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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by qbsbrown on January 21, 2006, at 22:40:33
You had mentioned that since it seemed that 1-2 drinks, or xanax diminishes all my problems (anxiety/obsessing/ruminating, derealization), although klonopin is horrible (induces depression), that Wellbutrin might be a choice.
Should i give this a go? Even through a valium taper?
It once helped my compulsions or addictions, lol (chewing tobacco, video games), it took away the desire for those (perhaps do the same for obsessions). I only took it for a couple of months 6 yrs ago to combat sexual side effects of paxil.
I have a high suseptibility for anxiety, but perhaps that could be a dopamine imbalance and not serotonin (SSRIS do nothing for me).
It does seem that it has a contradictory ritalyn effect already in being treament for ADD.
Xanax is great, but i have high tolerance probs, and a former alcoholic. Perhaps that's where the dopamine comes in.
Thanks for your help,
Brian
Posted by yxibow on January 21, 2006, at 23:27:50
In reply to Blueberry; could this work?, posted by qbsbrown on January 21, 2006, at 22:40:33
I don't mean to intrude, I was just going to add some things.
> You had mentioned that since it seemed that 1-2 drinks, or xanax diminishes all my problems (anxiety/obsessing/ruminating, derealization),
although klonopin is horrible (induces depression),
Klonopin seems to have a reputation much more than other benzodiazepines for depression.
that Wellbutrin might be a choice.
>
> Should i give this a go? Even through a valium taper?Valium is much more tolerable as a taper given its 24+ hour half life.
> It once helped my compulsions or addictions, lol (chewing tobacco, video games), it took away the desire for those (perhaps do the same for obsessions).
It used to be sold additionally under the name Zyban, so its not surprising that it helped with chewing tobacco. I'm a little concerned though about obsessions -- at least in me, it exacerbated "mental garbage" type OCD at night and made sleeping awful.
>I only took it for a couple of months 6 yrs ago to combat sexual side effects of paxil.
That I can believe also -- it definately improved my sex drive.
> I have a high suseptibility for anxiety, but perhaps that could be a dopamine imbalance and not serotonin (SSRIS do nothing for me).Tryed Cymbalta?
>
> It does seem that it has a contradictory ritalyn effect already in being treament for ADD.That's possible too, although weaker.
> Xanax is great, but i have high tolerance probs, and a former alcoholic. Perhaps that's where the dopamine comes in.
Well even Librium is used in alcoholism...
Valium or Librium could be a substitute for Xanax which has a short half life, given your tolerance problems, and the greater half life of them, especially Librium.
Posted by qbsbrown on January 22, 2006, at 1:17:36
In reply to Re: Blueberry; could this work?, posted by yxibow on January 21, 2006, at 23:27:50
> I don't mean to intrude, I was just going to add some things.>
No problem, i love advice from all.
Actually Cymbalta is/was the latest reccomendation from my PDOC. I just moved to China, and i don't think that they sell it here yet (from what i was told).What happened actually is this: I went cold turkey off of klonopin (1.5mgs) after 14 months of use. Dumbest idea i've ever had. Almost put me in the hospital.
Now back on it, given me brutal depression, hence the switch over to valium, and a taper from there.
For the mean time, i was looking to cymbalta, lamictal or wellbutrin for some stablization and/or depression boost.
Posted by yxibow on January 22, 2006, at 3:18:21
In reply to Re: Blueberry; could this work?, posted by qbsbrown on January 22, 2006, at 1:17:36
> > I don't mean to intrude, I was just going to add some things.>
>
> No problem, i love advice from all.
>
> Actually Cymbalta is/was the latest reccomendation from my PDOC. I just moved to China, and i don't think that they sell it here yet (from what i was told).
>
> What happened actually is this: I went cold turkey off of klonopin (1.5mgs) after 14 months of use. Dumbest idea i've ever had. Almost put me in the hospital.I won't place blame, but it isn't obviously the best idea... Its a low dose, but it can still cause all sorts of things that you've obviously experienced :/
>
> Now back on it, given me brutal depression, hence the switch over to valium, and a taper from there.Yes... I see... I tapered my klonopin over to valium not to get off of it or for any particular depression but to see if it helped my complex anxiety disorder better. (and it has a longer half life anyhow) It's been going on about par so far, give or take a bit now and then.
