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N-acetylcysteine (NAC)


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No, I don't take potassium, but will try that.  Magnesium does seem to help, and I do take fish oil but have never noticed a direct impact.  I shouldn't actually say that it's worse at night, because it also gets bad (and more distinctly uncomfortable) when I push myself mentally or when I exercise.

 

I wasn't suggesting that I'm atypical, just that autonomic dysfunction doesn't seem to tell the whole story.  But perhaps no one has ever said that.  I do think it's also unusual that my withdrawal symptoms didn't become acute until a full 2 months after I stopped the medication---I basically had no symptoms for a month; insomnia and cogntive problems started about 6 weeks in.  But perhaps that's not uncommon---I don't keep up with all the postings here. 

 

I suppose I'm still chasing the dream of figuring out some underlying pathology that might clarify treatment protocols, especially when it comes to cognition.  Your glumate theory seems like the best thing going---and I'm grateful for the knowledge and insight that constructed it, and don't think its a stretch to say that you are probably the person who has the most knowledge about this condition in the world---but it seems to be based largely on one animal study that wasn't really exploring the unsual condition that we all suffer from, and buttressed by the that fact that lamotrigine helped you.  It's not even entirely clear to me that the people that have severe, protracted problems can be said to have the same thing that people that have the brief withdrawal problems do, just in a more amplified and protracted form.  I have friends who have been on high doses of SSRI's, and have had upon discontinuation, say, brain zaps and other unpleasant symptoms for about a week, and then are completely fine; no hypersensitivity, etc.  That's obviously not novel information to anyone, but my point is: can what we have really be considered just an intensified and protracted version of this same phenomenon?  I had no brain zaps, no nausea, no temperature sensitivity, and no real symptoms of "withdrawal" for weeks.  This is why it makes more sense to me to talk about neurotoxity or "tardive" phenomena as thoughtful physicians like Healy and Shipko do.  There are some decent scientific theories about what causes, say, tardive dyskinesia or akathisia, and some decent treatments for those conditions.  And, terrible as those phenomena must be, they don't seem to be as horrifically systemic or comprehensive as our problems (in other words, my sense is that you can have tardive dyskinesia and the rest of your neurological functioning can be completely normal).  It almost makes me wish that there could be some systematic scientific investigation of our brains, tedious as that would be for us participants.

 

Sorry for the abstract discourse.  I know that most of us (myself included) are mostly just trying to get on with our lives and get what little relief we can from magnesium, fish oil, etc.  But I'm an academic by training and temperament, and every few months I just get the itch to understand better what's happened.  Hence these posts.  So for instance, what is our hypersensitivity?  Allergists know what hypersensitivity means in their context.  Pain specialists have some sense of what "central sensitization" is, but neither of these is as physiologically comprehensive as our experiences.  As far as I know, this is the only medical condition where people aren't able to take medications to help them feel better, including other difficult to theorize conditions like fibromyalgia or CFS.  When one takes a step back, it's a bizzare thing to realize, and surely there's some sort of general pathology that explains this fairly uniform experience.  I'm not so naive that I think that even understanding the pathology would lead to a clear treatment.  I think everyone who's been afflicted by this and has tried to do amateurish research has discovered how little anyone knows about the brain.  But I can't help but feel that understanding the pathology would at least be a step in the right direction. 

 

I hope this isn't taken as quarrelsome or difficult---it isn't meant to be.  It probably should be in a letter to my Congressman or something.

 

Oh yeah, and the pragmatic question: what did you mean by testing for inflammation?

-300 mg Wellbutrin 2002-2005 (withdrew cold turkey with only mild complications)

-150 mg Wellbutrin, 10 mg Celexa 2006-2010

-Discontinued both cold turkey Jan 1 2011

-Unsuccessfully reinstated Celexa March 2011, but stuck with it until Jan 2012.

-Remeron 7.5 since Jan 2013---only thing that puts a dent in perpetual headache and "akathisia"

6.5 mg Lamictal since Dec 2012

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I thought I should let people know that NAC has been only the thing that has made my severe case of SSRI neurotoxity (I follow Shipko in calling it this rather than withdrawal, for reasons that also h

  • Administrator

There are some general blood tests for inflammation which can indicate if you have an underlying organic condition.

 

You are correct, no one knows exactly what's going on. If you read up on autonomic instability, you may find the best model for iatrogenic dysregulation. No one knows exactly what's going on there, either.

 

The normal functions of the body are extremely complex and interdependent. This is denied by psychiatry's "chemical imbalance" model, which held, erroneously, that psychiatric drugs correct hormonal abnormalities in the brain and disregarded any systemic effects.

 

Psychiatric drugs affect the entire body. (The very common side effect of sexual dysfunction is evidence of this.) If you're lucky, the effects are so subtle, you won't notice them. They alter hormonal functioning of every kind. The body adjusts to their presence with normal mechanisms to maintain homeostasis. The autonomic nervous system is a network of these feedback loops.

 

But, upon discontinuing, those homeostatic mechanisms can be overwhelmed. Long-term chemical interference may have weakened them. The complex network may wobble imperceptibly for a while, then dominoes start to fall as it fails in various areas. This is why noticeable symptoms are sometimes delayed.

 

Still, the body struggles to regain a natural balance, and this is why you have waves and windows and changing symptoms. Because it is a complex system, it can't repair itself all at once, it heals in patches which finally coalesce in noticeable improvement. And because its stability is tenuous, only very gentle interventions can be used to support healing or we experience what we sense as paradoxical reactions or other destabilization.

 

(See http://survivingantidepressants.org/index.php?/topic/749-andrews-2011-blue-again-perturbational-effects-of-antidepressants/

I had extensive correspondence with the author, Giovanni Fava, and Robert Whitaker about whether the homeostatic mechanisms were broken or only temporarily malfunctioning. Since we do see improvement over time, temporary malfunction seems more likely.)

 

It's pretty clear these symptoms are neurological, and not due to organic injury. To my knowledge, hundreds of people with withdrawal syndrome have had various tests and scans and nothing physical has shown up. This would be consistent with a problem of autonomic nervous system dysregulation.

