Sertralinsomnia: Crash from Zoloft after 7 months

[scallywag]

Most people don't see improvement from reinstatement right away. It takes much longer than a few days ... think about a few weeks.

 

Peter, the best thing for a destablized CNS (central nervous system) giving off withdrawal symptoms is STABILITY. Skipping doses creates instability. We strongly urge people to take the same dose every day at as close to the same time as possible. We strongly urge people not to make sudden changes in dosage.

[Sertralinsomnia]

But in the reinstatement doc here in the forum says if bad reaction reduce or stop immediately. So i did, because the insomnia was unbearable last night i felt as my head was going to explode, and i freaked out, and only on 1mg. I am now afraid going in to 1 mg again, and thinking in going to 0.5

[scallywag]

There is no doctor here on the forum.

 

What is the bad reaction you're having?

[Sertralinsomnia]

I had suddenly a state of hyperalertness and constant tinitus. Like if the brain was about to explode, could not sleep a second all night. This happened in the 4 day of taking the low dose, in this case yesterday. My body wanted to rest but it was like the brain would not let it. Panic set in to. On the other side the sensation of electric shocks and head spinning has practically vanished. Today having involuntary movements on my feed fingers

[Sertralinsomnia]

Scallywag, I did not meant doctor but document.

If 1 mg zoloft had this effect on me i cannot imagine how will be the tapering only for this small ammount. I am also impressed on the brutal strength of only 1 tiny mg. Perhaps due to upregulation of receptors during the violent widthdrawal? It doesnt surprise me why this meds must be micro tapered.

[scallywag]

Adverse reactions *usually* start within hours of taking the dose, not days after.

 

To give us some data to confirm this, please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:
Take notes of doses and symptoms.

Post them here in your introduction for 2-3 days. Your notes may provide clues as to whether your symptoms are side-effects of the drugs or withdrawal symptoms.

[Sertralinsomnia]

Today i had a strange effect, this only started after the reinstatement, i felt this for two times now, the fellling of your entire body getting hot, hotfllahes do you know this side effect? is it common on ad? I heard this would be a widthtdawal symptom instead of side effect?

[scallywag]

Hot flashes and sudden short-lasting sweating episodes can be a withdrawal symptom. They can also be a side effect of medication.

 

How's your log of symptoms and doses going?

[Sertralinsomnia]

Its going well, i am noting every symptom during the day and night. The worst now is insomnia, i simply cant sleep, i hope it goes away while i am doing 0.5 mg zoloft, i am sticking with this dose. Is there anyone here on reinstating that had terrible insomnia at first but the subsided over time? I dont want to use sleep pills as i know they are all addictive too right? Or is is advisable to take any drug to aid sleep on short term if it becomes unbearable?

[scallywag]

When dealing with insomnia, the best place to start is with lifestyle and sleep habits.

• Are you getting any exercise? 30 minutes of gentle walking can make a big difference
• Are you taking any supplements? Some are stimulating and some are more relaxing. Please post what you're taking, if anything
• Then there's night-time habits and bedroom environment:

  Tips to help sleep.

Is your insomnia the type where you can't get to sleep? Or do you wake up and are then unable to return to sleep?

[Sertralinsomnia]

It is of the type i cant sleep. Like if my brain is overstimulated from the dose and together with a subtle tinitus. Today i did exacly that, i was all day doing walks for 2 to 3 hours. Lets see how i will do tonight. I have random thougths of stopping zoloft altogether. But i now, this will bring the problem of wd again. Im in a horrible loop now. For example, i remember when i slept well, before the crash on 23 January, i would feel automatically that sensation to fall asleep, now this is gone. I also lost my sneeze since then. Everything must be related to my CNS for certain.

[Sertralinsomnia]

Thank you very much for your answer, i appreciate it and this leaves me more confident on tapering.

[Sertralinsomnia]

Hello,

 

I would like to ask if there is someone here who got protracted withdrawal with a 7 or more month delay and then reinstated to the original med on a low dose, like 1-2 mg, stabilized, and tapered sucessfully after that?

 

Thank you all.

[scallywag]

Sertralinsomnia:  I've moved your question about a specific situation to your introduction thread. 

 

Because one of the purposes of the site is to provide information, we ask that you search for existing topics before starting a new one.  That way more related information is in the same place.