>
> For the mean time, i was looking to cymbalta, lamictal or wellbutrin for some stablization and/or depression boost.
>Oh.. now I remember something about China. I'm afraid I'm not the best advice on overseas medication. Generally western medicine there is pay up front and all but I'm sure you know more about it all than I know. I dont know if they control substances tightly like some Asian countries do, and whether you can import anything?
I can find scant information that you can bring medication into China, however once there I dont know if you can secure modern medication from overseas or through Hong Kong. You might want to contact the embassy in Beijing at (86-10) 6532-3831, which I'm sure you already have.
Posted by qbsbrown on January 22, 2006, at 4:11:56
In reply to Re: Blueberry; could this work? » qbsbrown, posted by yxibow on January 22, 2006, at 3:18:21
I've actually already been to a "western" clinic here. Great facilities and doctors. Plus the medication prices are amazingly cheap, even w/o insurance.
So i am inquiring to see if he could order cymbalta. I had asked about lamictal, they didn't have it, but could get it w/ in days.
So hopefully it's out there.
Posted by yxibow on January 22, 2006, at 4:30:41
In reply to Re: Blueberry; could this work?, posted by qbsbrown on January 22, 2006, at 4:11:56
> I've actually already been to a "western" clinic here. Great facilities and doctors. Plus the medication prices are amazingly cheap, even w/o insurance.
Probably a lot of generics, produced in India (fairly good quality) or locally.
>
> So i am inquiring to see if he could order cymbalta. I had asked about lamictal, they didn't have it, but could get it w/ in days.
> So hopefully it's out there.Interesting. Well I hope you find something to help your condition.
The Eli Lilly (makers of Cymbalta) Asian operations if your clinic is aware of it (and no I dont speak for them :)
:Asian Operations
Eli Lilly Asian Operations, Limited
27th Floor, CITIC Tower
1 Tim Mei Avenue
Hong Kong
Telephone: +852-2105-1600
Fax: +852-2104-6801
Posted by blueberry on January 22, 2006, at 5:02:46
In reply to Blueberry; could this work?, posted by qbsbrown on January 21, 2006, at 22:40:33
I wish I had good answers for your questions. All I know from my own experiences is that trial and error is the only way to find out. Trying to figure out the clues to match them up to a particular medication is sometimes helpful, but sometimes not.
From your descriptions and your own analysis, it would seem that dopamine and gaba could be major players. But choosing the right meds based on that is probably, sadly, still trial and error.
Wish I had something more helpful. I'm struggling too, so across the miles at least know you aren't the only one! :-)
Since the serotonin meds were not helpful for you, at least that narrows the choices a little bit. Just a crazy off the wall thought, but I wonder how St Johns Wort might work for you? I mean, it has reuptake inhibition of dopamine, gaba, serotonin, and norepinephrine. Just a thought. Honestly, it is so hard to predict things.
Geez. I hate being depressed. So tired of it.
Posted by qbsbrown on January 22, 2006, at 6:02:46
In reply to Re: Blueberry; could this work? » qbsbrown, posted by blueberry on January 22, 2006, at 5:02:46
I know blueberry, this is all a HUGE crap shoot. Fortunately when i developed panic disorder at age 19, i took paxil and i just felt this click. Worked great for 5 some odd years til the poop out.
Yes i have tried ALL, and i mean all natural routes (spent thousands), and St Johns did nothing unfortunately.
YXIBOW- Can the valium be taken in one dosage? I'm starting w/ 25mgs, and tapering down (2.5mgs a week?)
I have noticed less depression than the klono, but more tiredness/lethargy (given it's only been one week).
Also getting rapid heart beats occassionally? This common?As far as cymbalt, start at 30 (4-8 weeks)? then up to 60 if no change?
Thanks both,
Brian
Posted by yxibow on January 22, 2006, at 16:15:47
In reply to Re: Blueberry; could this work?, posted by qbsbrown on January 22, 2006, at 6:02:46
> I know blueberry, this is all a HUGE crap shoot. Fortunately when i developed panic disorder at age 19, i took paxil and i just felt this click. Worked great for 5 some odd years til the poop out.
>
> Yes i have tried ALL, and i mean all natural routes (spent thousands), and St Johns did nothing unfortunately.
