Melissa03: paroxetine / Paxil WD

[Heath]

I always have taken it in morning so I can forget about it and go on with my day. You are going through wd and start side effects. I couldn’t sleep either when I first started AD and I was taking in morning. This should pass. Keep up with the detailed daily notes and stay in touch with moderators they will guide you through!

[Melissa03]

Has anyone suscesfully reinstated after 3 months and 10 days? How long it took for drug to start working? I am feeling desperate.

[Zeena]

On 3/10/2020 at 7:09 AM, Melissa03 said:

What to do about this inability to sleep at all,anyone who has been through it ? 

This might help https://www.liebertpub.com/doi/10.1089/acm.2010.0778

 

[Melissa03]

Same day as yesterday. Just slight headache after seroxat. No improvement. I wasn't able to sleep at all last night. I took melatonin.this Morning I feel a bit dizy but I don't know is it the side effects of seroxat or cause of my insomnia. I feel desperate,can't get out of bed. What is the combination of mirtazapine with seroxat,just for sleep? Seroxat in hope that it would work eventually and mirtazapine before bed for sleep ,would it help ?

[manymoretodays]

Hi M03,

How much melatonin did you take?

  

On 3/16/2020 at 7:59 AM, Melissa03 said:

Yesterday

7 am waking up - sleeping is terrible for a month already 

Stayed in bed until 1

Lunch around 4 pm

Took seroxat around 5 pm

Slight headache

In bed around 11

Tossing and turning to get hour or two of sleep 

Terrible ringing in the ears 

Didn't have panic attacks these few days since that post,just a bit of black thoughts every morning when I wake up 

 

 

 

More notes please.  It looks like you slept for 8 hours.  You can note times, on the left, and then symptoms and all drugs and supplements, by name, with dosages, on the right.

Simple to do, really.  I don't even see a dose of seroxat noted.

 

Could be you slept badly due to staying in bed until 1 pm, or so, yesterday too.  I don't know.  You can note things, again, to the right of the time, like tossed and turned, woke up, and any symptoms that you are having through the night.  You did do some of this in your note I quoted.

We really need notes, drug and symptom notes, to answer your questions better, and make suggestions.

 

Black thoughts may be due to the cortisol effect:  Waking with panic or anxiety- managing the morning cortisol spike

Sometimes, it's the dark thoughts too.

 

Insomnia helps:

  

On 12/1/2018 at 2:20 PM, Altostrata said:

- "Sleep hygiene": Get off computer, tablet, or smartphone in early evening, turn down lights, plan to settle down for some time before bed. Keep bedroom dark and cool, don't do anything else in bedroom but sleep (and sex). Keep regular waking and bedtime hours.
TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime
 
- For those with light sensitivity Light-sensitive? Try blocking out blue light: Your computer may be your problem
 
- Meditation and meditative breathing: Stops "busy brain" and allows the nervous system to settle down for sleep
Easing your way into meditation for a stressed-out nervous system
Non-drug techniques to cope with emotional symptoms
 
- Magnesium, low-dose melatonin, and possibly fish oil before bed
Magnesium, nature's calcium channel blocker
Melatonin for sleep: Many people find it helpful
King of supplements: Omega-3 fatty acids (fish oil)
 
- Blackout curtains and sleep mask to reduce light stimulation causing early-morning waking.
Waking with panic or anxiety -- managing cortisol spike
Sleep problems - that awful withdrawal insomnia
 
Other relevant topics: Tips to help sleep -- so many of us have withdrawal insomnia
 
White noise devices for sleep
 
Update on milk peptides for sleep: Our friend Lactium again   
 
Glycine for sleep? 
 
Taurine (L-taurine amino acid) for sleep  
 
L-Theanine for anxiety, insomnia

 

1 hour ago, Melissa03 said:

What is the combination of mirtazapine with seroxat,just for sleep? Seroxat in hope that it would work eventually and mirtazapine before bed for sleep ,would it help ?

 

Not a good combination at all.  Drug interaction report from Drugs.com here

Please look at the link, M03..... it's blue and says here, you can just click on it to see.

And Drugs.com, is excellent, by the way to not only check drug interactions, but to check out any drugs, before you might try them.