 

Here are the search results I obtained from a google search using the search terms:

protracted  site:survivingantidepressants.org

 

List of search results.

 

You'll find introductions of people who have a similar situation to yours.  Some will be members who haven't posted in months or several years.

[Happy2Heal]

Hello,

 

I would like to ask if there is someone here who got protracted withdrawal with a 7 or more month delay and then reinstated to the original med on a low dose, like 1-2 mg, stabilized, and tapered sucessfully after that?

 

Thank you all.

 

 

Hi I don't know if this will help, but I stopped my lexapro at 2.5mgs, got horrible WD symptoms 5 mos later, and reinstated at a VERY low dose (currently 0.29mgs) and over the course of the past 4 mos, my WD symptoms have steadily decreased.

I am going to wait to taper, so I will be at this dose for several months or more

Not sure that helps you, as I was not off the drug for 7 mos

[Sertralinsomnia]

Thank you very much Catnap. A most valuable and empowering information for me. Upon reinstating the symptoms are still there, panic sinks in when i start being hopeless. I hope this go away, even if i am a year holding. Your example shows me that is preferable to stay on the reinstating dose until symptoms free, even if it takes longer or the symptoms still linger. I also thought that updosing would help. but i think that would be a wrong move, because the brain will find a way to relieve or manage those symptoms with time. The reinstatement only helps the brain and us to do it more easily We must also do our job, not adding stressfull thinks in our life during this journey.

 

By the way did you sleep this last two days?

[Sertralinsomnia]

Thank you Scally, for the tip. I will do that. Sorry for starting new topic. 

[Sertralinsomnia]

I was wondering, i found that those pipettes used in labs, also available in digital electronic pipettes, measure micro liters of liquid and could be very useful in tapering, since these intruments are perfectly precise in measuring micro ammounts of liquid. I searched here and didnt find no one using this. Anybody thought about this? I guess the only problem is that this pipettes are very expensive?

[ChessieCat]

This topic may be helpful:  Using an oral syringe and other tapering techniques

[Sertralinsomnia]

Thank you ChassieCat.

[Sertralinsomnia]

Would like to ask a question. If someone who was on doses like 50 or 25 mg zoloft for many years or on doses this high of other SSRIs, after months of widhdrawal, and then reinstates to a micro dose, like 1 mg or less. If this so low dose reinstatement works and symptoms start to dissapear or get less frequent or more mild, what would explain how the CNS gets stabilized on such microdose and not tolerating higher doses or updosings? Is it that with such small dose the amount of serotonin needed for normal functioning of CNS is restores? During the widhtdrawal until the crash, perhaps the CNS could only repair some amount of receptors, but in some last stage, the CNS somehow could not repair or handle the remaining level of receptors needed to complete repair and crashed on this final stage?

 

Im a trying to find a reliable answer for why the CNS will recover only on a smallest micro dose, if this is the case, after all this destabilization and months of delayed protracted widhtdrawal.

 

Also why some people here after sucessfull wean off and jump, sooner or later are hit again?

 

Perhaps permanent damage and down regulation of ssri receptors?

 

For example, for someone who got for the first time in his life panic attack, but only on the crash day and never ever on his entire life, not even before ever starting a SSRI, would not the level of serotonin receptors being much less or non existant, due to extreme diwn regulation for years, explain this?

 

Is panic even a widhdrawal symptom? Or simply lack of serotonin receptors? I found some studies that link panic to low serotonin. Is it not downregulation due to many years of serotonin recaptation inhibition, instead of widhdrawal? wouldnt be this much more logical answer?

 

What are the possible answers for this?

[scallywag]

Sertralinsomnia -- there are few if any studies about low dose reinstatement because most research is done by the pharmaceutical companies who do not want to publicly acknowledge that people have difficulties discontinuing their products. They also provide the "training" and "reference materials" to medical professionals who believe that proper scientific studies back up these reference materials.

 

You are not likely to find a "reliable answer for why the CNS will recover only on a smallest micro dose" because the people with the money to do the studies do not care and have a strong profit incentive to do nothing to investigate impacts. Several if not most of your questions about withdrawal fall into this no-data-no-information gap. Pharma manufacturers are spending their considerable resources on conning doctors that these drugs are harmless and on expanding the number of conditions that can be "helped" by their drugs.

