Cgomg: hi there, I am in full blown withdrawal

[Cgomg]

Hi there I’m new here , I’ve been taking 20mg fluoxetine fir the past 3 years and not knowing any of the stuff I’ve been reading here I’ve done everything wrong trying to give up and put myself in full blown withdrawal.   Desperate anxiety hopelessness catastrophising etc - I’ve reinstating my 20mg dose and am as bad but possibly lessening slightly .

 

i had no idea about any of the tapering protocols or how bad it could be until I found you guys - I feel like I’m living  a horror show where I’ll never be the same again.  In my ignorance I’ve made every mistake in the book including cutting down by skipping doses .

 

now I’ve been reading stuff here I’m actually beginning to understand what I should have done and why I’m so ill - I’m going to try and reinstate / restabilisr and then wait before I taper down .

 

can anyone advice me should I try a lower dose of my fluoxetine as my reinstated full dose has made me so ill ? I’d stopped for 3 weeks before full blown withdrawal and then fir the last 3 days I reinstated 1 tablet per day 20mg 

 

thank you 

Edited August 26, 2020 by Gridley

[Gridley]

Welcome to SA, Cgomg.

 

We recommend reinstating at a much lower dose than your last dose.  This is because your brain is sensitized from stopping the drug and now has been overwhelmed by too large a dose.  I'd recommend reinstating 5mg fluoxetine instead of the 20mg.  This link gives information about how to get the small nonstandard dose you'll need for the 5mg reinstatement.

 

Tips for tapering off fluoxetine (Prozac)

 

Please read:

 

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

 

It takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain.  It's a good idea to keep daily notes on paper to keep track of your reinstatement.  Please keep us updated on how you're doing.

 

Some members reinstate and can go back to their previous stability.  Other members reinstate and their symptoms reduce but they don't return to their previous stability.  

 

The idea of reinstatement isn't to get rid of withdrawal symptoms completely but to bring them to a bearable level.

 

   On 10/8/2012 at 6:17 PM,  Altostrata said: 

• Reinstatement may not immediately eliminate all withdrawal symptoms. It takes time to stabilize, you may still experience waves of symptoms, which usually lessen as time goes on. Give your nervous system time to settle down, be patient after you reinstate, do not leap to increase the dosage.
• Think in terms of months before you attempt to taper again. Once you feel withdrawal symptoms are reduced after reinstatement, give your nervous system time to stabilize before attempting dosage reduction. Do not attempt to taper again until you feel symptom-free, or at least until your withdrawal symptoms are mild, predicatable, and tolerable.

 

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 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) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

Edited August 26, 2020 by Gridley

[Cgomg]

Gridley thank you ! Obviously I’ve only just found you all and have already reinstated for 3 days at the higher 20mg dose .

 

should I drop down to 10mg or straight down to 5mg even tho I went back straight to 20mg ? Will it cause me more problems changing my dose yet again ? 
 

ive been so ill from it absolutely off the scale anxiety shaking can’t sleep terrified etc etc so would really appreciate your good advice 

[Gridley]

19 minutes ago, Cgomg said:

 

should I drop down to 10mg or straight down to 5mg even tho I went back straight to 20mg ? Will it cause me more problems changing my dose yet again ? 

 

I'd recommend going directly to 5mg. I wouldn't try 10. There are no hard and fast answers with reinstatement.   The negative effect of reinstating the full amount (in your case, 20mg) and the risk of overwhelming your system outweighs the negative effect of changing doses again.

 

I'm going to bring your situation to the attention of the administrators and other moderators.  But right now my advice is to make your next dose 5mg.

 

 

[Cgomg]

44 minutes ago, Gridley said:

 

I'd recommend going directly to 5mg. I wouldn't try 10. There are no hard and fast answers with reinstatement.   The negative effect of reinstating the full amount (in your case, 20mg) and the risk of overwhelming your system outweighs the negative effect of changing doses again.

 

I'm going to bring your situation to the attention of the administrators and other moderators.  But right now my advice is to make your next dose 5mg.

 

 

Gridley thank you ! Obviously I’ve only just found you all and have already reinstated for 3 days at the higher 20mg dose .

