief search myself.

 

I've gotten off quite a few drugs in the past and experienced that phase of "this is terrible" but then it passes. Never by any means to a point of "I feel fantastic" but ya know, as good as it gets and all that. I don't really have high expectations, this ain't my first time at the rodeo as the saying goes.

 

The thing is, the theory is that TDp is the physiological response of dendritic arborization (the reduction of neural dendrites associated with the serotonin reuptake system). I mean in terms of disease models I think this would probably be similar to what you see in, say, opioid tolerance. Since SSRI therapy is focused on symptom control, the depressed brain on SSRI therapy doesn't really look like the brain of a nondepressed person. I would venture to guess that a person who is genetically predisposed, say born with the genetic variant that has the short form of the serotonin transporter, would return to a depressed state even after the brain is able to repair the damage done by long term suppression of the serotonin reuptake system. 

 

But I think the El-Mallakh paper they chart TDp as becoming more severe with continued use of the SSRI. So, there are probably qualitative differences in the experience of TDp compared to the normal dysphoria of the depressed brain. I'm reading this over and realize that it sounds terrible sterile, haha I've been rewriting a systematic lit review and had to update the sample so I've been reading studies all day ugh. 

 

I went pretty rapidly from 200 to 100 mg, but I am doing OK at the moment so I'm just doing to chill at 100 mg sertraline right now and slow down.... but it's difficult because I really just want to quit cold turkey! The only thing stopping me is that I have to go to DC next week to do a bunch of trainings and present at a conference and I definitely don't want to have a breakdown there. I know that it is hellish, but part of me just wants to go through hell for a few weeks rather than small portions of anguish slowly over the course of years. I know it doesn't really work that way, intellectually. If it did, though, I would be all over that.

 

 El-Mallakh, R. S., Gao, Y., & Roberts, R. J. (2011). Tardive dysphoria: the role of long term antidepressant use in-inducing chronic depression.Medical Hypotheses76(6), 769-773.) 

 

 

1999 - Wellbutrin 150 mg ~ 4 months - cold turkey withdrawal (adverse reaction)
2001-2002 - Lexapro 10mg, lorazepam 1mg - cold turkey withdrawal induced a 2 week subacute seizure cluster
2002-2006 - Clonazepam 1mg, Prozac 40mg
2007 - Added Abilify (adverse reaction - hand tremors) 
2007-2008 slow wean off everything
2014 - Zoloft/Sertraline 50mg, increased to 200mg over the course of a year. 
2015 - Added Atarax 50mg
2016 - Added Gabapentin/Neurontin 1200 mg

June 2016: Rapid Gabapentin wean, rapid sertraline taper 200 - 100 mg

Current meds: 100mg/day of sertraline, 50mg atarax. 0.25mg klonazepam as needed (usually every other day or two)

Link to comment

Otter, yep that is a fast taper off gabapentin!

 

You've got the gist of what's been observed as a safe tapering approach.

 

Why taper by 10% of my dosage?  

 

You may want to have a discussion with your acupuncture therapist about the breakthrough anxiety you experience as part of withdrawal.  Some people find that their acupuncturist will avoid stimulating treatments which can aggravate symptoms such as anxiety and panic.

 

I don't know much about EMDR, Eye Movement Desensitization and Reprocessing, but I have heard and read that it can be effective in reducing PTSD symptoms. For instance the US Veterans' Administration lists it as a treatment for PTSD. It's probably not a good idea to try to address trauma while going through drug tapers and withdrawal.

 

A request:

Would you summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-18 months particularly? Any drugs prior to that can just be listed with start and stop years.

Please put your withdrawal history in signature

Yeah I don't know if I want to start EMDR at the moment. My talk therapist suggested it and I was like, no way! I had an immediate gut reaction. I literally have like 4 real courses plus my dissertation left and I will be done with my doctorate and I just want to get through the next couple of years. Of course I'll probably dither along until the end of my days putting it off. 

 

Little bits and bobs bubble up every now and then. I have like a mini breakdown, go through the process of unpeeling my awareness and unidentifying from the sensation of the emotions, put myself back together again and get on with the day as I can. It is a pretty lonely road, though.