 

(There is other evidence for glutamatergic disinhibition in the Journals section. After 6 years of research, I got tired of writing a PhD dissertation every week, so the source material is there but not summarized.)

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

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

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Thanks, Alto.  I understand that you've explained yourself to death over the years.  I think I understand the basic theory of autonomic dyregulation, and it makes perfect sense.  I guess what I still don't understand is the way in which autonomic dysregulation can affect cognition.  I get how it would cause sensory and affective problems---pain, insomnia, anxiety, depression---but it's less clear to me how it could cause, say, visuo-spatial problems.  (Though as I write this I've just found a pubmed abstract suggesting that the ANS can impact cognition more than we think, so perhaps there's my answer: http://www.ncbi.nlm.nih.gov/pubmed/8725968

 

One of my biggest frustrations early on with the doctors, including my brother, was the repeated claim that my cognition was bad because I was depressed or anxious.  (It's amazing how this wooly, catch-all abstraction, "major depressive disorder"---how do you know you have it?: you sleep too much... or too little; you eat too much.... or too little---becomes reified into a cause of anything else wrong with you.)  I knew very well that this was not the case, and that much of my depression and anxiety was actually caused by the fact that I was having to try to continue my academic performance with seriously compromised cognition.  The neuropsych testing finally validated this.  Do you have any theories as to how autonomic dysregulation impacts cogntition?  Is it as simple as the fact that everything in body or nervous system is connected?  It's easiest for me to understand how it might impact attention, slightly harder to understand how it could impact memory, and perhaps the most difficult to understand how things like visuo-spatial processing would be affected.  No need to respond to this if you feel like you've been over this ground before.

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-300 mg Wellbutrin 2002-2005 (withdrew cold turkey with only mild complications)

-150 mg Wellbutrin, 10 mg Celexa 2006-2010

-Discontinued both cold turkey Jan 1 2011

-Unsuccessfully reinstated Celexa March 2011, but stuck with it until Jan 2012.

-Remeron 7.5 since Jan 2013---only thing that puts a dent in perpetual headache and "akathisia"

6.5 mg Lamictal since Dec 2012

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Autonomic dysregulation could impact cognition in any number of ways as it affects circulation and timing of all hormonal releases. You'll have to do more research on its effect on cognition; please share your findings in a new topic here.

 

It could also be a problem in the Krebs energy cycle (NAC facilitates this) http://www.ncbi.nlm.nih.gov/pubmed/19821517

 

Those of us suffering withdrawal syndrome often find our brains and senses are not working as we expect. This causes a great deal of anguish. It could be that when you reach, cognitively, and find nothing but fog, an emotional reaction plays a role, too.

 

Also, your own assessment of your functioning might not be what others see. You might be able to pass as much higher functioning than you feel. In your situation, where there probably is a lot of competition to display brilliance, you are wise to lay low in a less-demanding job. Little by little, your cognitive capacity will come back.

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

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

All postings © copyrighted.

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I just placed an order for this after reading it might protect against reactions from anesthesia, particular ones of an ototoxic nature which I would be a sitting duck for due to my hearing loss and tinnitus.  I do intend to make sure what I am going to be given isn't known for ototoxic  properties.   But that still doesn't totally protect me.

 

And thankfully, it  is not forbidden to take before surgery.  Yeah!

 

I will keep folks posted.

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Thanks, Alto.  I understand that you've explained yourself to death over the years.  I think I understand the basic theory of autonomic dyregulation, and it makes perfect sense.  I guess what I still don't understand is the way in which autonomic dysregulation can affect cognition.  I get how it would cause sensory and affective problems---pain, insomnia, anxiety, depression---but it's less clear to me how it could cause, say, visuo-spatial problems.  (Though as I write this I've just found a pubmed abstract suggesting that the ANS can impact cognition more than we think, so perhaps there's my answer: http://www.ncbi.nlm.nih.gov/pubmed/8725968

 

One of my biggest frustrations early on with the doctors, including my brother, was the repeated claim that my cognition was bad because I was depressed or anxious.  (It's amazing how this wooly, catch-all abstraction, "major depressive disorder"---how do you know you have it?: you sleep too much... or too little; you eat too much.... or too little---becomes reified into a cause of anything else wrong with you.)  I knew very well that this was not the case, and that much of my depression and anxiety was actually caused by the fact that I was having to try to continue my academic performance with seriously compromised cognition.  The neuropsych testing finally validated this.  Do you have any theories as to how autonomic dysregulation impacts cogntition?  Is it as simple as the fact that everything in body or nervous system is connected?  It's easiest for me to understand how it might impact attention, slightly harder to understand how it could impact memory, and perhaps the most difficult to understand how things like visuo-spatial processing would be affected.  No need to respond to this if you feel like you've been over this ground before.

Binx Bolling, blaming cognitive issues on depression and anxiety greatly angers me.  I know someone who experienced a memory loss from anesthesia and that is exactly what she dealt with during the 6 years she was trying to find a doctor to take her seriously.   Several suggested antidepressants.

 

I am glad you received validation from neuropsych testing.   My only concern is as one who had it several years ago is that many of them also believe that psych meds are wonderful.   So you have to be careful about that.

 

I hope things improve for you.

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Well, I took a 600mg capsule this morning and it seemed to affect my eye pressure which was judged to be high by an optometrist recently.  Yes, I do have an appointment with an opthalmologist although due it possibly being too soon after my surgery, I may have to reschedule it.

 

May try it one more time just to see if it happens again.

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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I started taking NAC a few weeks ago to hopefully combat obsessive skin picking. Since then, I've been spotting randomly and feeling kind of moody. My roommate also tried the supplement and started her period the next day. This is definitely messing with our hormones. Is this normal?

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I've never heard of that. Try Googling and let us know what you find.

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

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

All postings © copyrighted.

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  • 1 month later...