 

should I drop down to 10mg or straight down to 5mg even tho I went back straight to 20mg ? Will it cause me more problems changing my dose yet again ? 
 

ive been so ill from it absolutely off the scale anxiety shaking can’t sleep terrified etc etc so would really appreciate your good advice 

[Cgomg]

Thank you xx I  absolutely terrified of changing anything - I’ve just spoken in zoom to a psychiatrist who agreed I was in withdrawal and suggested 10mg the good thing is he’s prescribed me the liquid form so that’s good - would I stay at 5mg to stabilise ? 
 

thank you xx 

[composter]

Hi there. The good news is you’re right within the timeframe to do well on a reinstatement. 

 

Can you give us more details on your drug history and put this into your signature?
 

Instructions:  Withdrawal History Signature

 

Account Settings – Create or Edit a signature

 

It’s important we know what type of tapering schedule you were on and if you are taking or have previously taken any other neuropsychiatric medications. This will help us with suggesting a reinstatement dose. 

 

[Cgomg]

Well that’s about the only good part of all of this !!

 

i originally took fluoxetine 20mg in my 20’s for a couple of years - came off

Then 14 years ago went back on it after post natal depression after the birth of my daughter - came off don’t remember feeling like this 

went on again 3 years ago but needed diazepam to go on it as my anxiety was awful getting back on it - settled after a couple of weeks to more manageable levels and then this episode 

 

I’ve taken .5 diazepam the last couple of days to try and calm my extreme anxiety and it has helped but obviously I realise I can’t / shouldn’t be taking it I just can’t cope with this anxiety 

 

I spoke to a psychiatrist tonight and he said drop to 10mg for 2 weeks then review 

 

but obviously you guys are saying stop yo 5mg - I just don’t want to feel this dreadful terror and anxiety .

 

ill do whatever is best for my poor brain and body ! I’m in shock still to be completely honest 

[Cgomg]

I don’t know how to put that info in my signature sorry ? 
 

oh and the psychiatrist has given me clonazipam ( not sure that’s spelt right ) for the next couple of days to calm me down 

[Cgomg]

I don’t know how to put that info in my signature sorry ? 
 

oh and the psychiatrist has given me clonazipam ( not sure that’s spelt right ) for the next couple of days to calm me down 

 

!!! sorry just seen it shows me how on the link - my anxiety is making me bonkers 

[Gridley]

13 minutes ago, Cgomg said:

would I stay at 5mg to stabilise ? 

Yes, 10 would be too much.  It's better to start low and increase if necessary.    I'd recommend you stay with 5mg for several days to give it a chance to work.  The two week time frame from the psychiatrists would be fine.  You can always go higher little by little if necessary.  But I'd advise you to be patient and give the 5mg time to work.   It's good you have the liquid--that makes the reinstatement easier.

 

 

[Cgomg]

Thank you please forgive me as well if I’m not very articulate and can’t spell - my anxiety is making it hard to type and then read what I’ve typed - do you think at 5mg some of this anxiety might level off ? 
 

I can’t tell if the anxiety is from stopping or from going back on now !!!!

[Gridley]

4 minutes ago, Cgomg said:

Thank you please forgive me as well if I’m not very articulate and can’t spell - my anxiety is making it hard to type and then read what I’ve typed - do you think at 5mg some of this anxiety might level off ? 
 

I can’t tell if the anxiety is from stopping or from going back on now !!!!

 

Did you notice a change in your symptoms after reinstating 20mg?  Better?  Worse?

 

The idea of the 5mg reinstatement is to alleviate the anxiety and any other withdrawal symptoms you have.  Some people get complete relief from withdrawal and for others the symptoms get brought down to a tolerable level.  You might get relief after a couple of days or it might take several days.  5mg might be the right dose or you or you might need a little more.  But, as I said, give the 5mg a chance to work.

 

[Cgomg]

Just started to feel a bit calmer tonight - even managed to eat -and to tell my family what was going on for me ! 
 

ill try 5mg and stay in touch on here as you say I can always try stepping it up a bit gently if it’s not enough xx 

 

 

[Gridley]

5 minutes ago, Cgomg said:

 

ill try 5mg and stay in touch on here as you say I can always try stepping it up a bit gently if it’s not enough xx 

 

Sounds good, Cgomg.