1999 - Wellbutrin 150 mg ~ 4 months - cold turkey withdrawal (adverse reaction)
2001-2002 - Lexapro 10mg, lorazepam 1mg - cold turkey withdrawal induced a 2 week subacute seizure cluster
2002-2006 - Clonazepam 1mg, Prozac 40mg
2007 - Added Abilify (adverse reaction - hand tremors) 
2007-2008 slow wean off everything
2014 - Zoloft/Sertraline 50mg, increased to 200mg over the course of a year. 
2015 - Added Atarax 50mg
2016 - Added Gabapentin/Neurontin 1200 mg

June 2016: Rapid Gabapentin wean, rapid sertraline taper 200 - 100 mg

Current meds: 100mg/day of sertraline, 50mg atarax. 0.25mg klonazepam as needed (usually every other day or two)

Link to comment

fyi comin atcha! 

 

Interactions between your selected drugs
Moderate clonazepam  sertraline

Applies to: Klonopin (clonazepam), sertraline

Using clonazePAM together with sertraline may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate sertraline  hydroxyzine

Applies to: sertraline, Atarax (hydroxyzine)

Using sertraline together with hydrOXYzine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

this fyi has been brought to you courtesy of the drug interaction checker: http://www.drugs.com...teractions.html

38 year old male

50mg sertraline for seasonal affective in spring of '13 through spring of '16

began uninformed taper mid march '16 ending 6 weeks later around may 1st

withdrawal symptoms began july 4th '16

reinstatement of sertraline at 25mg on july 7th '16

august '16 - present: many setbacks even more victories

currently holding at 25mg and ill hold there forever if I have to

looking forward to the day I can begin tapering

 

Link to comment
  • Moderator Emeritus

Otter since you're citing research papers, you'll probably be interested in the following topic:

 

Why taper paper: dose-occupancy curves

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Link to comment

Otter since you're citing research papers, you'll probably be interested in the following topic:

 

Why taper paper: dose-occupancy curves

Hey yeah thanks for sending me to this, but because I am a researchers (haha, I can clear a room) I am having trouble with the initial post's extrapolation of the exponential curve in the upswing of serotonin transporter occupancy upon initiation of SSRI therapy to direct correlation with the recommendation for a 10% taper. I'm not seeing the leap in logic I can understand the graph as it pertains to the data, but I'm not getting why this is proof as it pertains to drug discontinuation?

 

Anyway, I happen to have a colleague who admins a breastfeeding support page with me who is a pharmacological researcher for one of the bigger pharm companies - studying animal models. But I ran the article by her and she also seemed puzzled, and is now digging up studies related to SSRI withdrawal/discontinuation specifically for sertraline. 

 

I have institutional access to most research behind paywalls due to my university affiliation, but not to all the pharm databases since I am a social scientist by trade. I'm OK with looking at anecdotal evidence but I am not one to really take anything as gospel, especially when it comes to the field of medicine. Unfortunately, especially with psychology and psychiatry, many of the clinical recommendations are based on research on what we call "WEIRD" populations (White, Educated, Industrialized, Rich, Democratic) - and this calls into question the efficacy of treatments that are recommended or applied to those who do not fit within those particular categories, because psychosocial aspects heavily influence the success of any psychiatric treatment protocol. 

 

I wonder whether it would be better to post this in the other thread (why taper paper), mods please advise. If there is currently no existing methods to ascertain susceptibility to severe withdrawal symptoms, and the existing evidence demonstrates that slow tapers do not prevent withdrawal symptoms, then I suppose it is up to the individual to determine? I'd hate to be cutting by 10% for 5 years and going through prolonged withdrawal when I could just as soon do a rapid taper and go through the same prolonged withdrawal symptoms! That might be the rip the bandaid off impulse in me.

 

This is a more recent lit review that amalgamates all the studies (meeting the inclusion criteria of course) that pertain to withdrawal and SSRI discontinuation syndrome. I'm writing a systematic lit review at the moment, obvs on an unrelated topic, but let me tell you that 12+ months of work goes into those researchers reading and sorting and determining statistical significance and analyzing methodological rigor, so I particularly enjoy reading these:

 

http://www.karger.com/Article/Pdf/370338

1999 - Wellbutrin 150 mg ~ 4 months - cold turkey withdrawal (adverse reaction)
2001-2002 - Lexapro 10mg, lorazepam 1mg - cold turkey withdrawal induced a 2 week subacute seizure cluster
2002-2006 - Clonazepam 1mg, Prozac 40mg
2007 - Added Abilify (adverse reaction - hand tremors) 
2007-2008 slow wean off everything
2014 - Zoloft/Sertraline 50mg, increased to 200mg over the course of a year. 
2015 - Added Atarax 50mg
2016 - Added Gabapentin/Neurontin 1200 mg