Thought I'd update this thread with my latest experience with NAC. I bought a bottle of the Now brand NAC 600mg with Selenium and Molybdenum about a year ago, and I have taken it occasionally when I have morning anxiety or early waking. (I don't take anything regularly because it will either stop working or go paradoxical, and these days I can sleep OK and have no major anxiety over half the time.) I usually take it at the same time as l-arginine, but I've had trouble recently with cold sores because of too much l-arginine (after years of not having them), so this morning I took it by itself.

 

I took one capsule (600mg) when I woke pre-dawn with anxiety, and I was able to go back to sleep... until 9:45am! It was a disturbed, dream-filled sleep, but it was sleep nonetheless. I feel almost drugged every time I take NAC, like my blood pressure lowers (but I have no evidence for that). It stopped my heart from pounding and I felt sleepy and calm in my body, and yet somehow there was still worry somewhere in me because the dread affected my dreams and was still there. Once I got out of bed, though, I felt good. Even now I feel more calm and collected... almost slow and lazy, which feels fantastic!

When I have taken it at night I feel like I sleep more deeply, but wake earlier, so  I prefer to reserve it for early morning or mid-night waking. If I take it more than two or three days in a row, though, it does nothing or I get worse. Even though it's not a "magic bullet", I plan on using it again sporadically when my morning anxiety rears its ugly head again (less and less these days). I think it's best not to take ANYTHING, but sometimes disrupting the down-spiral can help me interrupt the build of anxiety... in my experience that is when you start worrying about the anxiety itself and it feeds back into itself and makes it worse.

'94-'08 On/off ADs. Mostly Zoloft & Wellbutrin, but also Prozac, Celexa, Effexor, etc.
6/08 quit Z & W after tapering, awful anxiety 3 mos. later, reinstated.
11/10 CTed. Severe anxiety 3 mos. later & @ 8 mos. much worse (set off by metronidazole). Anxiety, depression, anhedonia, DP, DR, dizziness, severe insomnia, high serum AM cortisol, flu-like feelings, muscle discomfort.
9/11-9/12 Waves and windows of recovery.
10/12 Awful relapse, DP/DR. Hydrocortisone?
11/12 Improved fairly quickly even though relapse was one of worst waves ever.

1/13 Best I've ever felt.

3/13 A bit of a relapse... then faster and shorter waves and windows.

4/14 Have to watch out for triggers, but feel completely normal about 80% of the time.

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 I wish I would have known of NAC to take during Benzo Withdrawal. I did and still do take Chelated Magnesium

 which also contains the amino acids glycine and lysine. Very beneficial as a supplement during and after Benzo tapering.

 

Question on the NAC, I do have "residual" Benzo withdrawal symptoms that come and go. Adding NAC sounds like a good idea

for the anxiousness, nervousness, which occasionally rears its head. But reading further, it can be stimulating?

 

Would like to hear more from others in regards to this.

 

Thank you

Olivia

100mg Zoloft

Tapered 3 mg of Xanax to 2mg @.25mg cuts. 5/12-10/12  Seizure 6/12

1mg X tapered to 0 1/13-11/28/13 .0625mg compound caps

100mg Zoloft to Taper

 

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Yes... Alto provided an excellent explanation earlier in the thread.

 

I took another one at night to see what would happen, and I had a terrible night. I felt like the NAC was provoking a deeper sleep, and my mind fought against it. I kept waking up gasping like I was losing control... my mind was afraid to let go into the state the NAC was creating. This is something that used to happen to me regularly before, and one of the reasons I think things go "paradoxical"... whatever you are trying to do to calm down can alert your system to danger!

So... I might just reserve NAC for early AM anxiety. I'm still thinking it's best not to take anything at all, but I don't always have the willpower to "tough it out"!

'94-'08 On/off ADs. Mostly Zoloft & Wellbutrin, but also Prozac, Celexa, Effexor, etc.
6/08 quit Z & W after tapering, awful anxiety 3 mos. later, reinstated.
11/10 CTed. Severe anxiety 3 mos. later & @ 8 mos. much worse (set off by metronidazole). Anxiety, depression, anhedonia, DP, DR, dizziness, severe insomnia, high serum AM cortisol, flu-like feelings, muscle discomfort.
9/11-9/12 Waves and windows of recovery.
10/12 Awful relapse, DP/DR. Hydrocortisone?
11/12 Improved fairly quickly even though relapse was one of worst waves ever.

1/13 Best I've ever felt.

3/13 A bit of a relapse... then faster and shorter waves and windows.

4/14 Have to watch out for triggers, but feel completely normal about 80% of the time.

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  • 3 months later...

Have had amazing results from this supplement.  I have gotten more done in a few days than I have in months.   And today, even t though my sleep was horrible last night, got more done than usual today.

 

I sure hope though it wasn't the cause of my having a higher than normal apnea index last night and causing a wakening after an hour on the machine due to a choking dream.   I will be horribly upset if the remedy is doing that but hopefully, it wasn't the cause of what happened last night.

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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That's good news, cs. Perhaps you can also add in the dietary ways to boost glutathione?

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

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

All postings © copyrighted.

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That's good news, cs. Perhaps you can also add in the dietary ways to boost glutathione?

Here you go:

 

http://www.immunehealthscience.com/glutathione-foods.html

 

Asparagus and Avocados have the highest amount.

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Ha! Had asparagus last night.

 

Looks like ingesting glutathione precursors, our old pals the cruciferous veggies, are the best way to increase glutathione.

 

Interesting that black cumin seed (nigella sativa) is on the list. GiaK has written about it regarding histamine intolerance, as a natural antihistamine.

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

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

All postings © copyrighted.

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  • 6 months later...

I am really thinking about trying this to take it during the day. I did try avocado as it is also very high in glutathione. I can not remember if it had a huge effect but I will try again.

 

I can get hold of l-cysteine easier than NAC. As I understand they are very similar, it seems that NAC converts to l-cysteine and then to glutathione. So will it have the same effect? 

