India: withdrawal (dissociation) after 9 years on citalopram

[jozeff]

Hi India,

 

Sorry to hear that you are not feeling great. Did you have too many input in London perhaps. Busy, having fun and then boom....wave coming in. 

That is so frustrating. Are you doing breathing exercises? Those can really be helpful. I bet tomorrow you'll be fine again. Every day is a new chance,!

 

The brain rebalances and you have some new energy a window is coming your way, no doubt. The chances you'll be feeling like this forever are close to zero!!

 

Stay calm. I panicked too today and I'm still alive and pretty ok. You'll be ok too tonight. Tough it out for some time and regain strength,! You can do it!!

 

Cheers

 

Jozeff

 

 

[India]

Thursday 11th September 

7am awoke anxiety 3/10, /dr=7/10

Brain  fog 5/19

8am m: took meds 

brain fog 6/10

9:00am DR 3/10

11:00am DR 2/10

12:00pm lunch of green juice dr at 2/10

12:30-1:30 long walk home from hospital 

1:30pm vacuuming 

2pm Shopping 

Memory issues worsen 7/10

3pm DR hits again 9/10

4pm i eat meal of healthy food 

5:30pm herbal kalms pill

6 pm anxiety 9/10 on return of stressful tenant 10/10 DR 

7pm-9pm

anxiety attacks 9/10 DS 8/10 DR 9/10 warm arms legs, palpitations, tingling , faintness, feeling weak and collapsed 

calm down. I lie down start listening to meditations. Eat nuts and kefir 

11:30pm DR reduces dramatically whilst watching tv show now 2/10 again  . Chronic pain high though probably unrelated. 

 

 

 

[India]

14 hours ago, jozeff said:

Sorry to hear that you are not feeling great. Did you have too many input in London perhaps. Busy, having fun and then boom....wave coming in. 

That is so frustrating. Are you doing breathing exercises? Those can really be helpful. I bet tomorrow you'll be fine again. Every day is a new chance,!

@jozeff Yes, this is exactly what it was I feel. I came from bed rest in the country to full-on London sensory overload. I am now suffering from heavy achy limbs  and exhaustion in a way I have not before. I am doing the breathing exercises...sometimes I find my muscles involuntarily contract and I can't get breath into the abdomen, because I am using accessory  muscles to breathe. How do you find the breathing exercises work for you? I find they work about 70% of the time.

'Everyday is a  new chance'. This is also a chapter in my mindfulness book given as a gift from my mum. I consider it synchronicity that you have mentioned it again. It is a beautiful phrase.

 

I woke up this morning rested and with only 1/10 derealization. I walked to the doctors and felt real again so I would rate DR as around 1/10 ( but who knows maybe this is relative to the intense DR I have been experiencing and, in time, i will experience clearer states). Despite the fact that I have new symptoms ( heavy legs, feeling a little faint, feeling extremely weak and exhausted) I felt a huge surge of relief. I  must celebrate this, i must feel gratitude for this! I tried not to project forward or backwards. @ButterflyHope said that she had to learn that the drugs were stronger than her, despite her desire to refute this. I share this feeling. paradoxically, I think you can gain more control by giving up this resistance. Of course, I still have to dialogue with my mind, which wants to say, yes, you feel real but what about life slipping away. @ButterflyHope , your comments on recovery, which I want to respond to on your page, were inspiring. Letting go of that concept of temporality, that life is linear and there is a boat to catch, and if you fall off that boat then you are left behind, cast adrift. Maybe instead life can be seen like the classic tale of the hare and the tortoise.

 

At the doctors, the dissociation was bad 7/10, DR was 6/10. I felt extremely weak 7/10 and my heart feels weak. This feeling has continued after taking my medication at 10:20, the earliest I could because of the doctor.

The doctor said that 'discontinuation syndrome' only lasted 6 weeks but agreed to memory test and he said he would educate himself on the topic when I mentioned FAVA's study (University of Bologna). I was having neurological symptoms but so far tests have revealed very little so I am wondering if theses symptoms occurred off the back of the year that I reduced from 20mg to 10mg. I will fill in my diary at the end of the day, once I have collated all symptoms. Memory has been testing but I keep saying to myself "My memory is healing and improving", Oliver James calls it doing a sales job on yourself but it seems to be working ( at times).

 

Thank you @Jozeff, to read your parallel experiences is extremely comforting and motivating. A consolation. How are you doing today?

14 hours ago, jozeff said:

The brain rebalances and you have some new energy a window is coming your way, no doubt. The chances you'll be feeling like this forever are close to zero!!

I held onto this, this morning, it is a sign we are regenerating. People's symptoms follow such similar patterns that is seems unbelievable that many in the medical community are in denial about this. Fortunately, my parents now believe in it ( though they do believe, as I do, that psychological components exacerbate the WD), my therapist and a few friends ( it's taken a while and some are more convinced than others).  The good news is, like you say, the windows and waves can be framed as healing. This is surely the hardest, most testing part, to experience these extreme symptoms without context, which leaves one so so vulnerable. When I experienced my first window, I thought with wishful thinking, here it is, it is here to stay, but it really does follow that pattern.

 

 

[India]

https://bryonysmadworld.telegraph.co.uk/e/scarlett-curtis/

 

This is not about withdrawal but it is about her pain being misdiagnosed by the medical community and her subsequent development of PTSD. It's a positive piece, as she finds healing in the end.

[jozeff]

Hi India,

 

Are you still in London? 

 

Being in a different place can be very disrupting. You know you should be having fun but also you have a different environment and a lot is coming your way. The subway, the people, public places, traffic, different bed..... These can all attribute to feeling uncomfortable. Of course it's fun and you're on a trip but still.

 

You have learnt to cope with your symptoms when you're at home. 

 

I went camping a few weeks ago with my six year old boy. We were like  a 100 miles from home. It's the first time we were together a few days without mom.

It had to be fun!

 

My son was looking forward to it so much. I started panicking at home because I wanted it all to succeed. This raised the bar and while driving to our camping place I started having this very sad feeling and kind of a panic attack.

 

It was pouring rain whem we arrived... We had to set up the tent and of course a six-year-old starts playing immediately. I had to make it work and we wanted to eat something but we were in the middle of nowhere. 

 

Next day we had to get up early to visit a cave I had tickets for. That's where I had a major panic attack. Busy crowds there and a long waiting line. My heart was racing like a madman. 