 

Could you answer two questions for me:

1.  Did you feel better or worse after reinstating 20mg?

2.  How long did you taper by skipping doses?  How did you feel during that period of tapering?

[Cgomg]

Sure I felt way worse reinstating at 20mg I was almost ready to end it because I was so anxious I just didn’t know what to do with myself .
But bizarrely this evening I feel like my brain is beginning to calm down and I feel that flooded with chemical feeling a bit numb not anxious buts it’s only happened in the last hour or so - so don’t know if it’ll hold 

 

I’ve been skipping doses for about 12 months normally I’d take 4 fluoxetine a week approx - I’d started to get physical symptoms but hadn’t realised what they were - arthritis in my hands , achy muscles , the most painful heels in the morning I could barely walk . About 2 months ago I got a flicker of anxiety and thought should I up my dose but thought no I’ll push through and did - that’s when the arthritis started 

 
then after being off about 3 1/2 weeks I could barely move , migraine and muscle pains in arms and legs - couldn’t  move almost at all and that’s when I knew I was in trouble .anxiety and pain started and almost immediately i took the 20mg to stave it off - I’d realised it must be the fluoxetine because of the migraine - I haven’t had one in years.

 

as soon as I took the 20mg the anxiety ramped up it was unbearable- I took a 1mg diazepam to damp it ( I’d had them from when I went on fluoxetine in the past to damp down the start up anxiety so knew it would help)

 

I keep getting waves of heat and anxiety but for the last hour or so I can feel a calming down of about 50% of my anxiety .

i have no idea if that will stay it definitely feels like the kick in feeling I’ve had before starting fluoxetine when I’ve gone on it in the past .

 

I’m happy to drop to 5mg if I don’t get a resurgence of that dreadful terror - that’s all I’m worried about - I just want to stabilise and then taper down property using the methods you outline here - I’m just desperately anxious about it all cx

 

 

[Gridley]

57 minutes ago, Cgomg said:

 

I’m happy to drop to 5mg if I don’t get a resurgence of that dreadful terror - that’s all I’m worried about - I just want to stabilise and then taper down property using the methods you outline here - I’m just desperately anxious about it all cx

 

Thanks for the information, very helpful.

 

You are well with the time frame when reinstatement predictably works.  Please try not to worry. 

 

I've found the following restorative yoga pose very helpful in coping with anxiety.  

 

10 minute Restorative Yoga for Relaxation | Up the wall

 

It's nice to make yourself comfortable and cozy with pillows and a cover or blanket.

 

And don't forget the magnesium and omegas I suggested previously, one at a time and starting with a low dose.  They can be very calming.

 

You will be okay.

 

 

[composter]

1 hour ago, Cgomg said:

I’ve been skipping doses for about 12 months normally I’d take 4 fluoxetine a week approx - I’d started to get physical symptoms but hadn’t realised what they were - arthritis in my hands , achy muscles , the most painful heels in the morning I could barely walk . About 2 months ago I got a flicker of anxiety and thought should I up my dose but thought no I’ll push through and did - that’s when the arthritis started 

 
then after being off about 3 1/2 weeks I could barely move ,

Thanks for answering Gridley’s question. 
 

Were you taking 4 tablets of fluoxetine a week for the past 12 months? Did you reduce that number at all? Prior to jumping off 3 weeks ago how many tablets were you taking per week? 

We are trying to determine the most recent dose at which you felt relatively stable. If you stayed at 4 per week for that period of time, this would equate to something like 11.4 mgai (active ingredient) in your system per day on average since it’s 80 mgai (4*20) divided over 7 days, using a gross estimation of half life. Of course skipping doses is not our recommended way to taper. 
 

Based on symptoms you described it looks like you did have signs of withdrawal while skipping doses. Definitely common. But I suppose not concerning enough that you connected the two. 
 

Please let us know if what I described lines up with the taper you did or if you made changes to that 4 per week schedule in the weeks or months before stopping. 

[Altostrata]

Hello, Cgomg. You're been taking 20mg fluoxetine for 3 days? Are you still taking diazepam? How often? How are you sleeping?