>
> YXIBOW- Can the valium be taken in one dosage? I'm starting w/ 25mgs, and tapering down (2.5mgs a week?)
> I have noticed less depression than the klono, but more tiredness/lethargy (given it's only been one week).
> Also getting rapid heart beats occassionally? This common?
>
> As far as cymbalt, start at 30 (4-8 weeks)? then up to 60 if no change?
>
> Thanks both,
>
> Brian
Yes, the Valium can be taken in one dosage, it has a 24+ hour half life. But since you're used to taking the Klonopin (I believe ?) more than once a day I think, it is best to start off once a day. You'll probably reach full plasma level of Valium in less than a week and then you can take it once a day. 2.5mgs a week is a very conservative and practical reduction, about 10% a week should not be too hard on your system.Some people start Cymbalta right at the beginning at 60mgs, but since a lot of people are medication sensitive, I would start at 20mg a day for a few weeks, then 40, then 60, give or take.
The rapid heartbeats I can't explain, you're only on Klonopin at the moment and a little Valium? Oh wait, now I remember, you went off completely. Its probably residual withdrawal from "cold turkey". The Valium should resolve that. Also anxiety itself generates a few rapid heartbeats every now and then. If you experience them (or notice them that much) more than say once every few hours or so, one might be more agressive on the Valium. Or one could add a slight dose of propranolol (but not too much since it can cause depression).
Posted by qbsbrown on January 22, 2006, at 17:19:46
In reply to Re: Blueberry; could this work? » qbsbrown, posted by yxibow on January 22, 2006, at 16:15:47
> Yes, the Valium can be taken in one dosage, it has a 24+ hour half life.
Will do. Today is the 7th day taking Valium. I thought the half life was 30-200 hours?
Should i wait til im completely off of valium (all meds) before deciding to go on cymbalta or wellbutrin? See what the "real" me is at.
This whole time the klono could have been diminishing all of my other neurotransmitters.
Posted by yxibow on January 22, 2006, at 18:34:23
In reply to Re: Blueberry; could this work?, posted by qbsbrown on January 22, 2006, at 17:19:46
> > Yes, the Valium can be taken in one dosage, it has a 24+ hour half life.
>
> Will do. Today is the 7th day taking Valium. I thought the half life was 30-200 hours?In vivo... in the lab... but at least, and I'm not holding him on a pedestal :)... my psychopharmacologist's experience has been about 1 day, maybe a little longer. There are yes, true sub metabolites but they may not be all that important.
> Should i wait til im completely off of valium (all meds) before deciding to go on cymbalta or wellbutrin? See what the "real" me is at.
> This whole time the klono could have been diminishing all of my other neurotransmitters.Its not necessary, but I understand what you are getting at, so if you feel no threat of anxiety, suicide, or any other issues, then yes, go ahead with that plan.
Posted by Phillipa on January 22, 2006, at 22:11:36
In reply to Re: Blueberry; could this work? » qbsbrown, posted by yxibow on January 22, 2006, at 18:34:23
Is your goal to use the cymbalta to rid yourself of anxiety? Fondly, Phillipa
Posted by qbsbrown on January 22, 2006, at 23:32:01
In reply to Re: Blueberry; could this work? ?yxibow, posted by Phillipa on January 22, 2006, at 22:11:36
No, the goal has been to wean off of the benzos. Cymbalta would be more for depression/anxiety management while i did this. If working well, and i had no ill effects, perhaps i would continue it.
YXIBOW: What would a normal-mildly aggressive taper from 25mgs valium be?
5 mgs per week?
Posted by qbsbrown on January 22, 2006, at 23:40:52
In reply to Re: Blueberry; could this work?, posted by qbsbrown on January 22, 2006, at 23:32:01
ps YXIBOW; Today is only my second day fully on valium, since the cross over from klonopin.
Do i need to wait one week at 25mgs before the wean?
Regards,
Brian
Posted by yxibow on January 23, 2006, at 4:42:05
In reply to Re: Blueberry; could this work?, posted by qbsbrown on January 22, 2006, at 23:40:52
> ps YXIBOW; Today is only my second day fully on valium, since the cross over from klonopin.
>
> Do i need to wait one week at 25mgs before the wean?