 

If you're interested in how this came to be please read the book Anatomy of an Epidemic, by Robert Whitaker. It describes the chicanery and scientific malpractice and data manipulation involved in how these each class of psychiatric drugs came to be so frequently prescribed.

[Sertralinsomnia]

This is bad news we are on a abandoned boat in the middle of the sea.

Scallywag, i found an article wish says in some people the receptors once downregulated never grow anymore being permanently disabled. The article, for my surprise even talks about this site and about Altostrata example, i will pu the relevant text here. Scallywag and Altostrata, did you knew about this article? What about the study the doctor of this article mentions, in the beginning of the part i am going to past here, about the permanent deactivation of receptors, what do you think about that? If its true and if anyone is lucky enough to recover from a reinstatement, the most wise choice is to stay on the dose forever. Here it goes, the url from the site is:

 

https://www.psychologytoday.com/blog/side-effects/201107/antidepressant-withdrawal-syndrome

 

 

Here is the relevant part:

 

 

Several receptors—including 5-HT1A—aren't especially malleable, moreover, and take longer to sprout anew after drug treatment ends, delaying the patient's return to neuronal health. Indeed, some studies I consulted found that in certain patients those receptors fail to grow back at all, in effect leaving the patients worse off than before. (See for instance "Dissociation of the Plasticity of 5-HT1A Sites and 5-HT Transporter Sites" in Paxil Research Studies 19.3 [1994], 311-15.)

 

As the proportion of SSRI-takers found to suffer from discontinuation syndrome is, by pharmacological standards, astronomical, and "one in ten Americans"—roughly 30 million people in the U.S. alone—"ingests" the drugs each year, as Peter Kramer noted only last week, it seems incredible that clinical trials have been so slow to recognize, and isolate for, withdrawal syndrome in patients trying to taper and end SSRI treatment. The number of people affected would, in any normal situation, drive a lot more targeted research on the problem.

 

However, while drug-companies have done their best to redefine withdrawal syndrome as relapse, to confuse doctors and patients into thinking the original depression or anxiety had returned, the good news is that research is starting to focus exclusively on the widespread problem of SSRI withdrawal syndrome.

 

Today, in her 7th year of recovery from severe Paxil withdrawal syndrome, "Kate"—also known as "Altostrata"—runs a website called "Surviving Antidepressants" that compiles research and data explicitly on the syndrome. She is still "hypersensitive to neuroactive medications," she reports, and recovering from severe setbacks 33 months after discontinuation, but with the help of a doctor who treats and has studied withdrawal syndrome, she is slowly recovering.

 

In addition to providing peer support for patients struggling to end their SSRI-treatment without massive, harmful problems, "Surviving Antidepressants" notifies readers of research-in-progress, including by Dr. Carlotta Belaise, a colleague of Fava's and a frequent co-author with him of scientific papers challenging the long-term use of antidepressants. While Dr. Fava's research recently has been publicized on sites such as The Daily Beast, Dr. Belaise, a research fellow in the Affective Disorders Program of the department of psychology at the University of Bologna, Italy, is collecting data on antidepressant withdrawal syndrome, "which," she writes, "we strongly believe is a very important, common and delicate clinical problem." (Update, October 19, 2012: the published results are summarized here.)

 

Precisely because of that delicacy, patients concerned about the drugs' adverse effects should NOT terminate their treatment abruptly, but should instead taper their dose very carefully and gradually, over a course of several months, always in consultation with their doctor, to ensure their own safety.

 

What follows is a list of links to articles (compiled by Altostrata for this blog), which those wanting to know more about SSRI withdrawal syndrome will find on "Surviving Antidepressants." The vast numbers of people suffering from this syndrome are very much in Altostrata's debt for helping to document this phenomenon and for giving it the medical attention it so clearly needs and deserves. The results of Dr. Belaise's study can be found just below. They indicate that 58% of the patients studied (7 out of 12) "reported persistent postwithdrawal symptoms: 3 of 3 paroxetine patients, 2 of 2 citalopram, 1 of 1 fluvoxamine, 1 of 3 escitalopram and none of both sertraline and fluoxetine patients."