 

 

from wikipedia:

 

 

Acetylcysteine serves as a prodrug to L-cysteine which is a precursor to the biologic antioxidant, glutathione and hence administration of acetylcysteine replenishes glutathione stores.[5] L-cysteine also serves as a precursor to cystinewhich in turn serves as a substrate for the cystine-glutamate antiporter on astrocytes hence increasing glutamate release into the extracellular space. This glutamate in turn acts on mGluR2/3 receptors, and at higher doses of acetylcysteine, mGluR5.[56][57] Glutathione also modulates the NMDA receptor by acting at the redox site.[36][58] Acetylcysteine also possesses some anti-inflammatory effects possibly via inhibiting NF-κB and modulating cytokine synthesis.[36]

1st short round: from 2012 april ~ july 

Sertraline 50mg with 1mg Larazepam fast wd few problems

 

2013 may - 2014 january:  75mg Effexor XR +  1mg Rivotril + 10mg Ambien(zolpidem)

2014 january ~ june :        150mg Effexor XR +  2mg Rivotril    cold turkeyed both almost at the same time (crazy wd of course)

 

two days after cold turkey of Effexor I started 10mg of Lexapro for around a month then did a fast taper (for some days took little Ambien to combat wd)

 

Reinstated to 1mg of Klonopin on 2015.04.23  took the 1mg total for 10 days.  I did in three divided doses 0.25 morning + 0.25 afternoon + 0.5 before sleep.  

Now: 1 mgs total K, divided into .75 night .25 day

 

Started taking 3mg Lamictal on 05.07...... Slowly tiltrated up to 6mg....

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1+ for NAC for me.

500 mg has a day has helped he a lot.

But I will have to give it 2 months to be sure.

It has only been a week. And I tend to go up and down in waves.

 

Cheers

 

Damien

Off all SSRIs as at November 2016.

 

Been on SSRIs (mainly Lexapro) for around 15 years.

failed attempts to go cold turkey before I got proper info on it.

Over last 2 years I've slowly gone from 20 mg Lexapro to 2.5 mg Lexapro.

on 25th Jan 2015 I've now moved to home made liquid Lexapro.

Plan is to drop roughly 0.2 mg per month over the next 1-2 years.  

25th Jan 2015 2.5 mg Lexapro liquid.

24th Mar 2016 1.0 mg lexapro (crushed tablet mixed and refilled into capsules)

Planned to be at 0.0 mg lexapro by about October 2016. 

I also take 50-100 mg modafinil per day, no short term plans of stopping/tapering modafinil but will re-evaluate after I'm off lexapro. 

 

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  • 2 months later...
Laura1981

Hey Damien,

 

I was just curious how the NAC experiment is going. What symptoms did it help with? 

 

I'm always careful with new supplements now, but I still have annoying brain zaps, fatigue, headaches and tingling feeling in the brain, so I am still curious to give it a try.

 

Cheers,

 

Laura

Feb 2015 Took venlafaxine for 5 days only... experienced withdrawal that made me completely non-functional

Mar 2015 took under 1mg of Sertraline for 10 days in an attempt to combat Venlafaxine withdrawal. Got adverse reactions. 

After stopping Sertraline, withdrawal got much worse. New, horrific symptoms. 

June 2015 Still non-functional but slowly getting better. Still brain zaps, migraines, sweating, heart racing, depression, crying spells

September 2015: 24/7 brain zaps, twitches in the face, no concentration, bad memory, language skills deteriorating. 

 

Profile feed: http://goo.gl/3g2GRn

 

Sign this petition for a blackbox warning on Prozac in Ireland:

https://www.change.org/p/leo-varadakar-hpra-the-lack-of-a-blackbox-warning-on-prozac-in-ireland-and-its-use-by-the-hse-in-under-18-s?recruiter=63289046&utm_source=share_petition&utm_medium=facebook&utm_campaign=share_for_starters_page&utm_term=des-lg-no_src-no_msg

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Hi Laura,

I still take it though it isn't a magic cure.

It has some great advantages.

Virtually no side effects.

Cheap.

 

If I was guessing it probably helps about 10% better/healthier.

 

It doesn't help any specific wd symptoms that I can tell except a small boost to energy levels.

 

Cheers

 

Damien

Off all SSRIs as at November 2016.

 

Been on SSRIs (mainly Lexapro) for around 15 years.

failed attempts to go cold turkey before I got proper info on it.

Over last 2 years I've slowly gone from 20 mg Lexapro to 2.5 mg Lexapro.

on 25th Jan 2015 I've now moved to home made liquid Lexapro.

Plan is to drop roughly 0.2 mg per month over the next 1-2 years.  

25th Jan 2015 2.5 mg Lexapro liquid.

24th Mar 2016 1.0 mg lexapro (crushed tablet mixed and refilled into capsules)

Planned to be at 0.0 mg lexapro by about October 2016. 

I also take 50-100 mg modafinil per day, no short term plans of stopping/tapering modafinil but will re-evaluate after I'm off lexapro. 

 

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Laura1981

Hi Damien,

 

thanks a lot! I'll give it a try. I tried 100mg yesterday. I have the feeling the headache and brain zaps are less.

 

But that could be down to the spa-day I had yesterday as well ;-P

 

Cheers,

 

Laura

Feb 2015 Took venlafaxine for 5 days only... experienced withdrawal that made me completely non-functional

Mar 2015 took under 1mg of Sertraline for 10 days in an attempt to combat Venlafaxine withdrawal. Got adverse reactions. 

After stopping Sertraline, withdrawal got much worse. New, horrific symptoms. 

June 2015 Still non-functional but slowly getting better. Still brain zaps, migraines, sweating, heart racing, depression, crying spells

September 2015: 24/7 brain zaps, twitches in the face, no concentration, bad memory, language skills deteriorating. 

 

Profile feed: http://goo.gl/3g2GRn

 

Sign this petition for a blackbox warning on Prozac in Ireland:

https://www.change.org/p/leo-varadakar-hpra-the-lack-of-a-blackbox-warning-on-prozac-in-ireland-and-its-use-by-the-hse-in-under-18-s?recruiter=63289046&utm_source=share_petition&utm_medium=facebook&utm_campaign=share_for_starters_page&utm_term=des-lg-no_src-no_msg

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  • 6 months later...