 

I started thinking......

-What if this panic attack continues in the cave?

-what if I throw up and I have to stay with the group of people in the cave.

-what if I get a heart attack?

 

Maybe irrational but I felt it!!

 

We walked into the cave and I kept talking to my son who was completely relaxed btw. Taking pictures. After half an hour my panic started to fade and I relaxed. I started to laugh and I was amazed by the beauty of the cave.

 

That night in the tent we were laughing having a drink and playing cards and I was 100% relaxed. Next day panic and nausea again. This time in a playground of all places... What if this happens all again??? Later, in my car again, driving back I relaxed suddenly.

 

When we arrived home after a few days I was suddenly very relaxed. We watched the pictures we took and laughed about our adventure. I updosed my citalopram immediately because I thought that was gonna help me. This panick attack never again .

This made me nauseaus and down again a few days later.....

 

What I want to say is this. This uncomfort and all these symptoms are not 100% caused by the absence of some medication.

 

Every thought in your brain is a chemical  or a physical reaction!

 

The interaction between your environment and your inner self is always present. Sometimes it has a lot of influence and sometimes it does not. Why, I don't know.

 

Don't blame yourself for feeling weak, tired, nauseous, anxious or whatever.

 

These are all chemical or physical phenomena in your brain and they won't last forever. It's very uncomfortable that's for sure but these things will never last. Your brain just doesn't tolerate it. You can't cry for three weeks because someone died. Your brain protects you.

 

Are you depressed or do you feel depressed?

That's what someone asked me a few months ago.

I said : I am depressed.

He said: do you feel depressed all the time? 

I said: no!

He said :do you feel depressed right now?

I said: no, because I'm talking to you right now.....

 

He said: then you ARE not depressed but you feel depressed sometimes and what you feel can be changed!!

 

Think about it. Don't feel lousy because you panicked in London? That is not you, that is just a moment in time.

 

 

Have a nice day

 

Cheers

 

Jozeff

 

 

 

 

[India]

Friday 12th October  

7am

awoke anxiety 4/10, ds/dr=3/10

Doctor 9am  DR 7/10 DS 8/10

took meds at 10:30am

fuzzy head 3/10

fatigue 8/10 

bed rest/lunch  11-12:30 dr 7/10

house viewing 1pm

ds/dr 8/10

anxiety 4/10

returned home with exhaustion 

4pm - therapy central london 

dr 7/10 but glad to be in therapist office 

sat in park before getting on tube fatigue 8/10

DR 9/10

Home at 7:30pm. Ate 

bed rest from 8pm fatigue and heavy limbs/ new fluey feeling ( started when walking to doctor's) 8/10

1:30am finally feel asleep watching laptop despite exhaustion all evening . 

Took herbal sleep aid. 

 

 

[India]

On 10/13/2018 at 10:09 AM, jozeff said:

Are you still in London? 

Hello   @jozeff I have lived in London since the early 2000s. My family's home is in a different part of the country, in the countryside. I have been spending time there due to my difficulties. In London, I am rent a place which I share with co tenants ( I am the unofficial manager which is a headache in itself). I am shifting between the two at the moment. My life was always here. I now have a new therapist in London, whom I see twice a week. I agree with you that transition can be disruptive and bring on symptoms. Depending on the change, because sometimes, getting out of my house into a park, or my trip to France when swimming in the sea, or seeing a friend that understands as I did yesterday can give me a sense of muted joy below all the brain fog and other symptoms. Cognitive tasks cause me much stress, they feed into my fear of a collapsing identity, since much of identity for me centres on what I can do, which then places me in the world. If I can now barely carry out tasks on computers, or read, etc.. what does this mean for my place in the world? I think it is hard to extricate ourselves from our intellectual capacities. I suppose Matisse achieved a certain shift with his cut outs. I have never responded well to my blocks and therefore, this is all the more testing for me to be going through this.

 

Today I am left with a increasing sense of anger at a system that has being brazenly allowed to harm. I can understand if it were a new phenomenon and that effects could not be predicted but I feel the sense of injustice that an undeniable body of evidence in the form of patient experience is being completely cast aside. It is the lack of balance, the lack of regulation, and the denial of the medical establishment that we are all up against. That is unfathomable to me. It's true, I was never forced to take these drugs, and a partly blame myself for not having thoroughly researched before ingestion, though I was indoctrinated quite young with the imbalance theory. At 16, I was prescribed Paroxetine or Paxil, luckily I only took it for some weeks, and decided that it was utterly useless. Thank god for that, I at least gave my brain a break until the age of 19 when a well meaning doctor prescribed me , in her words, "an amazing new safe drug, that has very little side effects", that was 2002. I came off it CT in 2005 without any withdrawal symptoms, my motivation was the severe stomach issues I developed whilst travelling.I was in a good place in my life at that time, young, fit and healthy. I would be put on Prozac, in the early autumn of 2007, after a bad breakup in which I developed a severe depression. Oh, to go back and commune with my younger self. However, I felt pretty invinciable at that time and didn't believe I would experience withdrawal. I took Diazepam on and off and had no severe WD so I don't know if the literature at that time would have affected me. However, I suspect the risk of neurological symptoms may have stopped me. I definitely wasn't presented with of the risks of the medications. I was later put on Mirtazipine by a very detatched, aloof, older psychiatrist. I put on so much weight ( I am very slim and never put weight on) but was very lucky to have mad the transit back to Citalopram and lose it all. Still, in the midst of a very traumatic time in my life, it is hard on reflection to extract what was ptsd and what symptoms were the meds. I was drinking at time which was providing a sedative effect.