June 2016: Rapid Gabapentin wean, rapid sertraline taper 200 - 100 mg

Current meds: 100mg/day of sertraline, 50mg atarax. 0.25mg klonazepam as needed (usually every other day or two)

Link to comment
  • Moderator Emeritus

Otter - It provides useful theoretical model of dose-occupancy which people's experience in dose-symptoms seem to follow.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Link to comment

Otter - It provides useful theoretical model of dose-occupancy which people's experience in dose-symptoms seem to follow.

Right. I tend to come off a bit overbearing (I blame aspergers) but I am not trying to be incendiary or attack anyone or anything, I just have a devouringly curious mind. It's even worse than you might imagine. But it's great if you do research, so I found my niche.

 

I posted a question about this elsewhere but I am now pondering the effects of genetic variation on enzyme activity specific to the action of antidepressant therapy, and the potential effect on withdrawal. This may explain why some people experience more severe withdrawal effects than others. 

 

The variants in these enzymes - CYP2D6 and CYP2C19 - range in a spectrum from being ultrarapid metabolizers (those who have the variants the cause hyper-activation of both these enzyme actions), to moderate, to poor, to those who actually have no enzymatic activity due to gene inactivation. 

 

This makes me have SO MANY QUESTIONS. All the research questions. Now I am curious about the epigenetic effect of SSRI medication on these two enzymes...

 

 

1999 - Wellbutrin 150 mg ~ 4 months - cold turkey withdrawal (adverse reaction)
2001-2002 - Lexapro 10mg, lorazepam 1mg - cold turkey withdrawal induced a 2 week subacute seizure cluster
2002-2006 - Clonazepam 1mg, Prozac 40mg
2007 - Added Abilify (adverse reaction - hand tremors) 
2007-2008 slow wean off everything
2014 - Zoloft/Sertraline 50mg, increased to 200mg over the course of a year. 
2015 - Added Atarax 50mg
2016 - Added Gabapentin/Neurontin 1200 mg

June 2016: Rapid Gabapentin wean, rapid sertraline taper 200 - 100 mg

Current meds: 100mg/day of sertraline, 50mg atarax. 0.25mg klonazepam as needed (usually every other day or two)

Link to comment
  • Moderator Emeritus

If you haven't yet browsed or read in the journals forum, you might find it interesting/fun.

 

From journals and scientific sources

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Link to comment
  • Administrator

Welcome, Otter.

 

Thanks, scallywag, I was just about to point Otter in the direction of the Journals forum. We have the El-Mallakh paper and commentary, as well as Andrews, 2011 Blue again: Perturbational effects of antidepressants,,.. and others.

 

Please note "tardive dysphoria" is a term El-Mallakh invented and his paper was published in Medical Hypotheses. However, he has done the world a service by documenting his observations and guesses.

 

It sounds to me, though, that you are talking about tachyphylaxis or tolerance (aka poop-out).

 

What is your current daily symptom pattern? It sounds like some symptoms started when you went off gabapentin, is that correct? What are they?

 

I literally stood up and walked out of my psychiatrist's office because I was asking for the evidence base so I could see the efficacy of taking 4+ medications for psychiatric conditions.

 

 

There is absolutely no evidence that these cocktails are effective, and a lot of evidence that they cause drug-drug conflicts and other health degradation.

 

(Also, we show the receptor occupancy curve in reverse to suggest you have to come off the drugs slowly to match the curve and avoid causing a precipitous slide towards the end.)

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Wow Otter you area  research guru how wonderful to have you join us.

 

 

I went pretty rapidly from 200 to 100 mg, but I am doing OK at the moment so I'm just doing to chill at 100 mg sertraline right now and slow down....

That's a fast taper done in what appears to be one month and withdrawal symptoms can be delayed so i think it wise to stop and chill for  awhile before continuing.

 

but it's difficult because I really just want to quit cold turkey! The only thing stopping me is that I have to go to DC next week to do a bunch of trainings and present at a conference and I definitely don't want to have a breakdown there.

With a 16 year history of exposure to these drugs i would like to tell you that a CT is not something you want to experience, the suffering will be unimaginable. Withdrawal is known to rip jobs off people.