Been taking 500mg every morning for maybe a month. Not sure if I notice anything either way.

10/2012 - Lexapro 10mg

2013/2014 - Started experiencing visual disturbances, like visual processing was slow, feeling drunk all the time

9/2014 - Lexapro 5mg, didn't notice any withdrawal, drunk feeling went away

2015 - Drunk feeling came back

5/2015 - Lexapro 2.5mg - 1.25mg - insomnia started

6/2015 - Lexapro 0.625mg

7/2015 - Severe symptoms started, in desperation on advice of pdoc restarted 5mg Lexapro - total disaster

8/2015 - Lexapro 5mg, disoriented, sleepless zombie

9/2015 - Very reluctantly started transitioning to Zoloft

as of 10/10/2105 - no lexapro, 37.5mg Zoloft

12/14/2015 - 35mg zoloft, 1/16/2016 - 34mg

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  • 1 month later...

Just want to put in my experience with NAC - tried two different brands from iHerb and it didn't work for me and I got REALLY anxious and even more depressed and my brain wouldn't shut up.

 

-1 from me...

 

I do take glutathione and it has worked really well for me. I have a bottle at work and I take it when I get over-anxious at work.

Prescribed Lexapro in 2003 and switched to Cipramil (5-10mg per day) 2004 with Lamictal.

Stopped Lamictal cold turkey with no withdrawals in 2014 with support of a Paleo diet. 

2003-2015 Cipramil only: 5mg 21 Dec 15: 2.5mg 28 Dec 15: 2.25mg 4 Jan 16: 1.575mg 10 Jan 16: 1.1025 11 Jan 16: 0.7875 25 Jan 16: 0.9, 1 Feb: 0.8, 8 Feb 0.75, 15 Feb 0.5, 29 Feb 0.25, 21 March 0.17, 4 April: 0.10, 25 April 0.05, 8 May 2016 0.05, 15 May 2016 NIL 21 June 2016 0.1, 5 Sep 16: 0.2 7 Sep 16: 0.15 16 Sep 16: 0.075 3 Oct 16: 0.015 17 October: 0.015, 14 Nov 2016: Reinstate 0.005, 26 Dec 16 0.0045, 2 Jan 17 0.004, 20 Feb 17 0.003, 3 Apr 17 0.002, 22 May 17 NIL. 

Supplements/Lifestyle: Paleo/AIP protocol, daily exercise, low histamine and salicylate diet. Church/mediation all the time! No supplements from March 2021 post pregnancy in Oct 2020. 

 

 

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  • 1 month later...

The reason such high doses are needed is because not enough gets into your intestines to be absorbed because the stomach acids destroy it. Try taking the recommended dosage along with two ginger pills. The ginger pushes the stomach contents through rapidly allowing more in your intestines. Or also find a brand that has a capsule or coating that is resistant to hydrochloric acid

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  • 3 months later...
downtongirl

I have had some genetic testing done by an integrative medicine doctor and I have a double mutation strain of the MTHFR mutation and am ABSENT for the COMT enzyme and the dr. has suggested for me to take NAC, L Methyl folate, and L glutamine.....I guess I should try....anyone else have these mutations and these supplements help them?

1995 - 2015 antidepressants and antianxiety medicine
Multiple failed attempts to quit/taper anti d/anti anxiety meds since 2008

June 17, 2016 began prozac bridge to get off of effexor xr, stopped effexor xr on June 24, 2016, could not tolerate prozac due to severe side effects so I had to stop it  Currently...300 mg ER of lithium, 1 mg of estradiol, 60 mg propranolol ER, Fish oil 2 x a day, Magnesium Glycinate,  zinc, vitamin c, vitamin d, NAC

 

 

 

 

 

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  • 3 months later...

 

What's confusing about this is that it should increase Glutathione which modulates NDMA receptors (hence its use in treating OCD) which could in theory alleviate the glutamatergic over activation that leads to anxiety/panick in withdrawal. However, L-cysteine also serves as a precursor to cystine which in turn serves as a substrate for the cystine-glutamate antiporter on astrocytes which increases glutamate release into the extracellular space, which we would theoretically want to avoid during glutamergic over activation. Perhaps the former outweighs the latter effect?

 

Good to hear from you, Binx, and good to hear NAC has been helpful.

 

I agree, autonomic dysfunction is highly various. The autonomic nervous system controls so many functions, the permutations are endless.

 

Don't worry about the "silver star" error -- many make it! It takes a bit to get used to the layout of the posts.

 

The neuropathic pain is an autonomic symptom (fibromyalgia is also thought to have an autonomic component). I had it for about 1.5 years in my hands, arms, and shoulders. It seemed to resolve with acupuncture.

 

The autonomic nervous system controls muscle tension, blood vessel dilation, nerve conduction and other subtle operations that might be the source of your neuropathic pain. Inflammation might also be involved (did you get tested for this?)

 

NAC is a precursor of glutathione http://www.jissn.com/content/2/2/38

Glutathione is involved in many immune system cell repair functions. (It's sometimes called an antioxidant, but that doesn't explain everything it does.)

 

From the paper abstract at http://www.sciencedirect.com/science/article/pii/S0163725813001952

N-acetyl-l-cysteine (NAC) has long been used therapeutically for the treatment of acetaminophen (paracetamol) overdose, acting as a precursor for the substrate (l-cysteine) in synthesis of hepatic glutathione (GSH) depleted through drug conjugation. Other therapeutic uses of NAC have also emerged, including the alleviation of clinical symptoms of cystic fibrosis through cysteine-mediated disruption of disulfide cross-bridges in the glycoprotein matrix in mucus.

 

....