[Sertralinsomnia]

here is another interesting study,

according to this paper a gradual recovery is observeable after 6 weeks, the autoreceptors could recover after months to Years and the benchmark seems to be 4 Years:

 

http://www.academia.edu/6087685/Antidepressant_Treatment_Reduces_Serotonin-1A_Autoreceptor_Binding_in_Major_Depressive_Disorder

 

Pasting only the relevant part:

 

cts who have never beenexposed to antidepressants, or not exposed for at least 4 years,have higher 5-HT

1A binding (BPF) compared with currentlyantidepressant-free subjects who have recently been treated with

antidepressants, suggesting that these receptors are downregu-lated and may take months or years off medication to revert tohigher levels again (13,14). Because the positron emission tomo-graphy (PET) radioligand used in these studies, WAY-100635, bindsequally to low- and high-agonist affinity receptor conformations,these findings suggest that downregulation of 5-HT1A receptors may be a therapeutically relevant effect of antidepressant treat-ment, independent but perhaps complementary to autoreceptor desensitization.We have found higher autoreceptor (and terminal field) 5-HT

1A receptor binding in two cohorts comprising subjects withmajor depressive disorder (MDD) who were antidepressant-naiveor who had not been medicated within 4 years, as well as a thirdgroup of medication-free MDD patients between episodes of major depression (13–15). On the basis of animal models andantidepressant exposure data in our previously scanned patients,we hypothesized that SSRI treatment would reduce raphe 5-HT1A autoreceptor binding in MDD. 5-HT1A binding was quantifiedusing PET and the radioligand [11C]-WAY-100635 before and afteran average 7 weeks treatment of DSM-IV diagnosed MDD withan SSRI.

[Sertralinsomnia]

This conversation is very important e crucial for us to make some decisions about tapering, because perhaps i suspect that widhtdrawal from the medication is one thing but another is changes that the medication made to our CNS due to desnsitization of 5HT1 receptors or downregulation. Is this downregulation, desensitization permanent? If so, is tapering worth it? How will we know?

If the case is, like the study i mention in my last post, that the permanent changes happens only in some people, can we risk to taper, and then be so unlucky and be one of that persons who cant regrow 5ht1 - receptors? Isnt it better you stay put? I am trying to be very carefull and want to see all options and evidences available.

[scallywag]

Please remember that a single study asks more questions than it answers.

[Butters]

Hi Peter

 

I was prescribed Zoloft for anxiety (50 mg daily).  Within one month my anxiety levels had dropped substantially - then disaster struck.  Gradually, over the following month, a zombie like feeling grew inside me.  I was often nauseous, my head was ringing, headaches, dizziness and lack of interest in life.  After one particularly bad weekend I went cold turkey and took myself off Zoloft. This was about a month ago. The last few weeks have been living hell.  Although the nausea subsided, a deep depression has set in which I have to fight daily.  I cry (or want to cry) almost every day.  I have bad dreams and sleeping problems.  I am constantly tired and have no energy.  The whole Zoloft experience has been a complete disaster for me.  But, thanks to sites like this, I realize that I'm not alone and gives me the determination to push through this. I feel a bit better when I "talk" to others about our shared experiences.

[ChessieCat]

Hi Butters and welcome to SA.

 

From what you have said it sounds like you are experiencing withdrawal symptoms for your cold turkey of Zoloft 4 weeks ago.  The only known way to bring symptoms to a bearable level is to reinstate as small amount of the drug.  About reinstating and stabilizing to reduce withdrawal symptoms

 

 

Please start an Intro topic for yourself we can support you and offer suggestions.  SA recommends a taper of no more than 10% of the previous dose followed by a hold of about 4 weeks to allow the brain to adjust to not getting as much of the drug.

 

introductions-and-updates at the top right, Start New Topic.

[Sertralinsomnia]

Hi Butters,

 

I appreciate very much your comment and i know what you are felling, trust me. I also tried to endure but the symptoms kept getting worst and i had to reinstate to a very small dose. I am now trying to decide if i will stay on it indefinitly or not, because i dont want to go trought this any more, and the tapering even if slow could bring this mess again, but everybody is different, and some can go free of this mess gradually, but we are playing the roulette here i think. In your case if you can handle it, try do handle, perhaps it can go away, if not, try to reinstate to a very small dose like 1 mg and wait at least 4 days. I felt improvement on the first days but had to find the minimial effective dose. In case you devide to reinstate, try yo ask your doctor or another one if he dont want to help, for the liquid form, it helps you to get this dosage with a 1 mg syringe, or use a digital weight instrument to measure 1 mg of the medicine and diluite it in water. There is instructions on how to do this in this forum.