 

On transiting to Citalopram ( not before an adverse reaction to Escitalopram that made me manic- I spent only a week on it). None of these symptoms were anything like what I experienced this time around. In the back of my mind, a little voice has always been saying... quick fixes don't exist, you can't go on like this forever, you are putting off the inevitable and creating a dependency. Logically, you are creating a deficit with long-term use of  psychotropic drugs. Why would ssri's be any different? but I think I so absorbed the pharma biomedical model messages that have pervaded culture since the late 90s ( having read 'prozac nation' by Elizabeth Wurtzel in which in many ways has a quite evangelical message about how the drugs saved her life. Fast forward to her 'More Now Again', in which she develops a severe addiction off the back of ritalin prescription) that somewhere subliminally I was buying into the idea they were safe because I needed to believe that. On the contra- extreme, once I decided they were poisons I wanted to oust from my body, I impulsively set about getting them out as quickly as possible and hence the cascade of extreme symptoms which have been so utterly traumatising I wonder how I have survived??? So now I must tread somewhere in the middle, sensibly as possible, harm reduction being the operative concept. Parts of my psyche still find it hard to accept that this drug has floored me, since I am attracted to the idea that you can will yourself out of anything with enough strength of mind. On other levels, I know this not to be entirely true, though attractive the idea that we have absolute agency, no human being does have absolute agency. Still, I suppose it is a protective mechanism, and one which can work quite well in times of distress ( nods to Buddhism, Law of Attraction). I suppose you can argue you have absolute agency over your response to things, but even that could be deconstructed. When I am distressed I have to cling to more spiritual outlooks because in those moments, my critical mind does not help my healing. I always find this to be a conflict within myself. I can see how life would be more simple if I could be absolutely religious.

 

I digress, 

On 10/13/2018 at 10:09 AM, jozeff said:

My son was looking forward to it so much. I started panicking at home because I wanted it all to succeed. This raised the bar and while driving to our camping place I started having this very sad feeling and kind of a panic attack.

 

It was pouring rain whem we arrived... We had to set up the tent and of course a six-year-old starts playing immediately. I had to make it work and we wanted to eat something but we were in the middle of nowhere. 

 

Next day we had to get up early to visit a cave I had tickets for. That's where I had a major panic attack. Busy crowds there and a long waiting line. My heart was racing like a madman. 

 

I started thinking......

-What if this panic attack continues in the cave?

-what if I throw up and I have to stay with the group of people in the cave.

-what if I get a heart attack?

 

Maybe irrational but I felt it!!

 

This is incredibly brave to have done this. From my perspective you have achieved and perhaps could frame this as bravery, and as a milestone, as a triumph. Of course, I will not know the exact state you describe, but I know the terror of panic, and have gone through many episodes like this. After my extreme two days before France, I kept repeating to myself, "You are so strong. If you can get through this, you can get through anything". Contextualising has helped, reaffirming logically statements from another part of myself has stopped me from truly losing the plot., even in great fear that it may not be true. I am sure someone well versed in philosophy and identity could dissect  that concept further. For me, the fear is always about loss of control and fear of humiliation, for a long time my panic manifested in the fear of losing control of my bladder. I think often the feeling of the panic gets concentrated into bodily mechanism ( for you it is the fear of throwing up that accompanies the panic), for me it's symbolic because it is also a fear of abjection, marginalisation, doing something that will cause being a social outcast. Still, these are all fears. We can so fear 'irrationality', yet everyone has these fears. I think psychiatry and the way society has viewed illogicality and 'madness' over the ages has permeated the collective conscious. I'm going off point.

 

I  think you have done an amazing job for your son. My view is that children do not need perfection. Obviously, parenting and what you choose to expose your children to is very personal. But as a child, and i know children are all different, but I was able to have a good time despite all sorts of drama going on. I could have fun in the simplest of environments. Even being in the rain was joy enough. Even if you had gotten sick, I think children mostly take it in their stride. After all, different emotional and physical states are a fact of life. I remember as a child being more curious than scared as long as it was presented of natural. I don't have my own children but have spent a lot time around other people's and actually I think it's very valuable for child to see models of how to deal with uncomfortable feelings. I think you did excellently, it is a lot to be taking on and you got through it.

 

I totally understand why you updosed. I remember reading that "quality of life" is the ultimate goal, the rate of taper should support this. The aim is to avoid a much pain and destabilisation as possible.

 

On 10/13/2018 at 10:09 AM, jozeff said:

What I want to say is this. This uncomfort and all these symptoms are not 100% caused by the absence of some medication.

 

Every thought in your brain is a chemical  or a physical reaction!

 

The interaction between your environment and your inner self is always present. Sometimes it has a lot of influence and sometimes it does not. Why, I don't know.

I absolutely love this and totally agree. There is a huge interplay. I am accepting my symptoms more at certain times and therefore, although testing, the fight and resistance is lessening. I think the changes are subtle. Everything in my instinct wants to fight it, I think this is sort of offshoot of the survival mechanism and in many ways it's gotten me through the worst. It's also stopped me from going to a psychiatrist. So far, my 6mg has failed to had any effect so I know there would be no point in updosing at this time.  I would updose if I knew it could stabilise me and then do the slow taper. I am quite traumatised by my own reaction to WD and the drug so far more wary now but I am trying not to get phobic as Dr. David Healy talks about. But the point is I am now trying to calm myself in relation to the symptoms,and not up my anxiety, which in itself will cause a reaction. They absolutely know that our psychological states affect healing, though not to disregard that many of the symptoms are so physical. It is quite  a mindfield but also one that has hope attached to it, that is the chance of adaptation. My ex was a lawyer, he was in an accident and sustained executive functioning issues due to a head injury, but he recovered and went back to work, there was a point where his lack of recall might have sunk his career but he healed. 

 

On 10/13/2018 at 10:09 AM, jozeff said:

what you feel can be changed!!

 

Yes, totally agree.

Even on this acid trip of a withdrawal my states are not fixed and immovable. There has been change. I guess we could all see ourselves on a heroes journey, like the myth of Orpheus.

 

How are you now? How has updosing been going?

 

 

[jozeff]

Hi India,

 

Just read your lung update. Interesting to hear your thoughts about all this.

 

I have little time right now because, believe it or not, I'm visiting a cave with my son and my mother today...... Hope I do not panic!!

 

My son and I are having a holiday week together.

 

You know, the chemical imbalance Theory has been intriguing me as well. I visited adaptor in 1999 for depressive feelings for the first time. He prescribed me venlafaxine. This stuff was amazing for me. I started feeling better in 3 weeks and this lasted for years. Because I felt so good I didn't need them anymore. Thank God I tapered myself,without reading anything, just because I thought that would be better. 3 years later I started Venlafaxine Again. This time it also worked and I stayed on for 2 years. I also tapered but not so slow. After suffering from alcoholism I was very nervous and agitated and decided to go back on venlafaxine again.

This time it didn't do much for me so I switched to citalopram. This was amazing in the first year but I played with my dose a bit too often.