This review seeks to re-evaluate the mechanism of action of NAC as a precursor for GSH synthesis in the context of its activity as an “antioxidant”. Results from recent studies are examined to establish whether the pre-requisites for effective NAC-induced antioxidant activity (i.e. GSH depletion and the presence of functional metabolic pathways for conversion of NAC to GSH) have received adequate consideration in the interpretation of the data. A key conclusion is a reinforcement of the concept that NAC should not be considered to be a powerful antioxidant in its own right: its strength is the targeted replenishment of GSH in deficient cells and it is likely to be ineffective in cells replete in GSH.

Curr Opin Pharmacol. 2007 Aug;7(4):355-9. Epub 2007 Jun 29.

N-Acetylcysteine--a safe antidote for cysteine/glutathione deficiency.

Atkuri KR, Mantovani JJ, Herzenberg LA, Herzenberg LA.

 

Abstract at http://www.ncbi.nlm.nih.gov/pubmed/17602868 Full text at http://www.mediafire.com/view/3tyroedsbc6f6bf/07_Atkuri_n-acetylcysteiine.pdf

 

Glutathione (GSH) deficiency is associated with numerous pathological conditions. Administration of N-acetylcysteine (NAC), a cysteine prodrug, replenishes intracellular GSH levels. NAC, best known for its ability to counter acetaminophen toxicity, is a safe, well-tolerated antidote for cysteine/GSH deficiency. NAC has been used successfully to treat GSH deficiency in a wide range of infections, genetic defects and metabolic disorders, including HIV infection and COPD. Over two-thirds of 46 placebo-controlled clinical trials with orally administered NAC have indicated beneficial effects of NAC measured either as trial endpoints or as general measures of improvement in quality of life and well-being of the patients.

 

Mark Hyman's opinion

Glutathione: The Mother of All Antioxidants

http://www.huffingtonpost.com/dr-mark-hyman/glutathione-the-mother-of_b_530494.html

 

Whey protein isolate also boosts glutathione production. Both NAC and whey protein isolate are often recommended for chronic fatigue syndrome, another mysterious condition with an autonomic component, the symptoms of which overlap with withdrawal syndrome. See paper at http://www.ncbi.nlm.nih.gov/pubmed/11703165

 

 

I have no idea if your benefit from NAC is because of the glutathione connection or something else. These reactions are so complex. But whatever works, works, and thanks for telling us about this.

 

...I did notice after I quit it that it contains a sulfa component. I was always wondering about the color of the material. It definitely is orange. Long story short, I've had a sulfa allergy my whole life. I wasn't sure that was the reason for the reaction I had to it.....

NAC does NOT contain sulfa; it is a sulfur compound -- sulfa and sulfur are entirely different!

Medication before problems: Took Paxil 60-100mg from 2003 to 2014 for OCD.
1) Last pill taken November 2014, horrendous withdrawal started six weeks later.

2) Re-instated successfully @ 20mg May 2015, but accompanied by severe anhedonia, loss of emotion, apathy, and fatigue

3) Switched to Prozac, Viibyrd, Zoloft, Nefazadone, Cymbalta, Nardil in attempt at abating WD symptoms while not re-introducing anhedonia. Each one either failed to relieve WD or brought back anhedonia. So re-stabilized on Paxil at 15mg

4) Tapered down to 7.5mg as of October 2016. More energy, anhedonia/loss of emotions remains apart from short windows.

5) May 2017 - down to 3.5mg of Paxil (no other meds)
6) Early 2018 - added 8mg of Prozac
7) January 2019 - down to 1.05 Paxil / 5mg Prozac and continuing

8) October 2019 - down to 0.2mg Paxil / 3mg Prozac

9) November 2019 - down to 0.1mg Paxil / 3mg Prozac 

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  • 9 months later...
On 4/12/2014 at 5:20 AM, Nadia said:

I feel almost drugged every time I take NAC, like my blood pressure lowers (but I have no evidence for)

 

I feel exactly the same way. I was on and off it for about a year and when I raised my concerns with my Naturopath Doc, she simply stated it cannot be harmful because it is not classed as a drug. I was prescribed L-Carneteine and CoQ10 to go with NAC and the first two are ok. They take away some of the neorological back and neck pain. I will only take a quarter teaspoon of NAC like others have said before bed if I just want to get some sleep.

 

As of 2017, I have a really bad feeling about NAC and would rather just stick to a tried and tested SSRI. What is the consensus ?

 Cymbalta, Zyprexa, Seroquil, Rispiridone, Valium, Zoloft, Clonazepam,. + 1 other Benzo. Total 11 yrs.

·           April 9th 2018 Hospital. 50mg Zoloft > 0 discontinued. 6mg Clonazepam > 2.5mg over 8 weeks stay.

           October 25th 2019: Hospital:  Clonazepam Bridged 1mg > to 20mg Diazepam.

           

           Anafranil: 90mg

      
  Diazepam (V): 25th October 2019, 20mg. 22 Dec 2019 19mg. 4 April 20: 18mg,  30 September: 17.5mg , 13 November 20: 17mg 01 January 2021: 16mg,

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  • 3 months later...
neurotransmission

This thing works in a different way. there is a sweet spot and titration that should be done is different person to person. its effect can dissapear after weeks. But in some person just popping high doses can immidiately improve some ssri withrawall issues and wellbutrin-adderal-ritalin withrawalls. It can give some guys sedative eeffect when you are above sweet spot. its stabilizing dopamine and preventing dopamine receptor upregulation. There is a lot of guys using it for using less ritalin,adderal for adhd even using less cocaine,mdma for recreational abuse.

on the sweet spot, you can get:

less anxiety from coffee and other stimulans and more motivation, alertness.

it can cure some type of OCD which is ressistant to ssri/antipsycotic combos. BTW Memantine is a far more potent agent which is working from the same pathway for ocd.

it can potentiate ssris and speed up onset action, (getting 10mg effect from 5mg lexa)

if you use it for weeks and start ritalin again you get can what you are getting from 10 mg  only from 2.5 ritalin like me.

it can prevent or reduce anxiety from stimulants and stimulant like antidepressants.

it is also very beneficial for humidity problems in nose after radiofrequency turbinate reduction for me.

 

 

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  • 3 months later...