>
> Regards,
>
> BrianFrom your previous bad response with cold turkey, its generally recommended that you discontinue at a rate of about 10% per week. You can go slightly faster, but you risk some withdrawal side effects. If you can stand a 20% taper, go ahead, but, I would be more conservative. It doesn't really sound like there is any rush for things.
Posted by qbsbrown on January 23, 2006, at 4:46:56
In reply to Re: Blueberry; could this work? » qbsbrown, posted by yxibow on January 23, 2006, at 4:42:05
My BIG rush is that my energy level is at an absolute zero, at a time when i am supposed to be out there marketing myself for jobs in a foreign country.
Hence me thinking about wellbutrin or cymbalta for energy asap.
This whole irregular/rapid heartbeat from valium still has me baffled. Did see that it was in the list of SEs
Posted by ed_uk on January 23, 2006, at 12:38:23
In reply to Re: Blueberry; could this work?, posted by qbsbrown on January 23, 2006, at 4:46:56
Fatigue can be a withdrawal symptom - so don't go too fast.
Ed
Posted by qbsbrown on January 24, 2006, at 1:45:06
In reply to Re: Blueberry; could this work? » qbsbrown, posted by ed_uk on January 23, 2006, at 12:38:23
So the deal is, can't get Cymbalta in china (ironically the manufacturor has a plant in hong kong).
Did get wellbutrin. Now the dilema is to take it or not to take it (for terrible depression/lethargy.Here's my dilema; i know that with klonopin, i've disrupted my CNS. I believe that under that, I'm fine, i might have panic attacks after, but im ok.
I could take the Wellbutrin in the mean time (during 2 month valium taper), to deal w/ the depression, and it might help many other symptoms.The other school of thought (the anti-med one), tapering off of benzos is slowly repairing my CNS, and that adding more meds is going to further mess it up, and prolong recovery.
What are you thoughts?
Much regard,
Brian
Posted by yxibow on January 24, 2006, at 7:53:48
In reply to Re: Blueberry; could this work?, posted by qbsbrown on January 24, 2006, at 1:45:06
> So the deal is, can't get Cymbalta in china (ironically the manufacturor has a plant in hong kong).
> Did get wellbutrin. Now the dilema is to take it or not to take it (for terrible depression/lethargy.
>
> Here's my dilema; i know that with klonopin, i've disrupted my CNS. I believe that under that, I'm fine, i might have panic attacks after, but im ok.
> I could take the Wellbutrin in the mean time (during 2 month valium taper), to deal w/ the depression, and it might help many other symptoms.
>
> The other school of thought (the anti-med one), tapering off of benzos is slowly repairing my CNS, and that adding more meds is going to further mess it up, and prolong recovery.
>
> What are you thoughts?
>
> Much regard,
>
> BrianI don't know your situation after the hospital with the Klonopin -- but with the small dose you're on, its doubtful you've made any permanent changes to your basic CNS functions. I mean, I did a similar cold turkey with higher dose Tranxene and I was given enough medicine to partially re-withdraw and taper (**** doctor at the University I was at wouldnt give the whole thing back which would have been correct.) I now have occasional scalp spasms. But they may not have anything to do with the Tranxene, or maybe they do. In either case, the situation is done.
If you're generally more depressed than anxious, Wellbutrin will probably work fine for you. I hope it is the extended release version. If they have some "copied" version in China (I dont know how well they follow patent laws), make sure that it is Wellbutrin SR. That greatly reduces the chance of seizures or anything nasty, not that it happens greatly, mostly in patients who have or didnt know they had a seizure disorder.
If you have OCD and you're far more anxious than depressed, something other than Wellbutrin should probably be used for depression. It eventually, at least for me, built up to a far too stimulating medication.
Sorry to hear Lilly can't get Cymbalta over into Shenzhen. Must be pricing.Tidings
Jay
Posted by shasling on January 24, 2006, at 11:56:19
In reply to Re: Blueberry; could this work?, posted by qbsbrown on January 24, 2006, at 1:45:06
Brian, If you will babblemail me, I have something you might be interested in, if you are still wondering about the dopamine thing. Its a document, I'd have to email it to you.
Suzie
Posted by qbsbrown on January 24, 2006, at 19:34:47
In reply to Re: Blueberry; could this work? » qbsbrown, posted by yxibow on January 24, 2006, at 7:53:48
"I don't know your situation after the hospital with the Klonopin -- but with the small dose you're on, its doubtful you've made any permanent changes to your basic CNS functions."