In oktober 2017 I had my first major panic attack and have been struggling since. I decided to start a taper in April 2018 (0.1 mg per day). After 85 days I tapered 8.5 mg. That day I crashed hard. I was crippled with anxiety and wanted to crawl out of my body. I stayed at 16.5 mg for 6 weeks but updosed to 18 mg because I felt so awful. Since August 14th 2018 I am taking this dose. I want to start tapering soon but I don't know when I will be stable and what stable really means. I'm pretty scared to start tapering to be honest.

 

I was thinking about the Brass Monkey slide method 10% and at 3 week hold in between. 

 

That's going to take me years but hey, that's not a problem if it's doable right. Going faster and crashing again sounds a lot more evil. 

 

Sometimes I wonder if I still have problems caused by my tapering in April. I cannot believe this to be honest but everyone says this might very well be possible. Just imagine how powerful these drugs are.

 

Well, I have to get dressed now for my two hour drive to the cave....

 

I will let you know how it went

 

Have a nice day India and take care!!

 

 

 

Heal!!!!!

 

 

Jozeff

[India]

@Jozeff I had to have an MRI and I am claustrophobic. I created a visualisation and closed my eyes deep breathing. Perhaps something like this will help. Good luck. You can do it! 

The drugs are so f**king powerful! I think street drugs do not even compare. I mean think of pharamaceuticals fentanyl versus opium, and heroin (o.k, the lack of regulation is the dangerous; what these things are mixed with). I am not advocating street drug use but rather have friends (it's quite rife in  the art and music industry) who did a month in rehab and got off all the hard  street stuff with no PAWS and have transited into civilised living quite well. 

After our experiences, most people are terrified of WD, and dose changes.

 

[India]

Saturday 13th OCT 2018

Meds- 10:30am due to waking late ( though I first awake at 7am ..anxiety 2/10 no cortisol spikes anymore at 4am) . Had taken KALMS herbal sleep 1 pill. Dr4/10 which quickly rises to 6/10 . Brain fog after taking meds 6/10

Weakness/fatigue 6/10

11am-12am: Phone Therapy ( DR 6/10. Anxiety reduces to 1/10). *

 

*Note*Therapy helps stabilise me. However , underlying depression always there but I know I cannot 'go' there as I have to concentrate on staying strong for my withdrawal. I think since the 2 days of hell- I have become more frightened to allow myself to go into my darker spaces, which I used to not fear ( I have always felt a sense of catharsis and consolation in the melancholy. This has now reversed. I am comfortable with the suicidal thoughts, but there are other OCD thoughts I experienced on reintroduction to meds during my protracted withdrawal that I now fear. I want to work on these phobias when I feel stronger).

Sunny beautiful day-- I notice that grey days excacerbate my symptoms.

1pm-4pm Spent time with understanding friend having healthy lunch Salad and a coffee ( I have reintroduced coffee as an experiment, will this wake me up a bit' (I have been a one a day drinker of coffee for years and years- I have read about it's antioxidant effect and protective mechanisms).

DR still 6/10 but anxiety 1/10. Brain fog 5/10. Able to talk concepts but cannot assimilate new information when my friend starts to talk about different medical protocols, supplementation and gene differences, numerical and scientific information that I cannot retain ( working memory issues 8/10). Word recall is improving slightly as is vocabulary. I notice that my vocabulary has shrunk since severe withdrawal. I am making spelling mistakes that I have never made. LT memory 5/10, Executive Functioning issues 7/10 (improving slightly). Motor coordination issues improving slightly 6/10. Fatigue improves 4/10

5pm-late-- Resting in bed/ eat meal. Fatigue 5/10

11pm- Sleep

 

Sunday 14th Oct 2018

Awake at 7am, go back to sleep until 11:30am. Wake up with 5 mins of DR at 2/10 then it quickly kicks in after 5/10 mins to 6/10

(Rainy miserable day-- worsens symptoms)

11:30am Take meds

Brain fog comes on 6/10

I try to sort out my clothes which are currently in suitcases and vac pacs due to my trip to France. Executive functioning issues prevent me from being able to ..I cannot 'sort clothes in my mind', DR 7/10, Fatigue 6/10, Coordination issues 7/10. I focus very hard on remaining calm inspite of these symptoms. 

12noon eat healthy brunch of Kefir tumeric, Sourdough toast and aubergine dip. Small coffee (wakes me up briefly).

Rest

3pm-- walk in the park, I am able to jog a little in small increments but get tired easily. Still this is progress. Derealization is high 8/10. Brain fog/numbness 7/10

4pm . Resting, listening to podcasts, phone calls to family. I wonder when I will get my old mind back?

 

#Even with the ptsd, the body dysmorphia, the physical pain issues, the depression, I could read about sculpture, and literature and engage in culture and the world around me. Now I cannot think of those things, I can hardly tolerate memories from the past. I am looking for familiarity but there is no familiarity anywhere and so the darkness of my numb and blank mind can only look back at my life and choices and see them as meaningless and all a mistake ( I know that this is not me, I know my depression well and it does not feel like this). I have noticed that memories assault me, mixed up, past and present and I am recalling memories long forgot but all through this bizarre de-realized, brain fogged, zombified blankness. At times, I am screaming inside, "give me my mind back". The only thing that gets me through is the belief, that like a stroke or TMI survivor, the more I work and repeat tasks and do things that used to be familiar the more chance that I will find some of my old self, albeit, this experience will be assimilated into it. I think the reason it feels so shocking to the mind, body and soul, is that it's like you wake up oneday a different person. That's my experience of WD. Instead of a slow transition, I think in life, even when the trauma I experienced drastically changed me, there was still something of my old self left. This feels radically different. I am having to also train myself not to ruminate on this or I can feel very trapped, and terrified. I keep telling myself I am  strong and in the end the strength of getting through this will mean I can transform my feeling of powerlessness into a trust in my own powers of resilience. I try not to feel disheartened that getting through this will just put me back to where I started, but it's been said to me I can co-heal, that healing is healing and I can be healing the WD AND the trauma issues.

 

7pm- Make myself healthy food

8pm -- exhausted 6/10 lay in bed watching TV shows on laptop

DR is 6/10

Physical pain issues/tics 7/10 

Watching videos on Akathisia and tardive dyskenisia terrifies me and I convince myself I have it . I calm myself, I have definitely had issues with not being to sit still, needing to walk and walk and the tics, but I remind myself that even this goes up and down and is healable. I do not have to catastophize. I find my body dysmorphia can intersect with reality and I lose proportion, it tos and fros which excerbates the twitching. I do have tics and physical postural issues due to pain/anxiety but it's only when I point them out that others notice. I do realise now that the citalopram used to brig on mania and I would sway a lot, people would point it out. At that time, I was an exercise fanatic, so alot of it would be distilled into this. I now see this as a side effect of the drug. I also noticed it in a friend, so petite and tiny and they had her on 40mg of Citalopram, she looked like she was on speed one night.