Anybody has some results for akathisia with this? I found some positive comments on other forums from people saying it helped them very much with akathisia even when on neuroleptics. I asked Dr Shipko about it today too. Waiting on his reply. Probably going to try it one of the coming days.

I have brutal akathisia from morning until noon, and a bit less in the afternoon, and mostly gone in the evening. So I'm going to take it in the morning. I'll post my progress. Propranolol 20mg takes the edge of the akathisia now, but I'd rather not increase this.

 

 

 

 

Origin of Panic Attack and Anxiety Disorder: Overdose of Hallucinogenic HOT-7.

2013-09 20mg escitalopram. In the 4 first months 0.5-1mg/day Alprazolam for sleep & difficult situations.

Tapered the first time from 20mg to 0mg in 17 months or so. Withdrawal 6-8 weeks after last dose. Didn't taper enough to low enough doses (+-1mg).

2015-01-02 Back on 10mg after one week of delayed withdrawal. Stable in 8 days.

Second time tapered 2 years from 10mg to 1.6mg. Stable for half a year in range 2.5mg-1.6mg.

2017-07-28 Measurement errors: went for 1-2 weeks on 2mg. Restlessness and anxiety. Tried back to go back to 1.7mg for 5 days. Anxiety stayed.

2017-08-03 - 2017-08-20 Switched to liquid Lexapro 20mg/ml (1 drop is 1mg). Updosed to 2mg hoping to stabilize. Horrible Panic and Anxiety. Hold for 17 days hoping to stabilize. Didn't work enough for me at the time.

2017-08-20 End of holiday approaching. No more time. Decision to up dose to 5mg escitalopram. Back to the pills. Tapering alprazolam.

A lot of side effects: Akathisia, more anxiety, very troubling sleep, every thought and movement gave me panic attacks. Worst time of my life. I did learn coping skills in this period. A lot. Mastering meditation, mastering floating technique and more Claire Weekes stuff... Can handle extreme anxiety pretty decent now.

2017-09-30 Going down again because holding got worse almost every day. ADVICE TO OTHER ESCITALOPRAM PEOPLE, if updose doesn't work in two weeks, go down again!!! WD is not as brutal as adverse updose effects! After every taper (while tapering pretty manageable, after couple weeks holding, akathisia and extreme anxiety came back)

2018-01-29 Got to ZERO. A hard way down for sure. And now hoping for improvements along the way... Tapering melatonin gave me dystonic reactions however.
14 months after zero: Alternating akathisia, dystonic reactions and WD. Very unstable. No meds whatsoever. 31 months after zero: dystonia got worse, still very high anxiety, and many symptoms... no healing in sight. Adverse reaction destroyed me.

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NAC so far after a couple of days:

 

600mg in the morning and 600mg in the evening - Take it with food in the morning, otherwise too hard on the stomach (and I have never had stomach issues!)

 

Mood more stable, less WD symptoms. Overall good impression, so far the best supplement I have tested. Fishoil and magnesium doesn't do much for me.

 

 

 

 

 

 

 

 

Origin of Panic Attack and Anxiety Disorder: Overdose of Hallucinogenic HOT-7.

2013-09 20mg escitalopram. In the 4 first months 0.5-1mg/day Alprazolam for sleep & difficult situations.

Tapered the first time from 20mg to 0mg in 17 months or so. Withdrawal 6-8 weeks after last dose. Didn't taper enough to low enough doses (+-1mg).

2015-01-02 Back on 10mg after one week of delayed withdrawal. Stable in 8 days.

Second time tapered 2 years from 10mg to 1.6mg. Stable for half a year in range 2.5mg-1.6mg.

2017-07-28 Measurement errors: went for 1-2 weeks on 2mg. Restlessness and anxiety. Tried back to go back to 1.7mg for 5 days. Anxiety stayed.

2017-08-03 - 2017-08-20 Switched to liquid Lexapro 20mg/ml (1 drop is 1mg). Updosed to 2mg hoping to stabilize. Horrible Panic and Anxiety. Hold for 17 days hoping to stabilize. Didn't work enough for me at the time.

2017-08-20 End of holiday approaching. No more time. Decision to up dose to 5mg escitalopram. Back to the pills. Tapering alprazolam.

A lot of side effects: Akathisia, more anxiety, very troubling sleep, every thought and movement gave me panic attacks. Worst time of my life. I did learn coping skills in this period. A lot. Mastering meditation, mastering floating technique and more Claire Weekes stuff... Can handle extreme anxiety pretty decent now.

2017-09-30 Going down again because holding got worse almost every day. ADVICE TO OTHER ESCITALOPRAM PEOPLE, if updose doesn't work in two weeks, go down again!!! WD is not as brutal as adverse updose effects! After every taper (while tapering pretty manageable, after couple weeks holding, akathisia and extreme anxiety came back)

2018-01-29 Got to ZERO. A hard way down for sure. And now hoping for improvements along the way... Tapering melatonin gave me dystonic reactions however.
14 months after zero: Alternating akathisia, dystonic reactions and WD. Very unstable. No meds whatsoever. 31 months after zero: dystonia got worse, still very high anxiety, and many symptoms... no healing in sight. Adverse reaction destroyed me.

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  • 9 months later...

Would be okay to try NAC whilst taking a magnesium supplement? Has anyone tried taking both? 

2002 started 20mg Seroxat for anxiety. Attempted 1st withdrawal in Autumn of 2006. Went to 0 in around a month-hell. Massive crash. Reinstated.

 

May 2013 started 10% taper with liquid seroxat as follows:

May 2013- 18mg                Aug 2015- 7.7mg           Jan 2017- 3.2mg

July 2013- 16.2mg             Oct 2015 -7mg               (This is where it gets a bit hazy..