 

I know that it is hellish, but part of me just wants to go through hell for a few weeks rather than small portions of anguish slowly over the course of years. I know it doesn't really work that way, intellectually. If it did, though, I would be all over that.

My guess is a CT wont be hellish for a few weeks only. It could well be hellish for years.

Many cant endure the withdrawal from a CT,  and so end up being put back on drugs to relieve the withdrawal symptoms.

 

 

Regarding the SERT diagram.

Here's my take on it.

The SERT study (and its diagrams) is not about tapering per se. However it does provide a validation for the tapering regimen that is recommended on this site. And what people have found to provide the best chance of getting of these drugs and staying off.

10% of the previous dose per month tracks according to a decreasing geometric progression and provides a very close approximation to the SERT graphs. (a kind of  logrithmic curve only we are travelling in reverse direction) Which is what the mid section of these graphs follow.

Recall: Abrupt changes in serotonin levels is what can trigger suicidal and homicidal ideations.

So we do not want to taper in a manner that triggers abrupt changes in serotonin levels.

 

Note: The graph does not follow an arithmetic progression ie a straight line trajectory. 

Hence inferring the safest way to taper and the way to follow the graphs is to make each drop smaller than the previous drop. (Done by making each successive dose a % of the previous dose, each successive drop will be smaller)

This has proven the best way to get off the drugs. It allows the brain time to adjust to a smaller dose and remain stable.

 

Note also how critical it is at lower doses ...the serotonin occupancy is very dose sensitive at lower levels ie at lower dose levels small changes have big effects unlike at large doses there is not so much of a change. Perhaps because there is an over-saturation of the drug.

This is why many people can get from 60 to 20 say without too much trouble but struggle to go lower after that.

 

Similarly you appear to have gotten from 200 to 100 okay (emphasis on 'appear to' as wdl symptoms can be delayed and we dont know what may be currently in the pipeline) but sooner or later if you don't slow down you will crash heavily.

In other words the lower you go the slower you must go. Following a straight line trajectory may eventually cause you to fall off a cliff.

 

Online support groups such as this have found that 10% of previous dose (not the original dose)  is the best way to taper and minimize withdrawal symptoms. Some may be able to go faster some have to go even slower.

 

My long pontification can be summed up in one sentence:

Alto: We show the receptor occupancy curve in reverse to suggest you have to come off the drugs slowly to match the curve and avoid causing a precipitous slide towards the end.

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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Welcome, Otter.

 

Thanks, scallywag, I was just about to point Otter in the direction of the Journals forum. We have the El-Mallakh paper and commentary, as well as Andrews, 2011 Blue again: Perturbational effects of antidepressants,,.. and others.

 

Please note "tardive dysphoria" is a term El-Mallakh invented and his paper was published in Medical Hypotheses. However, he has done the world a service by documenting his observations and guesses.

 

It sounds to me, though, that you are talking about tachyphylaxis or tolerance (aka poop-out).

 

What is your current daily symptom pattern? It sounds like some symptoms started when you went off gabapentin, is that correct? What are they?

 

 

I thought I had already replied....ah well. I started a long, terrible slide into depression again around sept./oct. of last year - when I finally relented and started seeing the psych clinic at my university hospital. That was when the trial of adding various thing began. The gabapentin was added by a fill in psychiatrist (my psych was frequently unavailable) who thought it might help with my PTSD flashbacks.

 

My daily symptom pattern varies according to what I am experiencing at the time. I had a pretty chill weekend. Today has been a mess for a variety of reasons and I can't stop crying. However, I hesitate to attribute this to w/d. 

 

1. My partner who is a sometimes functioning alcoholic woke up at 11pm last night to grouse about the fact that the toddler took a late nap and was still up. Then he woke up and continued his tirade as well as some additional things he was unhappy about and left for work. 

2. This was followed by a conference call at 11am that also went disastrously because the funding agency that encouraged the grant proposal is now currently in administrative chaos and no one knows what the hell is going on

3. I received a nasty email from my dissertation committee chair threatening a negative evaluation for my fellowship committee because I haven't been able to update a systematic lit review sample with 2 years worth of data, rewrite the manuscript and update the figures and tables in 3 weeks. Which is kind of an unrealistic expectation even if you don't consider that I have been in a super challenging 5 week theoretical model seminar that just ended. 