11pm fall asleep in my clothes

Wake up at 2am to brush teeth and get myself ready for bed.

 

First night NO HERBAL remedies taken

 

Monday 15th October 2018

 

Awake at 7am anxiety 2/10 Depression5/10 DR 3/10 quickly rises to 6/10

Back to sleep 

awake at

11:20am Take meds

Brain fog 7/10, DR 7/10

Brunch 12:00.. listened to Jazz .Eggs, Avocado, Tumeric and Cardamon, Coconut Oil, Kefir Smoothie. Small coffee. wakes me up briefly DR 4/10

13:40 now- Writing Diary/

Brain fog= 6/10

Fatigue= 5/10

Depression 5/10 ( feel numb but some anaethetisation which I believe to be the meds).

I am fighting feelings of wanting to WAKE UP. Previously discuss a higher reinstatment or updose( back up to 10 mg) with my mum but not before waiting another few months for stabilisation to occur. At the same time, I don't want to prolong the taper process. I remind myself I have been playing around with doses and need to wait and see if I will stabilise on this 1.15ml which I only started on 8th October. Agree with my mum that updosing to 10mg is a risk ( though doctor's will tell you that anything below 10mg is not a therapeutic dose). If I knew it would stabilise me I would do it in a heartbeat since this has been like throwing a grenade into my life. My whole family are suffering. My confidence and sense of self shattering as I have to inhabit this non-functioning and needy/helpless role ( I have always hated dependency). I am once again so so so angry today at the lack of regulation and subsequent lack of knowledge/support in tapering from these drugs. . I would rather be addicted to heroin that these SSRIs.

 

I was reading an article on Deborah Orr's experience of SSRIs. There is doctor that appears in the comments. An avatar for the attitudes I have experienced in relation to my protracted withdrawal. You see him playing out on other's commentaries what plays out in surgeries every day. He challenges withdrawal experiences and directly suggests the commentator mental health is the problem, "I am worried about you, you do not seem well". The poster retorts, saying he is of sound mind and asks him not to patronise. The 'Doctor' (if he is what he proposes to be) litters his comments with cynicism, and sweeping statements and arrogance. I know this must be how they are trained but it is amazing to see this control of the narrative in action, this absolute invalidation and denial of lived experience. What becomes clear is that though he proposes to be coming from a research based and scientific position, his premises are plucked out of thin air, with no evidence to back up any of his claims. His posting name is "scubadoc" you can find him under the first set of comments, where it says 53 more comments.

https://www.theguardian.com/commentisfree/2017/jul/08/antidepressant-effects-psychotherapy-mental-health-crisis-nhs

 

 

[India]

O.K. I just took my dose of Citalopram at 11:20am (I am keeping it at this time for now) and noticed it is affecting my heart. My heart feels speedy and fluttery. I don't now about previous days because maybe other symptoms were taking over. But today I can absolutely saying my heart feels different. I know I have been to my doctor's so much recently I will avoid them if I can. I didn't used to get this feeling on 10mg but obviously times have changed. I had my heart rate taken when I was in the hospital a few weeks back and they said it was fine.

[needhelpguy]

Hi India,

For vocabulary problem, Im facing the same problem. My english vocab are just utterly destroyed. One time I cant rmbr the word younger brother but said smaller brother instead.  That is how bad my memory is just from 1 year of prozac. Ialso cant really feel and reminisce my past life memory as they all feel distant/ vague. Anyone face similar issue and manage to recover? I cant really daydream normally anymore as my mind can't really hold the fantasy for more than 10 seconds. Its like Im thinking to swim since the weather is good but the next second I forget why I wanted to swim in the first place. I thought ssri/ prozac is one of the mildest AD boy I was wrong and that psychiatrist of mine didn't tell me health anxiety ppl need to take AD for life in the first place.

[India]

On 10/16/2018 at 1:18 PM, needhelpguy said:

Hi India,

For vocabulary problem, Im facing the same problem. My english vocab are just utterly destroyed. One time I cant rmbr the word younger brother but said smaller brother instead.  That is how bad my memory is just from 1 year of prozac. Ialso cant really feel and reminisce my past life memory as they all feel distant/ vague. Anyone face similar issue and manage to recover? I cant really daydream normally anymore as my mind can't really hold the fantasy for more than 10 seconds. Its like Im thinking to swim since the weather is good but the next second I forget why I wanted to swim in the first place. I thought ssri/ prozac is one of the mildest AD boy I was wrong and that psychiatrist of mine didn't tell me health anxiety ppl need to take AD for life in the first place.

@needhelpguyI'm so sorry to hear this. You aren't alone in this, though it can be truly horrifying. Are you also experiencing derealization? I know that has impacted my memory. My guess is that frontal lobe, executive functioning, working memory and parietal lobe ( which governs movement). Are you in AD withdrawal currently? Please do hold onto the fact that the brain is plastic, plasticity, neurogenesis. I have seen some small improvements, with gentle exercise, stress reduction (know it's hard- mindfulness around acceptance-- good parallels are chronic pain). The other thing is to keep trying to read and write, exercise the brain. That's what I have been doing, trying to do the things that are hard. It's good to read up on techniques that helped patients with stroke and TMI (brain injuries). Most people get back. I wish there was more research on SSRIs and memory loss/ issues with the language centres of the brain. I am going for memory tests at my GP tomorrow. Do you feel that might also be helpful. I too would be interested to hear other people's success stories around this and how they recovered. I don't think there is any such thing as a mild SSRI, I felt the same about Citalopram. They are psychoactive drugs, stimulants ( with little research) and we all have different brains, different bodies. You can get back. The most unlikely outcome is fixedness. I do think we have to do things to help us on our way. Thats' why I alerted the GP so that I might get some help with my memory. My therapist said I'd made some improvements- not enough but some. However, I am making slow improvements so don't give up the faith.