We are also, just so you know, not in the habit of further drug recommends.  We are a site more for harm reduction tapering and WD, and support around that.

 

I think you are experiencing WD, even though, you reinstated a hefty dose, and/or some dysregulation now.  You reinstated much higher than what we usually suggest.  Not to chastise you, just that is why we have people reinstate real low, more often with .5 mg or 1 mg, at most, with your particular drug.  And you have had the same symptoms, as you stated, for a month now too.  I know it's tough, but try to refrain from making further drastic drug changes or additions right now.  Your nervous system will thank you.

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur. And sleep is really important during withdrawal.  Insomnia is no small deal.  So, let's see if we can help you find more non-drug coping to help with sleep now.

 

Did it used to work for you, or have any benefit?  The seroxat?

 

Can you update your signature, as to when you re-started/reinstated the 10 mg dose of Seroxat please.  Year, month spelled out, and day/date.  Go to Account Settings/signature and then don't forget to hit save.

 

  

On 3/8/2020 at 8:11 AM, Gridley said:

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

And then, we usually ask members to use caution starting these ^ too.  Just start with one or the other, at a low amount, until you know how you do with it.  You can use your notes for your own benefit too, if you only make one change or addition at a time, you are more likely to know, what might cause what.

 

Thank you. 

Best, and L, P, H, and G,

mmt

Edited March 17, 2020 by manymoretodays
added quote and additional

[Melissa03]

11 minutes ago, manymoretodays said:

think you are experiencing WD, even though, you reinstated a hefty dose, and/or some dysregulation now.  You reinstated much higher than what we usually suggest.  Not to chastise you, just that is why we have people reinstate real low, more often with .5 mg or 1 mg, at most, with your particular drug.  And you have had the same symptoms, as you stated, for a month now too.  I know it's tough, but try to refrain from making further drastic drug changes or additions right now.  Your nervous system will thank you.

So you think it won't help since it didn't help till now ? So what to do,to cancel it or to stick with it ? I took 3 mg melatonin pill.

[manymoretodays]

Hi again.  You could consider the below.  Reducing your dose.  Has it just been a week back on the 10 mg dose of seroxat?

Did the 3 mg melatonin, help with sleep then?  You might want to go with a smaller dose, to start too, on melatonin. 1 mg or 1.5 mg.   You can look at that link.

 

And I really like when members can follow through with the drug, supplement, and symptom notes.  It sure makes it easier to know at a glance what is happening day to day.  And to make suggestions based on.

  

On 3/8/2020 at 2:34 PM, Altostrata said:

Welcome, Melissa. Did the reinstatement of 10mg paroxetine cause insomnia? If so, I would immediately reduce it to 5mg. This may still be too much.

 

Be sure to take your drugs at the same times and dosages each day. As brassmonkey advised, let us know how you're doing,.

 

Do you think the 10 mg has caused the insomnia, or have other WD symptoms worsened?  If so, if it were me, I think I would cut the dose in half, keep the notes coming, and see if that helps.  It does takes 4-7 days for the body to register a dose change, so you would still need to use as much non-drug coping as you can.  And try to HOLD with the change.

 

It may not cure you of all symptoms, but might help lessen the intensity of some of the symptoms.  And improve your sleep too.

 

Meantime, if you can, take really good care of yourself today.  If it helps to distract and watch t.v., then do so, or something else you might do, while you don't feel like you can even get out of bed.  Music?  A craft?  A good book?  Call a friend?  Make sure and eat something too.

 

((((Melissa03))))

Edited March 17, 2020 by manymoretodays
lavendar

[manymoretodays]

Including:

Tips for tapering off Paxil(paroxetine)

^ includes information on how to lower your dose, and you can cut the pill/tablet

Do save the cut pills as well, for further usage, in a clean dry storage container, well marked

 

How to cut up tablets or pills (using a pill cutter)

you may be able to cut it with a sharp instrument as well, some tablets are scored.  pill cutters do okay too, and are not real costly, here in the U.S., and are readily available.

[Altostrata]

Melissa, when did you reinstate 10mg paroxetine? Please put this information in your signature.

 

Overall, do you feel better or worse since you reinstated?