 

I also cant believe your doctor started you with that dose, normally we want to start low to be safe.

 

I hope you can get trought this Butters, Chassiecat is already helping and is giving good recomendations. You are on the right track by following this forum. Hang in there, use all the weapons of knowledge from this forum and you will prevail.

[Sertralinsomnia]

Today i had some thoughts about the protracted widhtdrawal and reinstatements. I connected some expressions of recomendations on reinstating and the recovery and came up with something.

For example on the Autostrata recomendations about reinstatements there is a part where it says: "Do not attempt to taper again until you feel symptom-free, or at least until your withdrawal symptoms are mild and tolerable."

 

My idea here is that i only believe the first part of that sentence "Do not attempt to taper again until you feel symptom-free", the other part, "or at least until your withdrawal symptoms are mild and tolerable", i believe is a shoot in the dark. Why do i believe this?

 

Because if upon reinstatement we recovered a little bit from the worst symptoms, and even if they are tolerable, i dont believe it would be a good idea to drop if we still having symptoms, even if they are mild. Why do i think this?

 

Because if you having still symptoms on reinstatement period, its because the CNS still needs more time to readapt, i still needs time to compensate for those remaing symptoms. It could mean that the CNS is still unable to produce its own serotonin to relieve those remaining symptomps or at least the intensity of them.

 

If you think carefully and look back to the time where we crashed with the protracted widthdrawal, the crash happened because the CNS could not deliver the serotonin needed to compensate those symptoms of crash and therefore crashed. And for some people, they realize that upon reinstating with a small dose, the symptoms get gradually relieved or reduce in intensity. If so, that means, that even with some of the symptoms lingering, the CNS has now time to figure out what to do to somehow rebuild the specific serotonin system for calming down and elminating the remaining symptoms. But if we just drop only because we are tolerating the symptoms and not wait until they are vanished that would be a premature move.

 

Why is that? Because if you still have symptoms, even mild, its because the CNS still hasnt found a way to deal completly with them. That explains why most people who doesnt reinstate at all, after a crash, only get a partial or full recovery after 4 years or more. Because CNS really need lots of time to rebuild the serotonin system to its original state.

 

But a good thing in the reinstatement, is in fact, that you are , in my opinion, in the same boat as someaone who never reinstated, in the sense that you are still having the symptoms, but with one crucial difference, it allows you to tolerate more easily this symptoms, allowing you to do your normal day activities, and allows the CNS to recover has it would without reinstatement.

 

The fact that the symptoms were reduced by reinstatement its a proof that the CNS could still not deliver serotonin on its own to some parts of the brain and therefore entered in a state of chaos. But now, after reinstatement, you still may feel the same symptoms but they are more mild as time goes by, and why is that? My belief is that now you are having help, yes, that´s it, you are having help from the serotonin being incremented a little bit by the reinstatement. But help does not mean its over, it only means that the reinstatement is delivering the missing serotonin to the brain receptors needed, but not all the needed serotonin. The "whole package" i mean. And this is the part after the reinstatement where you still feel symptoms, but they are not so intense.

 

The other part, for the symptoms to completly dissapear, this is the part that the CNS needs to figure out, and i believe it will, like it does when there was not even a reinstatement, except that it will be harder to bare and take more time, months or years. In reinstatement case, it could also take months or years, but at least, you can tolerate them symptoms. So if you in this stage begin to taper, you are in fact forcing your CNS to take a step forward, when the step before wasnt still completed. And step by step of droping with the mild sympmtoms, not waiting for the CNS to deal with them completely, will lead almost for sure to a crash.

 

So, i my case, i will follow this idea, yes. And i feel more secure with it. The fact that symptoms are more milder upon reinstating is good news in it self, now i have to give time to the CNS to fully adapt and start build the process needed for the remaining serotonin needed to resolve all the symptoms. When it does, it is a good go to begin tapering slowly. And when you do this carefull step more securelly this time, you will have to hold until the symptoms appear again, they will, but not when we want. In my case i only had a crash seven months after incorrect taper. In between i felt the sypmtoms, but never tought it was from widthdrawal.  Does this mean that on each drop i need to wait 7 months to be certain that with this drop i will be fine? If it takes that time, i am willing to wait, because the CNS deceived me and delivered me a great crash only 7 month after, and during that seven months the CNS was playing with me with what we call "mild and tolerable" symptoms, and then BANG.