I think the whole SSRI thing is a massive scandal, but a scandal that never seems to break the status quo (as yet)

[India]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002481/

[needhelpguy]

On 10/22/2018 at 8:01 AM, India said:

@needhelpguyI'm so sorry to hear this. You aren't alone in this, though it can be truly horrifying. Are you also experiencing derealization? I know that has impacted my memory. My guess is that frontal lobe, executive functioning, working memory and parietal lobe ( which governs movement). Are you in AD withdrawal currently? Please do hold onto the fact that the brain is plastic, plasticity, neurogenesis. I have seen some small improvements, with gentle exercise, stress reduction (know it's hard- mindfulness around acceptance-- good parallels are chronic pain). The other thing is to keep trying to read and write, exercise the brain. That's what I have been doing, trying to do the things that are hard. It's good to read up on techniques that helped patients with stroke and TMI (brain injuries). Most people get back. I wish there was more research on SSRIs and memory loss/ issues with the language centres of the brain. I am going for memory tests at my GP tomorrow. Do you feel that might also be helpful. I too would be interested to hear other people's success stories around this and how they recovered. I don't think there is any such thing as a mild SSRI, I felt the same about Citalopram. They are psychoactive drugs, stimulants ( with little research) and we all have different brains, different bodies. You can get back. The most unlikely outcome is fixedness. I do think we have to do things to help us on our way. Thats' why I alerted the GP so that I might get some help with my memory. My therapist said I'd made some improvements- not enough but some. However, I am making slow improvements so don't give up the faith.

I think the whole SSRI thing is a massive scandal, but a scandal that never seems to break the status quo (as yet)

Sorry for late reply, yes I do experience derealization, before, not during, and after prozac. It's the main reason I decided to take prozac from doctor in the first place. During treatment, as far as I rmbr I dont have them, but during months before my cognitive decline start, I have it once every 2 weeks. Still rmbr the day before my cognitive decline start, at the gym I suddenly felt out of touch with reality. I just ignored it and went to sleep that night the next morning bamm my memory and cognitive ability is fried.

 

I'm still in AD withdrawal I think, left ear tinnitus at night this week (monday till thrusday, no more for now), heavy lightheaded/ dizziness in september once every other day (exacerbated by excercise).

 

I agree, I think keeping the brain active like doing quiz, reading, and focusing on work will definitely do good things to our brain. I did simple GP office memory test and my GP said my brain is normal. Honestly, I felt that our neuron receptors are not blocked by our SSRI so the serotonin can't do their job normally like before, it will take time for the brain to adjust its optimal environment again.

 

If only my family didn't dismiss my health anxiety easily, I won't be down this path  anyway, lets keep each other updated and lets pray we recover from this ordeal

[India]

I've gotten behind with everything. Exhausted. I have found it difficult to navigate the site and even to write my symptoms down. A low, I might say. Memory tests have confirmed what I already know in respect to deficits. DR won't leave me... some things are slowly incrementally improving but many are not. At least, this is how I feel. The fear is poking through again. I have kept my dose stable. But I do not feel that I am where I was prior to my rapid taper pre July! The worst symptom is the pancake brain feeling- flat brain.. 

It's just the repetition and relentlessness. And the exhaustion from the circulatory nature of the symptoms

@jozeff How are you? 

@ButterflyHope Sorry for my lack  of response. 

I will check out your feeds. 

@needhelpguy Sorry for your dismissive family. It's impossible for others to understand the extremity of symptoms.. thus, those who have been through it are the best mentors. Are there any projects near you that help with withdrawal. There seem to be more U.S based than U.K.

[India]

Monday 30th October

(Night before KALMS)

Awoke 10:30am very  drowsy/sleepy weak 8/10

Depression 9/10

DR 9/10

Memory deficits 8/10

11am took citalopram 1.15ml

Memory deficits 9/10 (all afternoon)

11:15am DR 9.5/10

Vision/perception issues 8/10

New symptom this week, breathlessness 5/10

12 lunch

3pm magnesium bath

temp reduction in depression/ pain

Rested in bed all afternoon

Weakness 8/10

flu like exhaustion 8/10

DR 9.5/10

8pm ate dinner

Back to bed resting

[ButterflyHope]

Hi @India dont worry for not replying thank you for your message, Im sorry to hear you're having a tough time- we're all here for you and this too shall pass. Hang in there and allow time to pass by minute by minute, hour by hour- you dont need to do anything else.

[India]

Thank you @ButterflyHope 

Having a difficult evening . 

 

I just had a session with my therapist today who said it was futile to argue about withdrawal and the  derealization and memory problems from  WD would be seen by a psychiatrist or doctor as evidence of psychosis and that I would further discredit myself by doing so . I

had planned to present my gp with the  evidence after he said on the phone today that my memory issues were psychological. 

I felt a real sense of powerlessness and mental shape shifting. I'd been happy with the therapy up until now. But I felt very triggered and isolated. 

Any thoughts appreciated.,

[jozeff]

Hi India,

 

So sorry for you. You must have felt awful.

 

I'll get back to you I promise but I have to get to work now so I'm in a hurry....

 

 

Talk to you later ok?

 

 

 

Cheers

 

 

Jozeff

[jozeff]

Hi India,

 

As promised here I am...

 

I understand you feeling of powerlesness. This is too bad for you. I can feel your despair. 

 

My therapist, whom I have been visiting at least 20 times, tends to forget that I'm taking medication in the first place. He asked me a few times...uhh.. what is the name again of that stuff you are taking. And....are you still taking those antidepressants or was it benzodiazepines? I spelt CITALOPRAM and he literaly never heard of that. He's a psychologist who has had his own practice for 30 years. I mean, there must have been a patient before me with the same meds...

 

What i'm trying to say is that you are the one taking medication or having wd symptoms. You are the one who has tot deal with it and can take decisions to hold or to taper or to take other meds. I know that understanding is an important feeling and can help tremendously in healing and just feeling relaxed and calm. I seek understanding and respect for my situation all the time. Some people, like my in laws, never ever asked about my mental health and are not interested in it whatsoever.  My colleges dont feel very responsible for my well being either. My gp prescribed me the drug two years ago and if I'm remember correctly asked only once about it.

 

You dont alway get from your environment what you want or deserve. That is a tricky thing because we expect something and can feel very misunderstood, angry or upset when we don't get that. This may, in itself, ramp up WD symptoms or symptoms of discomfort. If I have some argument with a coworker or with my wife my heartrate goes up and I feel adrenaline pumping like crazy. Afterwards Im very confused and tired/derealized/sad...whatever feeling but the truth is that it ramps up WD!