 

3 hours ago, Cgomg said:

I’ve taken .5 diazepam the last couple of days to try and calm my extreme anxiety and it has helped but obviously I realise I can’t / shouldn’t be taking it I just can’t cope with this anxiety 

 

A reaction of extreme anxiety to a day or two of Prozac is not a good reaction. You should not have to take a benzo to tolerate it.

 

If I were you, I'd reduce to 10mg. Even 5mg might be enough, but see if reduction to 10mg lowers the activation to the point you don't need a benzo.

[Cgomg]

In the taper before stopping I probably dropped a bit further for a couple of weeks - because I had no idea this would happen or even what withdrawal was I’m not sure now.

 

i appreciate your trying to work out what’s best for me but I thought back then before I found you guys that what I was doing was the way to stop I reckon for the last free weeks before completely quitting I probably took 2-3 a week for about 4 weeks.

 

i feel completely stupid not being more able to tell you more but if I tell you I had no idea that what I was doing could be a problem or that I needed to be very aware of how much I was taking when . I’m ashamed to tell you I thought these tablets were relatively benign and that the issue with stopping was about symptoms I’d had before taking them re-emerging not that the drugs themselves would cause trouble on cutting .

 

my best guess and safest guess would be 3 a week for a couple of weeks then down to  2 and 1 in the last 2 weeks before finally stopping.

 

this morning I’ve got lots of arm and shoulder pain , terrible anxiety , both over stimulated and exhausted at the same time .

 

i don’t whether to take 10mg this morning or 5mg 

 

plus as part of my HRT my doctor prescribed DHEA 10mg every other day I’ve been taking it for  about 6 months should I keep taking it ?

[Cgomg]

In terms of diazepam I took 1mg yesterday morning - my anxiety kicks in about 3am and then I fall asleep again - then when I wake at 7am I’m raging with anxiety .

 

so the last 3 days where I went back on the Prozac 20mg I took 1mg the first day ,

1mg twice the second day and yesterday 1 mg 

 

id like to take 1mg this morning just to function .

 

when I started Prozac I had to take them because I had this reaction so I just assumed it was normal !!!!!!! 
 

[Cgomg]

I think 4 a week is about right in terms of feeling stable - now I realise I was withdrawing all the time a little bit. because I’d been given Prozac in the first place for anxiety I just assumed it was my anxiety coming back so tried to tolerate it - I Never thought it was the drugs themselves if you see what I mean - which now sounds completely mad !!!!

 

you will all think I’m completely stupid I’m sure but I always thought the issue with stopping was the original symptoms coming back not the effects of the drug leaving causing chemical imbalance.

 

even as I type that I see how stupid that sounds 

 

 

[ChessieCat]

5 minutes ago, Cgomg said:

you will all think I’m completely stupid

 

No we do not.  Many of us here have not realised what these drugs and/or their removal causes.  After 2 weeks of reducing my Pristiq from 100mg to 50mg I was unable to type.  I'm a professional typist from way back BC (before computers).  When I updosed at the suggestion of SA after only 4 hours (not days) I was able to type again. There was no way this was placebo.

[Cgomg]

I am still in a state of complete shock both on my CNS and in my awareness of the reality of these drugs and what they do !

 

i totally bought into the idea they were just correcting an imbalance in my brain and that all I was looking for when stopping them was to take it slowly and look for re-emerging symptoms ! I had no idea at all what could / does happen none ! Now I know I’m still so shocked I can’t take the information in !

 

plus I’m having issues with trust due to the fact I can’t believe I trusted doctors were doing the best thing for me and didn’t tell me about the dangers .

 

i think i’m not just in withdrawal I’m in breavement for a way of thinking about these drugs and these doctors as beneficent helpers who would always be there if I needed them 

 

my husband is very concerned about me being in the forum and taking advice from non medical people which has also added to my anxiety - I understand he is just desperately concerned for me but it’s very difficult while I’m so unstable 

 

once I stabilise - please god - I can taper Uber slowly and then I’ll feel in control of the process I hope xxx

[ChessieCat]

2 hours ago, Cgomg said:

my husband is very concerned about me being in the forum and taking advice from non medical people

 

Altostrata is the owner of the survivingantidepressant website.  She was recently on an after show discussion panel of the documentary "Medicating Normal".  Because I'm in Australia I was unable to view it due to the late screening time.  However, some of the other moderators and some members have made very positive comments about Alto's contribution to the discussion.  The discussion should be available for viewing in the next few days.  The announcement will probably be made in this topic:  medicating-normal-documentary-film-about-going-off-psychiatric-drugs

 

If you wish to view the documentary there is link in the topic for the upcoming showings of it.