Actually never went to hospital, had to reintroduce klono. I was wandering around stating my name, address, what HS i went to, just to convince myself that i was real. Complete derealization/depersonalization. Couldn't sleep literally ONE minute. Could not escape my head, my thoughts, LITERALLY, like i was hypnotized.
Took xanax, all went away. next day at work was my best i had ever had at that job. But went back on klono, because that was what i had taken for over one year (although i hated it), and planned a taper. The klono immediately induced depression.
"If you're generally more depressed than anxious, Wellbutrin will probably work fine for you"
Generally, im extremeley more anxious than depressed. I'm usually only depressed becauase of the anxiety.
Not now. This is full blown depression, and anxiety is low. I do feel it's benzo induced. Now on valium, doesn't help, im just left tired w/ no motivation.This has happened before. Months of anxiety to months of depression (hhhmmm possible BPII). Probably anxiety 90 percent to depressions 10.
>
"If you have OCD and you're far more anxious than depressed, something other than Wellbutrin should probably be used for depression."Tried em all, all too stimulating, make me feel more crazy. Nothing has worked.
Lamictal once pulled me out of a 3 year depression, only to wear off (i have access to here if i want).Remember my goal is to get off of meds. I figured it out, and it'll take me til April 1 to wean off of valium. I'm not sure if i can deal w/ this depression in the mean time.
>
"Sorry to hear Lilly can't get Cymbalta over into Shenzhen. Must be pricing."Yes, odd, seeing that Lilly has a plant in Hong Kong. It was tough for them to get Wellbutrin, imported from GSK from thailand.
I could give Wellbutrin a couple weeks go. I'm usually very sensitive on how they are working, and could abandon it if i feel more anxious/obsessive/ruminating.
Who knows, it could work. All the ones they thought would, haven't. Could try the reverse pharmacology.
Or i could go to lamictal for balance.
Or i could just ride the taper out alone.Regards,
Brian
Posted by qbsbrown on January 26, 2006, at 18:31:45
In reply to Re: Blueberry; could this work?, posted by qbsbrown on January 24, 2006, at 19:34:47
"Contrary to what you are led to believe by the majority of the medical profession, as well as the pharmaceutical companies, we have learned that the usage of anti-depressants, anti-psychotics and/or supplements in an attempt to alleviate the withdrawal symptoms experienced while tapering benzos significantly increases the level of withdrawal one experiences rather than gives relief. It also inevitably prolongs the recovery time one must endure considerably; leaving one with yet another drug, or number of drugs to taper from. This is not just a supposition; this is based on much research as well as a vast number of past and present personal experiences of our own members. Those who have tried ultimately experienced unbearably negative results and have, or still are paying the price. Because of this we take a strong stance on not advocating the use of such medications and/or remedies on this forum."
My own personal opinion about the use of antidepressants and other adjunctive medications in benzodiazepine withdrawal is that it is almost invariably unwise and sadly, many succeed in replacing one addiction with another or inheriting a whole new set of side-effect problems. In my experience those who do not resort to drugs fare better and recover more quickly. With a slow and careful taper the use of adjunctive medications is rarely necessary.
The nervous system in benzodiazepine withdrawal is in a very raw and fragile state and it will take time for it to recover. Taking antidepressants (or any other drugs) may impede that recovery and create new problems and are therefore best avoided IMO. A friend of mine puts it this way:
"I always feel that putting other mood altering into a system that's already damaged by drugs and trying so hard to repair is really like putting gasoline on the fire. The person who does this then has the added stress of more side effects and another drug to taper with possible withdrawals. I don't believe in adding extra suffering."
Posted by yxibow on January 27, 2006, at 0:32:44
In reply to Blueberry, YXIBOW: Your opinion on this??????????, posted by qbsbrown on January 26, 2006, at 18:31:45
I don't know or want to comment much on the political source of the argument, notwithstanding the usual diatribe of the psychiatric professsion, etc...
But there is sound reason for not adding more to the mixture, you're right. There's no reason for a fast taper of any benzodiazepine, and regardless of how long one has taken it, a reasonable taper can and has been done times countless beyond numbers. The usual taper is about 10% per week of the substance.