 

The doctor told you it was psychosis but thats just an opinion. Tomorrow it might be something different and as long as the medical professionals keep denying WD as an option there will be some misdiagnosis. 

I felt very miserable after coming of off venlafaxine and the doctor prescibed me zoloft which I took for a week and then prescribed citalopram which he thought of in 10 seconds. He wrote a prescription in 5 seconds that was it.

WD symptoms only last for a few weeks at most.... that's what several doctors told me. I read so many stories here that prove otherwise. It is a shame.

 

You should and MUST focus on yourself. You are the one in WD. All the energy you spend on anger/fighting is lost. You need ALL the positive energy to heal. I know it sounds easy but I' trying to ignore negative input and focus on myself.

The world keeps on spinning, with or without your frustrations. Just focus on yourself... listen music, sports, talk to friends, have a nice meal, walk in a forest. Anything to calm and feel better.

 

I know its difficult but you must try.  You are more then welcome to ask for advice here. The answers might not heal you but at least there are people here who understand what you are going through. 

 

Are you planning on keeping your therapist or would you like to switch to someone else. If they don't listen to your arguments some changes may be helpful.

 

Good luck and I hope you had a nice day today!

 

keep on healing and think about it........you can spend your energy only once, better spend it on something worth wile.

 

My spelling checker does not work and Im dutch so there may be some errors in here

 

cheers

 

Jozeff

 

 

 

[India]

Thank you so much. I've been having a difficult time. I will reply tomorrow . I really appreciated reading this after an awful day. It is so hard to keep having to deal with this, day in day out. I wonder how I've survived , how any of us have.

 

[India]

On 10/31/2018 at 6:25 PM, ButterflyHope said:

Hi @India dont worry for not replying thank you for your message, Im sorry to hear you're having a tough time- we're all here for you and this too shall pass. Hang in there and allow time to pass by minute by minute, hour by hour- you dont need to do anything else.

@ButterflyHope Thank you for the support. I've had moments in the past week  when I really have felt I can't go on. Of course, my trauma issues are intersecting with withdrawal . I try to hold onto what is good but I acutely feel my marginalisation . I had a vibrant and creative mind. I had plans for a course. Perhaps this was always looming .. throwing antidepressants at the trauma. I was awaiting this horrendous  crash/derailment . The affect on my health has been two fold. I am alone and that scares me. I feel the acute isolation. I try not to get consumed by the fear of the system I have become entangled in. I just feel very very sad at what's happened to me. There were a few moments in my life when I felt happy, vivacious, productive, loved. The possibility of flourishing after some of the darkness I saw and lived through. 

The only thing that keeps me going is the hope in my soul that I can get my spirit back. It's the relentlessness of WD that is so unbearable. All the while I watch the spring in the step of those of the outside, unperturbed and unaware of this hell. It's this chasm that tortures. 

I have been in bed for 3 days now- experiencing exhaustion and depression and anxiety. I will re-read Jozeff's words as they were supportive and I am thankful. I feel so cognitively unagile. I know I need to tell a more positive story to myself and for others. Thinking of you- I know you've had some difficult times with the new liquid switch over  

[jozeff]

Hi India,

 

Sorry you feel so bad. I'm glad thayy words helped. Only a little maybe but every support is welcome of course.

 

Are you still in bed??

 

We're you sick or couldn't you just not get out?

 

I feel so lost sometimes and getting out of bed feels so unsafe. You know, the cold, starting the day again, anxiety/depression kicking in. All reasons to stay in bed.

 

But.......

 

After 2 or 3 hours I'm much better of if I started my day and just go to work. Recently I stayed in bed one morning and felt pretty ok and happy with it. After a few hours my wife came home and I wash a complete wreck. Depressed, very anxious and focussed on myself just horrible. I started having a fight and she reacted very bad to it since she just got out of work, which I fully understand.

 

The rest of the day was garbage. My blood pressure was way too high, I couldn't rest or read something and felt suicidal. If I just went to work and got out of bed things wouldn't have been so cruel.

 

Some times we have to invest some energy to receive more energy later. I think this is sometimes so hard because of WD and we cannot imagine doing anything else then sleeping or lying down.

 

I was severely depressed a few weeks ago and going swimming with my son was the last thingbin thento cross my mind. We did go swimming and suddenly all tension just disappeared and we had a relatively relaxing afternoon.

 

Do you have wave/window pattern within 1 day??

 

Hope you are feeling a bit better

 

Hugs from a sunny Netherlands!!

 

Good luck!

 

 

Jozeff

[Rosetta]

India,

 

I'm sorry you are caught up in this mess.  Please don't expect help from doctors.  Asking them to accept that they did this to you is only going to make you feel worse.  They will never admit what they have done.  Instead they will turn the blame on you and your supposed "biological" issues.  This will make you feel worse.  I have improved immensely without any help from doctors.  Your own body will heal you, but it will be very slow.  All you can do is keep your dose stable and consistent until you reach a point at which you can taper.

 

My heart breaks for you as I have been where you are -- derealization and Depersonalization are very, very upsetting.  If your nerves are too stimulated by going out is it possible to get a treadmill?  Walking everyday will help you.  If you could look out a window and get as much sunlight as possible while you walk that would be best.  

 

Sitting in the sun everyday is important, too.  I hope you have a place you can go to do that.  At first it will be uncomfortable to go outside, but if you go to the same place everyday you will get used to it.  That place will start to feel familiar and comfortable.  That's what happened to me.  I was very afraid to go out, but I went on the same walk everyday and after a while I felt comfortable with the familiar path.  You may feel comfortable quickly if you sit in the same spot everyday.  It helps if you can watch birds.or people going by.  That way you can be distracted by the activity of the birds or people.

 

Do not allow anyone to tell you these intense symptoms are natural for you.  They are not, and they will go away in time.  They are caused by the abscence of the drug your body was dependent upon.  (Unfortunately, putting the same level of drug back into the system will not help if you have had your system destabilized by the rapid cessation.). ADs are extremely addictive and using a different terminology for addiction does not make them less so.  If anything, the definition of addiction should be expanded to include the effect of ADs.  The fact that simply putting the drug back does not help us makes AD addiction even more serious.  The marvelous thing is that our brains and bodies can heal.  It's extraordinary that this is so.  In that way we are very lucky.