 

This website was started in 2011.

 

This is Alto's story and there is a link in Post #1 to a video she made.  I suggest that you and your husband watch it.

 

about-altostrata-withdrawal-syndrome-since-2004

 

[Cgomg]

I know it’s only because he’s so worried about me and also because he like me was brought up to “trust the doctor” 

 

I don’t know right now which is worse the shock of withdrawal or the shock of knowing what’s going on for people da after day and doctors and psychiatrists just deny it or ignore it !!!

 

my doctor said “well why do you want to come off it anyway if it makes you feel good ? “ ....,  not that I ever said it made me feel good rather that coming off made me feel bad - which the last time I checked isn’t the same thing !!!!

[Cgomg]

Thank you by the way about the documentary I’d really like to watch that ! 
 

there is that feeling that you’ve just stepped into another world and now nothing will ever be the same  so it would be nice if he could watch it and get an idea of what people are going through x

[ChessieCat]

I felt the same way after I discovered SA and started doing lots of reading and watching of videos both on this site and elsewhere.  I was like a dry sponge soaking up water.

 

Because I wanted to alert relevant medical professionals (not general doctors) to the fact of antidepressant withdrawal I gathered as many email addresses as I could from the internet and sent them an email.  Because I needed to keep it brief so they might read it, and didn't want to add an attachment because they might not open it because of the risk of a virus, I created a website and provided the link to it so that I could provide more information to the recipients who wanted to know more.

 

https://adwithdrawal.weebly.com/  (there is a main page and a links page)

 

I documented my email campaign here:  email-campaign

 

 

Edited August 27, 2020 by ChessieCat

[Gridley]

6 hours ago, Cgomg said:

 

i don’t whether to take 10mg this morning or 5mg 

Alto is very knowledgable about these drugs.  If she recommends taking 10mg without the benzo, I'd follow her advice.

13 hours ago, Altostrata said:

 

 

If I were you, I'd reduce to 10mg. Even 5mg might be enough, but see if reduction to 10mg lowers the activation to the point you don't need a benzo.

 

[Cgomg]

I took 10mg but tricky because I don’t have the liquid yet but I did the 20mg in 20ml water and then drank 10ml 

 

I know it’s not an exact way of doing it but better than nothing .

 

i did take 1mg Benzo this morning my anxiety was awful but I know I can’t take them and will stay away from them unless I’m completely manic if that’s ok ?

 

I’m really hopeful that I’m getting my support systems in order as well which will help with anxiety

 

i can’t thank you all enough xx

 

i want to ask your advice about my mum who has been on fluoxetine long term and who’s health is dreadful and it’s breaking my heart which topic board should I post it on ? 
 

 

 

 

[Erell]

2 hours ago, Cgomg said:

I know it’s only because he’s so worried about me and also because he like me was brought up to “trust the doctor” 

 

I don’t know right now which is worse the shock of withdrawal or the shock of knowing what’s going on for people da after day and doctors and psychiatrists just deny it or ignore it !!!

 

Hello Cgomg 

 

You don't sound stupid at all. We are all here because we trusted what we've been told. 

You're not alone in this.

Fortunately,  lot of people have been there before us, and thanks to their testimonies we are able to highlight some patterns.

 

I can only ditto the advice : if 20mg cause too much activation, you might feel better with a lower dose. 

Once a CNS is destabilised,  more is not necessarily better.

 

Let us know how you're doing ❤

[Cgomg]

I took 10mg but tricky because I don’t have the liquid yet but I did the 20mg in 20ml water and then drank 10ml 

 

I know it’s not an exact way of doing it but better than nothing .

 

i did take 1mg Benzo this morning my anxiety was awful but I know I can’t take them and will stay away from them unless I’m completely manic if that’s ok ?

 

I’m really hopeful that I’m getting my support systems in order as well which will help with anxiety

 

i can’t thank you all enough xx

 

i want to ask your advice about my mum who has been on fluoxetine long term and who’s health is dreadful and it’s breaking my heart which topic board should I post it on ? 
 