 

I wonder if my rumination wouldn't be as significant if I was still taking the doses I was previously, but I felt just about as miserable then. This is a series of bad things happening one after the other and logically I think anyone would be upset and unhappy about these multiple layers of obstacles.

 

I've still been able to be moderately functional - but I can't get myself to touch the lit review project. I made an appointment to speak with the grad program coordinator to discuss options tomorrow afternoon (either taking a leave of absence or finding a new mentor who has the capacity to be more supportive). So I am depressed and bummed but I am not defeated. Just feeling yuck. Existential crisis. Not sure if I could attribute this to SSRI withdrawal or not. The thing with my advisor isn't new (she is actually part of the reason I started back on SSRIs actually, haha. sigh). I recall when I started the doc program everyone looked at me like I was insane...like, your mentor is Dr. J?? 

 

She reminded me of my mother - very judgmental, narcissistic....I thought I could handle her. I've learned how to juggle my mom in my early 30s. But no, this was a terrible blind spot. I have a lot of those. 

 

Edited to add - this may very well be signs of progress and me moving out of a paralyzed state, since I've sort of passively accepted that I had to have her as my advisor. Maybe this is a good thing. Maybe I need to take action in order to move my career in a positive direction rather than spiraling into the depths of shame and self-doubt....all because I have a crap supervisor. Lord knows it wouldn't be the first time this happened. 

 

1999 - Wellbutrin 150 mg ~ 4 months - cold turkey withdrawal (adverse reaction)
2001-2002 - Lexapro 10mg, lorazepam 1mg - cold turkey withdrawal induced a 2 week subacute seizure cluster
2002-2006 - Clonazepam 1mg, Prozac 40mg
2007 - Added Abilify (adverse reaction - hand tremors) 
2007-2008 slow wean off everything
2014 - Zoloft/Sertraline 50mg, increased to 200mg over the course of a year. 
2015 - Added Atarax 50mg
2016 - Added Gabapentin/Neurontin 1200 mg

June 2016: Rapid Gabapentin wean, rapid sertraline taper 200 - 100 mg

Current meds: 100mg/day of sertraline, 50mg atarax. 0.25mg klonazepam as needed (usually every other day or two)

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  • Administrator

It sounds to me like your "depression" may be situational, in reaction to relationship and life stresses.

 

Drugs cannot completely compensate for this, although they do make some people numb enough to tolerate such distress.

 

Please keep daily notes on paper about your symptom pattern, when you take your drugs, and their dosages.

 

Frequent use of Klonopin can cause reactions such as "depression," anxiety, and sleeplessness. Hydroxyzine can also have paradoxical effects.

 

http://primarypsychiatry.com/managing-side-effects-of-anxiolytics/

 
Hydroxyzine

Hydroxyzine is an antihistamine that has FDA approval for the treatment of anxiety. Several placebo-controlled clinical trials reported that hydroxyzine at dosages between 25 and 50 mg/day decreased anxiety symptoms in patients with GAD,57-59 but the overall anxiolytic effect was modest at best. For example, only approximately 40% of the patients responded to treatment in two of the studies.57,58 The most frequently reported side effect is sedation, which occurs in approximately 33% of patients, but this effect is generally transient.57,59 Other reported side effects include colitis, depression, agitation,59 weight gain, dry mouth, loss of concentration, and insomnia.58

 

Although hydroxyzine has fewer cholinergic effects than the other classic antihistamines, precaution should be taken when administering to the elderly, who are more prone to anticholinergic side effects such as impaired cognitive function, confusion, blurred vision, and urinary retention.60 Clearance of the drug is also significantly impaired in the elderly60 and in patients with hepatic dysfunction.61 Hydroxyzine is metabolized by the liver to an active metabolite, cetirizine, which is subsequently excreted by the kidney in unchanged forms.61 The drug can be taken once or twice a day as the elimination half-life is approximately 20 hours for the parent compound and 11.4 hours for the active metabolite.60

 

 

 

As oops44 so helpfully contributed, drug-drug interactions may also cause you to feel incapable.

 

Daily notes will help determine if this is a factor.

 

Given you are having such difficulty with your dissertation, work, and home life, this may not be the best time to taper off sertraline.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment

It sounds to me like your "depression" may be situational, in reaction to relationship and life stresses.