 

So in conclusion, i will only have secure confidence in tapering or droping until i am symptom completly free for at least 3-5 months. Of course, everybody is different, and each one has to calculate his own hold based on the period that the CNS took to surprise you with a full blown crash. This could take months, years. But wouldnt it take the same time if we were recovering without reinstatement at all? Of course. But at least i can live with it, giving a splint (reinstatement) to my broken bone (CNS), until it is healed.

[Sertralinsomnia]

Felt a brain zap today after 11 days of steady dose of 0.5. Is it side effects or widhtrawal? I am confused

[Sertralinsomnia]

Is there anyone here who reinstated at a low dose and eventually recovered from insomnia?

[AliG]

 There are a lot of success stories. It's up to you what you believe. I have always chosen to believe that healing happens . I recovered from long term insomnia without drugs . It is the best way to naturally heal. Drugs are not the answer for long term success but I'm sure there are those who have recovered their sleep after reinstating.

 

Sleep problems - that awful withdrawal insomnia

 

Ali

[Sertralinsomnia]

I understand. But now i am in a reinstatement phase, and that is why i am asking it.

[Sertralinsomnia]

Hi all,

 

Currently i am taking a probiotic called saccharomyces boulardii 250 mg 2 times a day. Saw some sites that say probiotics can actually increase serotonin in blood.

 

Alto mentions in the Trazodone post here http://survivingantidepressants.org/index.php?/topic/2883-tips-for-tapering-off-trazodone-desyrel/that the "But even an increased serotonin level of serotonin in the bloodstream can be dangerous"

 

Does this mean i can have a serious reaction from to much serotonin if the propbiotics increase serotonin in blood?

 

By the way the link to the danger Alto mentions is not on the forum anymore.

[PoetJester]

Hi Peter,

 

I saw that you had posted on my intro thread. Sorry, I haven't gotten back to you sooner, but I haven't been doing too well lately. I have started taking wormwood capsules in the past week and am flushing out all sorts of roundworms and larva so there is a little hope for me. I started developing a bloated stomach and constant constipation and fecal breath last year which are signs of intestinal parasites, and the wormwood is starting to help clear a lot of it up including my awful fatigue, but my sleep is still pretty poor.

 

You had mentioned on my thread that I was giving advice about reinstatement while being in protracted wd myself, which is true. This is actually my 3rd or 4th withdrawal. I originally withdrew from Zoloft and zyprexa in late 2003 for a couple of months and was hospitalized and reinstated and was doing much better for a year or so. I withdrew cold turkey again in 2005 for a year and a later forced reinstatement caused me to develop hypersomnia and fatigue where I would sleep 12-20 hours a day and hardly ever got off my couch and rarely ever left my apartment for 8 years. this last wd, I was 1 1/2 years into it before I finally got internet service for the first time and found SA. I didn't really know about any of the tapering theories and so I just quit the pills cold turkey. I am not sure that a 3rd or 4th reinstatement would work for me, but it might. I think about it quite a bit and even went to my doctor who would only prescribe trazadone (which I haven't taken). I would have to set something up with a psychiatrist to get anything else prescribed and it's a bit of a process although I may try, just to see if I can stabilize my sleep and have non depressed dreams again. (reinstatement has ended all these vivid depressed dreaming in the past for me)

 

Has your micro reinstatement gotten any better or did you decide to give up the 1 mg of Zoloft? The insomnia didn't sound very good although a lot of us go through it for quite some time after going into wd. On one of the stories I had mentioned before on your thread about a younger guy who had quit Zoloft after 6 years. When he reinstated Zoloft after 8 months or so, he had an adverse reaction after one day and ended up in the ER. He later reinstated with Effexor and after a couple rough weeks adjusting, is doing well again.

 

Basically, to get back to the question you had for me on my thread, I have had a successful reinstatement in the past, but am now back in wd again and am now just trying to offer advice on the reinstatement option (when I even have the energy) to those in wd now, possibly for the first time, before they languish with these miserable wd symptoms for too long.

 

poetjester