[Melissa03]

I updated signature,it was around 1 March. I don't feel any better I think. I just have another simptom this morning like ocasional cricket in my ear and nose. And my tinitus seems worse. And vision problems when I close my eyes like some white circles. Emotionally I don't feel anything ,huge depression and unability to get out of bed. What to do,to updose or downdose ? Or to hold ? Insomnia is the same. Is this what you call kindling, reinstatement didn't work ? 

[Melissa03]

The problem Is cause of Corona virus situation I can't go to psyhistrist but I doubt they will be of any help.

[Melissa03]

I am at that point that I started even having suicidal thoughts . I was never like this ,I took seroxat only for mild social anxiety. But tinitus insomnia complete lack of hope is making me wanting to end all this.The problem is I read many stories on this site and they are not giving me much hope.

[manymoretodays]

Hi Melissa03,

Yes, it's a good idea to perhaps limit your reading to the Success stories forum, and then other information, around WD(withdrawal) syndrome and symptoms.

Unfortunately, your large reinstatement has not taken away your WD symptoms.......and that is often the case, in that it may mitigate some WD symptoms, but not completely take them away.  I don't think that you are kindling, no.  And since you have been on your 10 mg paroxetine dose now since March first, it may be best to use non-drug coping now, and then begin to prepare for a more judicious taper, when you feel even just a bit more stability......WD stability.

 

Please, please seek ground help, if needed, if you do feel out of control:

Please read through the first post, above, you just need to click/tick the little arrow at the top right and it will take you to it.

 

1 hour ago, Melissa03 said:

I just have another simptom this morning like ocasional cricket in my ear and nose. And my tinitus seems worse. And vision problems when I close my eyes like some white circles. Emotionally I don't feel anything ,huge depression and unability to get out of bed. What to do,to updose or downdose ? Or to hold ? Insomnia is the same. Is this what you call kindling, reinstatement didn't work ? 

 

Apathy, anhedonia, emotional numbness, emotional anesthesia

Tinnitis

Vision problems

 

On 3/17/2020 at 1:17 PM, Altostrata said:

Overall, do you feel better or worse since you reinstated?

 

For, now Melissa03, I think you might just HOLD steady.  Can you give us some idea of how a day goes, in relation to when you take your paroxetine? 

Notes again please.  In the post above the one below, you'll see the how to outlined.  Time on the left.  Drug(s) by name and dose on the right.  Symptoms as they occur throughout the day on the right.  Include sleep, and any supplements used.  Then post 24 hours right here.  Are you using any more benzo now?  I think it was lorazepam, that you had used on occasion.

Then we can see how symptoms are too, throughout the day.  If they let up or not too.......do you generally feel better at certain times of the day? 

What is:  Insomnia is the same?

When do you take your 10 mg of paroxetine?

 

Are you able to keep in communication with others, even somewhat during this time?  That may help.  Watch some non-distressing television or other programming.  That can help too.

 

Okay, and Best,

L, P, H, and G,

mmt

 

Edited March 26, 2020 by manymoretodays
fiddling around with quotes and stuff

[Heath]

@Melissa03 keep going! Don’t give up this is only temporary!  I was in same place years ago and had to reinstate after a 3 or 4 months time and it took me about 6 months to recover. It is rough but you can do it. It will pass. Hang in there !

[Melissa03]

1 hour ago, manymoretodays said:

And since you have been on your 10 mg paroxetine dose now since March first, it may be best to use non-drug coping now, and then begin to prepare for a more judicious taper, when you feel even just a bit more stability......WD stability

I didnt get this one. You think since it's not better till now ,there is no point of using seroxat any more ? Do I still need to taper since it's been one month ? Are this physical symptoms worse cause of reinstatement?

 

1 hour ago, manymoretodays said:

now Melissa03, I think you might just HOLD steady.  Can you give us some idea of how a day goes, in relation to when you take your paroxetine?

Since I am in house due to Corona virus ( here is total carantine noone can go out ) it's just lying in bed while day and watching news. I am a bit worse today than usual,woke up with some nousea,and terrified of crickets im my ears. I am scared as this symptoms continue to progress. About insomnija Is like two days with no sleep then maybe third day some hours of broken sleep.