 

Drugs cannot completely compensate for this, although they do make some people numb enough to tolerate such distress.

 

Please keep daily notes on paper about your symptom pattern, when you take your drugs, and their dosages.

 

Frequent use of Klonopin can cause reactions such as "depression," anxiety, and sleeplessness. Hydroxyzine can also have paradoxical effects. 

 

 

 

 

As oops44 so helpfully contributed, drug-drug interactions may also cause you to feel incapable.

 

Daily notes will help determine if this is a factor.

 

Given you are having such difficulty with your dissertation, work, and home life, this may not be the best time to taper off sertraline.

 

I am aware of the paradoxical effects related to clonazepam, but of course due to this precaution I don't take it every day. 

 

I suppose you're right. I was hoping to taper off the sertraline because it isn't really doing anything, but I suppose if tapering off of it would actually make me feel worse, then it's clearly not advisable.

 

What a horrible drug. I wish I hadn't ever agreed to go on it. In the long run it had no benefit, and now I can't get off the damn drug without feeling even worse. So I'm stuck taking a medication that doesn't benefit me in any way. It's just the worst. 

 

Thanks for the help. I suppose I will return to the forum when I am at a more appropriate stage.

 

The irony of reaching out for help when everyone says you should and finding that there is actually none to be had. 

1999 - Wellbutrin 150 mg ~ 4 months - cold turkey withdrawal (adverse reaction)
2001-2002 - Lexapro 10mg, lorazepam 1mg - cold turkey withdrawal induced a 2 week subacute seizure cluster
2002-2006 - Clonazepam 1mg, Prozac 40mg
2007 - Added Abilify (adverse reaction - hand tremors) 
2007-2008 slow wean off everything
2014 - Zoloft/Sertraline 50mg, increased to 200mg over the course of a year. 
2015 - Added Atarax 50mg
2016 - Added Gabapentin/Neurontin 1200 mg

June 2016: Rapid Gabapentin wean, rapid sertraline taper 200 - 100 mg

Current meds: 100mg/day of sertraline, 50mg atarax. 0.25mg klonazepam as needed (usually every other day or two)

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Don't leave Otter im enjoying your presence on this forum.

Feel free to update any time whatever you decide.

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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  • Moderator Emeritus

Otter, in Lakelander82's thread you wrote:
 

Someone suffering from chemical imbalances due to their physiology cannot morph their brain into having the physiology of a non-depressed brain. Therefore, it's not really a realistic expectation for a depressed individual to take or taper off antidepressans and suddenly have a non-depressed brain.

This is probably why talk therapy + medication is so much more effective than medication alone - you literally train your brain how to reframe perceptions so that they are less difficult to process and don't lead to the same sense of learned helplessness that you see in someone with paralyzing depression.


Your point about talk therapy is a good one. I realize you've only mentioned the chemical imbalance hypothesis but thought you should know that SA has a rule against promoting it. From the topic, "What will get you warned or banned."
 

The "chemical imbalance" or "serotonin deficiency" theories for mood disorders, which were in vogue for about 20 years, have been disavowed by medicine. There never was any basis for this. If a doctor tells you that is the reason for your distress, the doctor is wrong, misinformed, or not being straightforward with you.

This is also true of alternative or "natural" practitioners. The "chemical imbalance" theory is invalid wherever it pops up.

The "chemical imbalance" theory or its variants does not bear discussing any more than does a theory that says the sun revolves around the earth. It is a waste of time. This site will not add to the dissemination of this misinformation. Expect credulous discussion of such to be discouraged on this site.

See Again, chemical imbalance is a myth. Stop the lies, please. and Ronald Pies says doctors tell patients the "chemical imbalance" lie as a favor

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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Otter

Question: What chemical do you think is in imbalance?

 

The chemical imbalance view point is a mass collective delusion within the medical profession and this delusion has flowed on into society fuelled by the pharmaceutical marketing departments and it has reaped staggering rewards for them as a result.

 

Are you familiar with the reserpine study as done by Shepherd?

 

nz11

"The idea that there is an imbalance of serotonin in depression is completely mythical. It arose in the marketing department of SKB the maker of paxil." Healy 2013, Pharmageddon p 83

 

"The chemical imbalance theory is dead in the water, and its resuscitation seems an unlikely possibility." Kirsch 2010

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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  • ChessieCat changed the title to Otter: requisite introduction

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