If this is intolerable, and one is experiencing "withdrawal", then it isn't a successful taper. There shouldn't be great "withdrawal" symptoms. Just dial it down a notch, to 5% per week. It's just like losing weight (which I am attempting to do at my best) -- you only are supposed to do 1-2 lbs per week (I do about 2-3, which is on the high side of okay).
There's no rush to remove the substance from the system, benzodiazepines have been tested time immemorial and 46 years of knowledge has created a whole insight into the process. You'll gradually get it out, one way or another.
No point seeking other substances to replace it, other than ibuprofen or something if you experience a tension headache, but that's about all I'd say for it. If you have a reasonably good liver and kidney, which most people do, there's no particular harm done. Valium is eliminated by the
liver at CYP P450 3A4. If it makes you feel better for your doctor to do a blood draw for liver testing, that's perfectly fine -- I dont know how that's done in China but its a simple test here. Just make sure they're using clean needles, I assume there's sufficient knowledge of Western hygiene practices as you've informed me about the clinics.
Posted by qbsbrown on January 27, 2006, at 7:51:00
In reply to Re: Blueberry, YXIBOW: Your opinion on this?????? » qbsbrown, posted by yxibow on January 27, 2006, at 0:32:44
Well all psychiatric debates aside, it was still a question of whether or not i was to try something to manage the depression while the taper of the benzos.
Today was day 4 of 150SR wellbutrin. A notice in antidepressant effect, will go to 300 soon. Anxiety/irritibility hasn't skyrocketed at all yet (although derealization has).
Does seem to induce nasuea and migraines, which are due to my liver (i read wellbutrin is one of the hardest on the liver). If supplements can't maintain and assist the liver, i'll drop it.So either it'll bomb like the rest of the meds, or it'll be a sucsess (hopefully only through taper). With my extremely addictive personality, im hoping that dopamine and norephrinine are my thing.
Posted by yxibow on January 27, 2006, at 23:07:44
In reply to Re: Blueberry, YXIBOW: Your opinion on this??????, posted by qbsbrown on January 27, 2006, at 7:51:00
> Well all psychiatric debates aside, it was still a question of whether or not i was to try something to manage the depression while the taper of the benzos.
>
> Today was day 4 of 150SR wellbutrin. A notice in antidepressant effect, will go to 300 soon. Anxiety/irritibility hasn't skyrocketed at all yet (although derealization has).
> Does seem to induce nasuea and migraines, which are due to my liver (i read wellbutrin is one of the hardest on the liver). If supplements can't maintain and assist the liver, i'll drop it.
>
> So either it'll bomb like the rest of the meds, or it'll be a sucsess (hopefully only through taper). With my extremely addictive personality, im hoping that dopamine and norephrinine are my thing.
I personally wouldn't read too much into supplements that claim to do anything to the liver but you're entitled to your own view.You are right, Wellbutrin has metabolites (3), especially hydroxybuproprion that is metabolized by CYP P450 2B6 at a considerable higher level than the drug itself (7 times). I wouldn't be too concerned about liver levels as long as you're not taking too many multiple drugs. At the level you're currently at, nausea is only slightly higher than placebo in trials. Migraine is near zero, unless you happen to suffer from an organic migraine disorder. But as they say, your miles may vary.
The nausea will probably pass. I wouldn't go to 300 too soon, that will just cause a greater chance of your migraines and nausea. Upward tapers of these things are measured in weeks, not days. These are are largely transient effects of most antidepressants.
At the moment, since you're tapering off of Valium, you're pretty protected from the only thing I would be concerned with patients on Wellbutrin, which is seizures.
Thats the main bold warning, which is on the order of 1 in 1000, and obviously more in those prone to seizures. This goes up exponentially above 450 mg/day. I personally would take it with a pinch of my preferred benzodiazepine per day as a preventative , or Neurontin or something, but that's up to you.
Derealization can occur and is a component of depression itself. Its also a possible component of benzodiazepines. I'm not sure about Wellbutrin.
Although I'm happy you have response on day 4, there are very few antidepressants (with the exception of certain antipsychotics) that have that immediate of an effect. Placebo effects occur as much as 1/3 of the time, and they're just as good :) These things take time and I would take plenty of time to build to 300 or 450mg, to reduce the risk of the rare seizure effect.
To good health
Tidings
-- Jay
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