Life is such torture now.

[manymoretodays]

24 minutes ago, Melissa03 said:

Do I still need to taper since it's been one month ? Are this physical symptoms worse cause of reinstatement?

Do I still need to taper since it's been one month ?  Yes.

Are this physical symptoms worse cause of reinstatement?  It is difficult to say.  It could be WD(withdrawal) symptoms too.  Even 2 weeks of Lorazepam, might have caused dependency, and then WD symptoms from that, along with what you were already experiencing from your paroxetine/seroxat.

 

Notes would really help, from you.  And help you, as well as us, to provide answers to your questions.  And then, answering questions yourself, when they are asked.  I know it's tough right now.  Some consolation perhaps, in that it is tough for so many across the globe, or world.  I think, we can all do our parts too, in generating some positive energy, as much as we can muster on up, and that it can make a difference.  If we all focus on the negative, and fears now, and unknowns.......that just isn't great.

 

Have you tried any of the insomnia coping tips, or been able to look at, or use any non-drug coping?

 

Are you forced to watch news all day?  Is there something a bit healthier you could be doing, to distract and take care of yourself now?  Reading, journaling, arts and crafts.  Changing the channel comes to mind:

"Change the channel"- dealing with cognitive symptoms

 

Try some simple notes, as outlined.  Offer support to others here too, when you feel ready to do so.  That can help alot.

 

((((Melissa03))))

Best, L, P, H, and G,

mmt

 

 

Edited March 26, 2020 by manymoretodays

[Cocopuffz17]

The symptoms will lessen as you gain stability. I went through this as well. The tinnitus will improve. Keep going. 

 

Everyday that passes is one day closer to being healed! 

[Heath]

You will recover. Time and steady 

[Melissa03]

@Gridley what do you think ?

[Gridley]

@Melissa03

 

Manymoretodays has given you good advice.  You need to hold where you are at 10mg Seroxat and make no further changes.  You will stabilize. It may take some time.  Then, once you've stabilized you can begin a slow, safe 10% taper.  But not now.  As met said, some of your symptoms may be due to bento withdrawal, some may be due to the large reinstatement, and some may be due to withdrawal.  It's often impossible to sort out what's causing what.  But regardless of the cause(s) of your symptoms, stabilize where you are and work on the non-drug coping skills met mentioned.

[Melissa03]

By stabilizing, you mean this insomnia and symptoms will go away soon with reinstatement? You think it ll work ? @Gridley

[Heath]

Insomnia and anxiety and the others you mentioned are only symptoms from nervous system disruption. So once you stabilize these will go away. Meaning take same dose med same time every day for a period of time Speaking in many months. Meanwhile you can treat the symptoms with self care things to help you sleep. Hot baths. Excercise, etc . Being in the water has a calming effect and that’s a know fact. Hot tub or swimming. When we try to juggle treating symptoms with vitamins and supplements it can make things worse. Nervous system will heal . 

[Gridley]

3 hours ago, Melissa03 said:

By stabilizing, you mean this insomnia and symptoms will go away soon with reinstatement? You think it ll work ?

 

Reinstatement doesn't make the symptoms go away but makes them become less strong and more bearable.   Unfortunately, "soon" is not really the word to use.  It can take several months for you to stabilize with a reinstatement  That's why it's important to be patient and hold where you are and make no changes from your current dose. 

[Melissa03]

Couldnt sleep at all previous two nights. I feel like I am dying and dont know how much i can take this. 

I wanted so badly to be drug free. I have been on this drug for the most part of my twenties and wanted to be off mostly cause i wanted to be mother one day . now all my future seems dark. 

i cant get out of the bed,i have severe insomnia. my thinking is so slow and i cant concentrate. my ears ring my eyes are weird. i have lost 15 kg and i am anoreksic now. i have terrible hair loss.

i am obsesed about finding suscesfull stories on this site. but more i read the more i am aware what i have done to myself. first taking this drug in the first place-when noone warned me that it is so addictive and that i probably will be on it for the rest of my life. secondly for not telling me to taper,just to cut pill on quaters.when i finally managed to be drug free i was hit by the prolonged wd and i am in hell-bigger hell that i have ever been,which can last for years. i am so traymatized by this,that even if i ever stabilize i doubt i will taper this. i am having this dark thoughts about who ll take care of me in the future when my parents die,will i end up in the mental institution. i cant believe what have i done to myself,sometimes i dream about never going to that dr and taking this pills. what are they studing at that faculty if they are so ignorant about what these drugs do to the people,how is possible they dont know?