Aug 2013- 14.6mg             Nov 2015- 6.4mg            I continued to do a slow wean but

Oct 2013- 13.2mg              Jan 2016- 5.6mg            didn't keep records of all my further

Jan 2014- 11.8mg              Mar 2016- 5.2mg           reductions, have filled in what I remember)

March 2014-10.6mg          May 2016- 4.6mg          Aug 2018- 0.8mg

May 2014- 9.6mg               July 2016- 4.2mg          June 2019- 0mg

Dec 2014-8.6mg                 Nov 2016- 3.6mg         

 

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  • Moderator Emeritus
10 hours ago, thinkpink said:

Would be okay to try NAC whilst taking a magnesium supplement? Has anyone tried taking both? 

 

Just did a google search for nac and magnesium and quickly and easily found this:

 

https://www.drugs.com/drug-interactions/magnesium-oxide-with-nac-1516-0-97-4252.html

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from 17 Apr 2021:  Pristiq 0.2665mg  now holding each dose for 3 weeks

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Thank you Chessie Cat

2002 started 20mg Seroxat for anxiety. Attempted 1st withdrawal in Autumn of 2006. Went to 0 in around a month-hell. Massive crash. Reinstated.

 

May 2013 started 10% taper with liquid seroxat as follows:

May 2013- 18mg                Aug 2015- 7.7mg           Jan 2017- 3.2mg

July 2013- 16.2mg             Oct 2015 -7mg               (This is where it gets a bit hazy..

Aug 2013- 14.6mg             Nov 2015- 6.4mg            I continued to do a slow wean but

Oct 2013- 13.2mg              Jan 2016- 5.6mg            didn't keep records of all my further

Jan 2014- 11.8mg              Mar 2016- 5.2mg           reductions, have filled in what I remember)

March 2014-10.6mg          May 2016- 4.6mg          Aug 2018- 0.8mg

May 2014- 9.6mg               July 2016- 4.2mg          June 2019- 0mg

Dec 2014-8.6mg                 Nov 2016- 3.6mg         

 

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  • 1 month later...

I have used NAC occasionally for UTI and had no serious side effects. But this time things got out of hand, I think it triggered me into a nasty zopiclone withdrawal ( https://www.survivingantidepressants.org/topic/11607-asdf-zopiclone-tolerance-crossover-to-benzodiazepine/?do=findComment&comment=406239 )

 

 

Not sure I understand how NAC works. If I take NAC with medications, which increase GABA (diazepam and zopiclone) and the dose of NAC is wrong, is it possible it has the same effect than withdrawal of these medications?

 

 

 

 

 

On and off several drugs since 1995.

2009: march - sulpiride 100 mg (AP Betamaks), quetiapine 25 mg ,stopped both by the end of the year

09. 2010: sulpiride 100 mg, quetiapine 25 mg, zopiclone 3,75 mg, anafranil (stopped anafranil after three months, had side effects), bromazepam occasionally

03.2012: started lamotrigine (lamictal) 75 mg

03.2013-12.2014 tapered sulpiride, last dose december 2013

02.2014-06.2014 lamictal from 75 mg to 65 mg; 11.2014-05.2015 lamictal from 65 mg to 15 mg, zopiclone from 3,75 to 2,5

08.2015-01.2016: insomnia (at first due to personal crisis), started taking extra zopiclone as needed, doses different, every day 3,75-7 mg, sometimes more), developed withdrawal insomnia.

04.2016 zopiclone interdose withdrawal, started crossover from zopiclone to diazepam

02.2019: lamictal 15 mg, quetiapine 25 mg, zopiclone 0,54 mg, diazepam 5 mg

 

 

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Can I just say, I took NAC about 2.5 years ago. I was on Zoloft and Clonazepam and i was able to drive.

 

Once i started NAC, yes it really took the burden off my withdrawal symptoms. But, I eventually stopped driving because of it. I wouldn't wish NAC on anybody my cognition and concentration just went funny.

 

Also it has a really short half life, I took it up to 3xtimes in a day at one stage, that is including before bed.

 Cymbalta, Zyprexa, Seroquil, Rispiridone, Valium, Zoloft, Clonazepam,. + 1 other Benzo. Total 11 yrs.

·           April 9th 2018 Hospital. 50mg Zoloft > 0 discontinued. 6mg Clonazepam > 2.5mg over 8 weeks stay.

           October 25th 2019: Hospital:  Clonazepam Bridged 1mg > to 20mg Diazepam.

           

           Anafranil: 90mg

      
  Diazepam (V): 25th October 2019, 20mg. 22 Dec 2019 19mg. 4 April 20: 18mg,  30 September: 17.5mg , 13 November 20: 17mg 01 January 2021: 16mg,

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I have never used NAC regularly, only for UTI. But I think I felt it`s short half life, when I took a very small dose on wednesday, just to see if it affects me. It relieved my anxiety a little and the effect lasted for 2 hours. 

 

I am just trying to find out what happened. I feel like I am in zopiclone interdose withdrawal, is it possible that taking NAC may have caused this?  And if so, what can I do? 

Last time I started crossover to diazepam and reduced the dose of zopiclone and it helped with acute withdrawal symptoms. But I could not complete the crossover, because at some point it became impossible to reduce zopiclone. 

 

 

On and off several drugs since 1995.

2009: march - sulpiride 100 mg (AP Betamaks), quetiapine 25 mg ,stopped both by the end of the year

09. 2010: sulpiride 100 mg, quetiapine 25 mg, zopiclone 3,75 mg, anafranil (stopped anafranil after three months, had side effects), bromazepam occasionally

03.2012: started lamotrigine (lamictal) 75 mg

03.2013-12.2014 tapered sulpiride, last dose december 2013

02.2014-06.2014 lamictal from 75 mg to 65 mg; 11.2014-05.2015 lamictal from 65 mg to 15 mg, zopiclone from 3,75 to 2,5

08.2015-01.2016: insomnia (at first due to personal crisis), started taking extra zopiclone as needed, doses different, every day 3,75-7 mg, sometimes more), developed withdrawal insomnia.

04.2016 zopiclone interdose withdrawal, started crossover from zopiclone to diazepam

02.2019: lamictal 15 mg, quetiapine 25 mg, zopiclone 0,54 mg, diazepam 5 mg

 

 

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