 

Rosetta

 

[ButterflyHope]

Hi @India Sorry I havent been in touch, yes its been rough with the switch im starting to see some light now for which im grateful for.

 

 I know how lonely this experience is, to be honest I have people around me in my life and it doesnt change the feeling of loneliness, however I'm finding my connection via here and facebook groups- have you joined them theres one which is 'lets talk withdrawal' and another 'citalopram should be illegal'. Dont compare yourself to 'normal' people not going through this right now it'l make you feel worse, just keep reaching out to others going through this and feel the connection through joint suffering. Its not a path any of us dreamt of or planned for, but assume this is the path we're meant to be on and help each other through. None of us know what the future holds, and sometimes things only make sense backwards. I also know 'normal' people who look like they have it all who are incredibly lonely, this level of profound suffering also offers an opportunity for deep, genuine connection amongst us all and just as you have helped me by reaching out I hope you continue to do so for yourself. All the time we feel we cant stand it, we are standing it. We dont have to 'do' anything, we have to learn how to just 'be', for now.

 

Dont worry about not being positive, it is hell and its rational to experience utter despair. I am just, for now, having a complete blind belief that it will get better. I dont need it to be tomorrow, but all I have to do is stand each day and I have been doing that and will continue to do so, and you can too. Believing is seeing. This is becoming a well trodden path, we know of the success stories and we have proof it happens, lets assume it will be us too. While we go through hell we must keep reaching out to each other to keep that hope alive between us, or for someone else that day. You are not alone, we can all relate to what you are writing so keep doing it.

 

Butterfly x

[wantrelief]

I know this post was meant for India but it was beautiful, @ButterflyHope, and helpful.....thank you. 

[wantrelief]

On 11/13/2018 at 2:10 PM, India said:

The only thing that keeps me going is the hope in my soul that I can get my spirit back. It's the relentlessness of WD that is so unbearable.

This is wonderful that you feel that hope, India, hold onto that.  The relentlessness of WD does indeed make this all the more difficult.  I know it is cliche but take it one day at a time.  I hope you feel better soon.

[ChessieCat]

7 hours ago, India said:

Hi butterfly! Keep holding on. I had a day today when the anxiety was so bad I too felt I couldn't stand it. I was curled up in bed and I was too scared to get up.  Sorry I can't offer more solace only that I feel your pain. It did pass slowly slowly . I had to listen to losts of positive meditations and repeat to myself i was going to get better. It took a long time to work. Read as many positive stories as you can. Can your husband massage you? I know that my mum did this and it really helps calm me down. I've been filling myself with passiflora , kalms day and night non-stop. I read some of Katie Piper's book about her acid attack. I managed to walk also for an hour. I wish I had a magic wand to make everyone's pain go away. You will stabilise. Thinking of you.

 

It's a good idea to research anything you take or think about taking.

 

From your drug signature:

 

"Herbal/Supplements since 1st September:  day- kalms stress relief, night- kalms night both contain, valerian, hops, and passiflora."

 

From https://www.webmd.com/vitamins/ai/ingredientmono-856/hops:

 

Depression: Hops may make depression worse. Avoid use.

 

I also found this which is worthwhile checking out:  https://www.thesleepdoctor.com/2017/06/19/understanding-valerian-hops-how-valerian-and-hops-can-help-you-de-stress-relax-and-sleep-better/

 

valerian-root

 

And from passion-flower:

 

 

[India]

Thank you for the information. A day of cortisol spike hell. A wave. I've had to re-read everyone's messages. I am literally holding onto my phone and reading these messages and success stories. I was so ill with panic. I can hardly type. I'm thinking of everyone. I know it's the withdrawal but I think I don't know who I am without meds because of taking them since age 25.. Did i build an identity based on the drugs. No, I don't believe this is me.. this isn't me.. this insane anxiety beyond all anxiety, this DR. I want to thank everyone for their messsages because I have been in a dark place. I refuse to give up though. I refuse to believe I won't heal though there are times when the fear is so amplified. I want to write back to everyone . I just can't right now.. the wave is so bad. I find myself asking the universe to heal me..to get me through ..

[Rosetta]

Oh, India.  I have been there.  It will get better.  It really will.  Just hold on.  There is another life waiting for you.  I have improved so very much.  The dips are tough, but overall there has been vast improvement.  It will happen for you, too. -- Rosetta

[Rabe]

I am so sorry you are having such a rough rough day India!!!  You sounded good on the 15th...maybe it is what you are taking?  I hope your system resets itself soon!!!  Please know we are all caring about you, thinking about you, admiring your courage and strength!!!  It will pass!!  Please take care!! 💜

[India]

Hello everyone, I'm sorry I've been too exhausted to reply but I wanted to report that I woke up today in a window. A window from the derealization. I don't want to tempt fate but this morning I have 0 derealization . My memory is still not back to what it was, and I still don't have accesss to full vocabulary and I still have other symptoms but I felt a fragile version of what I used to feel. I can only theorise a few things: I reduced the amount of kalms I was taking, I rested a lot, I had positive interactions with a friend, my therapist and a physio. I find validation and supportive interactions help infinitely. However, previous days anxiety attacks were happening frequently.  I felt terrified. The relief to not feel the derealization is immense. I am still on 6mg. Does anyone else notice that a little bit of the meds gets trapped in the syringe? I realised this very recently. I have to take water into it once more and swallow that to get the full amount. I have just started a new bottle of liquid which should  last me 3 months. I'll be back in touch soon. 

[Rosetta]

So happy for you!!  Enjoy some time without DR.  I'm doing ok today, too, which is lucky because it's our feast day.  

 

I'm glad you had some positive interactions.  It's a very, very good sign that you were able to experience those interactions as positive, too.  

 

Very smart of you to catch the fact that some of your medication was left in the syringe.  That could make a difference.

[India]

Just to let everyone know I am in a window. I still have my psychological issues but I believe them to be more in tune with my identity. The Derealization has left me for about a week now. I know I ached for this moment so I am trying to be grateful and not focus on the other symptoms. Memory is improving compared to where it was. I get anxiety but I am managing it. I am trying to see it as huge to be on such a low dose (6mg)  and negotiating life. I am going to stay here stabilising for a few months before I attempt my 10% taper. Honestly, I have never been through so much hell in all my life as that derealization . Pure torture. 

Thank you Rosetta for your support! Appreciate it. I'll be back soon. I'm just trying to ride this window.

[Rosetta]

Enjoy your window!