 

 

 

[Cgomg]

Sorry I’ve realised I’ve missed a drug off my list 3 years ago when I went back on fluoxetine I was given pregablin as well !!! 
 

my memory is only just beginning to function again after the last couple of days ! I’ll add it to my signature - I think I took it for about 2 months but I can’t remember the dose I just remember I didn’t like it - god it’s worse than I remembered it all seemed so reasonable when I was given them !!!!

[Cgomg]

And now I think about it I took diazepam 1mg over a period of 3 weeks about 4-5 weeks ago - we were moving house and I had terrible pain in my neck and I thought diazepam would help ! I didn’t take it everyday just over about 3 weeks as I packed the house up and moved I had pain pain killers couldn’t shake off and took the last of the ones I’d kept from the last time I had them .

 

i never related taking them either to being addicted as I take them very intermittently or to the fact that I was already in withdrawal and the pain was withdrawal not from packing and moving 

 

I’m sorry I’ve had to add these details I wasn’t withholding it’s just I was so anxious when I joined I’m only just sitting down and actually remembering what’s been going on for me and things are coming back to me 

 

I’ll update my signature accordingly 

[Cgomg]

I also need to add after a particularly painful operation in January I was given a weeks worth of zopiclone because I couldn’t sleep due to pain - I’m only adding it as it seems despite my additional drugs being intermittent or even once only they will all have added to my instability .

[composter]

11 hours ago, Cgomg said:

my best guess and safest guess would be 3 a week for a couple of weeks then down to  2 and 1 in the last 2 weeks before finally stopping.

Based on this I do think that your body is probably more adjusted to that ~11 mg equivalent from taking 4 per week rather than anything lower since the 3 and 2 per week happened only for the last month. So the 10 mg would be our best guess for you to stabilize. Of course we can continue to monitor how you’re doing on this. Give it about 4-7 days to see how you’re feeling. It helps to take notes on paper with your symptoms and the dates you made drug changes. I suggest you do this to the best of your ability and fill out symptoms and doses for the past month as well. 
 

4 hours ago, Cgomg said:

 

I took 10mg but tricky because I don’t have the liquid yet but I did the 20mg in 20ml water and then drank 10ml 

 

I know it’s not an exact way of doing it but better than nothing .

 

i did take 1mg Benzo this morning my anxiety was awful but I know I can’t take them and will stay away from them unless I’m completely manic if that’s ok ?

 

I’m really hopeful that I’m getting my support systems in order as well which will help with anxiety

 

Good! This is actually a great method to use as long as you did so using a syringe or similar method of measuring mL. 
 

If I were you I would stay away from the benzo. You don’t want to end up dependent on this drug and have to taper off from this as well. I understand it can feel like an easy fix to get relief from anxiety but you’ll need to do your best to find non-drug techniques to soothe the anxiety. Personally I enjoy listening to relaxing music from YouTube, going for light walks, sitting in the sunshine, and talking with trusted family and friends. These all helped to manage the withdrawal anxiety. 
 

Alto believes that you felt surges of anxiety because the 20 mg reinstatement was too high. Hopefully with 10 mg now your system will settle. 
 

Glad you’re thinking about your support systems. This will be very helpful for you. 
 

Remember we all went through the same experience as you...having the rug pulled from under us and having our eyes open to the harm done by these drugs. It’s normal to feel frustrated and upset by the mess in general but with the documentary Chessie described above and even emerging medical research, the word is getting out and medicine is being forced to acknowledge what’s going on. 
 

Your husband will need to trust that you can trust your own judgement and you are listening to your body. Also you can remind him that the psychiatrist you consulted with recently agreed its withdrawal and even suggested that 10 mg reinstatement independently. We heard your case and symptoms as well and figured 10 mg would be safe. 
 

4 hours ago, Cgomg said:

I want to ask your advice about my mum who has been on fluoxetine long term and who’s health is dreadful and it’s breaking my heart which topic board should I post it on ? 

It’s very difficult for us to help with a relative and not the person themselves. As you can imagine it’s hard to get an objective understanding and account and also the person has to be willing to taper properly. We never know if there are other things going on.