[manymoretodays]

Oh Melissa, 

It sounds brutal.  Hoping tonight will give you some sleep.  It can be so very difficult to cope, without any restorative sleep.

Keep ideating, positively, on your brighter future.  It's not all a bust. 

Symptoms will come and go, and you'll start to have some better whole days soon I think.

 

And I know.  Boy do I know!  How something is really quite wrong with prescribers, and their models of treatment, and mis-information, or not enough information being given to us, from the start.

 

I think I gave you some anxiety coping tips, on the previous page.  Here are some more links now, that might help you to read over:

 

Non-drug techniques to cope with emotional symptoms

 

Easing your way into meditation for a stressed-out nervous system

 

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

 

Mindfulness and Acceptance

 

Ways to cope with daily anxiety

 

Dealing With Emotional Spirals

 

Shame, guilt, regret, and self-criticism

 

Health anxiety, hypochondria, and obsession with symptoms

 

Deep emotional pain and crying spells, spontaneous weeping

 

Coping with irritation, anger and rage

 

Let us know, what helps, or even add to some of the discussions in those topics.  And just keep on getting through each day.  Sometimes, just the chunk of one day, is a whole lot more manageable, than getting into the future tripping.

You can do this! 

 

Love, peace, healing, and growth,

mmt

[Cocopuffz17]

Hey! I know how crappy it is to come of this ****. It does get better. I have been making great progress. Everything you describe is exactly what I went through. I thought it would never end and it did. I am do way better now! Keep pushing. Nutrition to me is huge and I strongly believe it is the only reason I got off the medication this time. 
 

Remember everyday that passes is one day closer to being healed! 

[Melissa03]

again zero sleep last night. and symptoms just keep adding,i woke up with tingling in one arm and two fingers. i am scared i ll be totally disabled . is this adverse reaction,should i continue with reinstatement? i am so scared.

[manymoretodays]

Hi Melissa03,

Can you break it down into some kind of notes, throughout the day, as outlined above. 

 

You can find out the adverse reactions to Seroxat at Drugs.com.  Just plug in your drug name and side effects.

 

Tingling can be a fairly common WD effect too:

Paresthesia: Pins and Needles, Numbness, Tingling, Burning Sensations

 

I don't think you will be totally disabled Melissa03.

 

Any coping skills helping?  Sleep hygiene? 

I hope you are feeling some periods of relief from fears, Melissa03......even if they are brief, savor them.

 

Best, L, P, H, and G,

mmt

[Melissa03]

I am thinking maybe this reainstatemnt was too high. Its been a month of 10 mg,how safely to lower the dosage,without making more damage? here there is only 20 mg tablets,i cut them in half.

[Colonial]

Hi Melissa! 🙂

 

Can you say why You believe these symptoms to be the result of the reinstatement being too high and not just the temporary WD?

I know it took me a good 6 weeks before I started to stabilize once I stopped dropping my dosages.

 

Are you aware the 2 weeks of the Lorazapam this month could very well be the reason your not doing well, and not the Paxil?

 

Your signature shows a lot of med changes recently:

 

Few attempts to quit during 7 years

March 2019 went from 20 mg to 10 mg ( managed symptoms for 3 months ,crushed on trip and returned to 20 mg while on trip) 

Went again on 10 mg after trip

In September 2019 again on 20 for few weeks

For suspecting my health symptoms I had for a long time Are cause of paroxetine, lowered to 0 in two months or less November 2019

 

And if says that the reason You Cold Turkey'd was of "health symptoms", which may have been WD issues from the drop from 20 to 10 in March, etc.

 

My other concern is you have made posts like this one: 

 

On 3/29/2020 at 10:42 AM, Melissa03 said:

i am obsesed about finding suscesfull stories on this site. but more i read the more i am aware what i have done to myself. first taking this drug in the first place-when noone warned me that it is so addictive and that i probably will be on it for the rest of my life. secondly for not telling me to taper,just to cut pill on quaters.when i finally managed to be drug free i was hit by the prolonged wd and i am in hell-bigger hell that i have ever been,which can last for years. i am so traymatized by this,that even if i ever stabilize i doubt i will taper this. i am having this dark thoughts about who ll take care of me in the future when my parents die,will i end up in the mental institution. i cant believe what have i done to myself,sometimes i dream about never going to that dr and taking this pills. what are they studing at that faculty if they are so ignorant about what these drugs do to the people,how is possible they dont know?

 

I think what happened is you accidentally scared Yourself into thinking that the WD Symptoms you have had this year from changing your dosages around...

Were actually the medication injuring Your health for being on them to begin with, but then You said "If I stabilize doubt I will ever taper".

You then panicked into cold turkeying, and now have reinstated and added 2 weeks of Benzo use as well.

 

But again, part of the issue is your signature is too vague so we can't see when you actually made changes:

 

Went again on 10 mg after trip

In September 2019 again on 20 for few weeks

For suspecting my health symptoms I had for a long time Are cause of paroxetine, lowered to 0 in two months or less November 2019

2020 March 4th, Lorazepam x 2 weeks

 

Can You Please put in your signature line the actual dates as best you can remember them for:

1. "went on 10 mg again after trip"

2. When in Sept. did you go to 20 mgs for "a few weeks"

3. When did you start dropping from 20 to 0, to end up at 0? And how long were you at each dose along the way?

4. What day in November was your last dose?

5.  What was your dose of Lorazapam for 2 weeks starting March 4th and how often did you take it?  

 

If you only answer it here, it's not as helpful, because every time someone tries to look at your history, its very time consuming to try to scroll back through your thread.

So that is why it would be great if you could make the changes in your signature line.

 

Again, I'm not seeing anything to indicate the 10mgs was too high per se.

I see not enough time yet to stabilize added to the benzo use that, if your having WD from that, is why You may not be doing well.

 

If there is some other reason, medically, you believe the 10 mgs is too high, please let us know, and update the signature line will be a big help. Thanks! 

 

 

[Zpssd]

On 3/30/2020 at 7:15 PM, Melissa03 said:

,i woke up with tingling in one arm and two fingers

I had tingling too on my arm after i reinstated,it went away after few days

[Melissa03]

@Colonial  I reinstated in hope for relief and for preventing further damage ,but since than my physical symptoms just keeps adding which scares the **** of me. I have always been a bit hypohondric and this symptoms i am experiencing are like my worst nightmare is real. Paxil has short half life and from what I am reading all symptoms seem to be permanent. Tinitus is really loud and is driving me crazy.- i cant imagine having it for the rest of my life.There is no relief in insomnia,you were right at that previous post,that good night of sleep when i reinstated was just a coincidence.  Its been almost two months of bad sleep or no sleep at all. So I am still taking this 10 mg,and what when i decide to taper-probably my symptoms could go worse,what if my tinitus gets louder? Is this 4 months of suffering for nothing since I am still taking the drug and it will be only worse when i decide to taper?After even slow taper i have to prepare for months or years of suffering. I think i found 0 relief in this reinstatemnt, or I am just too traumatized by this whole experince that 10 mg can not help. I ll update my signature-but i screwed myself badly from what i read,it was from 20-10 in march (not that big deal) and maybe in one month from 10-5-0. 

[Melissa03]

I havent found any succesful story which has the similar backround as mine.

[mstimc]

52 minutes ago, Melissa03 said:

I havent found any succesful story which has the similar backround as mine.

Hi Melissa

I took Paxil for nine years and successfully tapered.  It took me three years to taper and recover, but it certainly can be done.  I, too, endured severe hypochondria during withdrawal and recovery, but the feelings decreased over time and with the correct coping tools.  

[Melissa03]

Yes, @mstimc I realize it can be done with slow taper,but I have already almost CT and reinstated.:( The prognozes of this are really scary.

[mstimc]

Several years ago, I was a member of Paxilprogress and knew several people who recovered after CT.  The recovery arc was steeper and in some cases the symptoms were more dramatic more often, but they were able to do it.