SSRIs

Question:

For the past 3 months I’ve been taking 300 mg of neurontin twice a day, to help with pain related to a compressed nerve. I haven’t taken the neurontin over the past 4 days- scrip ran out and I didn’t fill it until today. Over the weekend, I had some terrible crying jags, feelings of anxiety (I’m on elavil for depression), jitteriness. Could this be related to going off the neurontin? Michele

Response:

Heya, Michelle,     Yeah, definitely. It’s not a good thing to do, at all. I understand you were kinda forced to, but you coulda had a major seizure.      Not chewing you out, ‘cuz I went off prednisone all at once myself, due to non-stop bleeding. Another no-no. I knew I was risking having a psychotic episode, but I figured who could tell? I also risked having my adrenals fail. Shame on us both, huh?      The neurontin’s working well for me and I’m aware it’s one of the ones to titer down from. Hope you’re aware of that now, too. Whoops! Hugs from Rosie — "If you wanna get it done, you gotta fight for yourself."  – Meat Loaf, Bat Outta Hell II

– Hide quoted text — Show quoted text -> For the past 3 months I’ve been taking 300 mg of neurontin twice a > day, to help with pain related to a compressed nerve. I haven’t taken > the neurontin over the past 4 days- scrip ran out and I didn’t fill it > until today. Over the weekend, I had some terrible crying jags, > feelings of anxiety (I’m on elavil for depression), jitteriness. Could > this be related to going off the neurontin? > Michele

Response:

>For the past 3 months I’ve been taking 300 mg of neurontin twice a >day, to help with pain related to a compressed nerve. I haven’t taken >the neurontin over the past 4 days- scrip ran out and I didn’t fill it >until today. Over the weekend, I had some terrible crying jags, >feelings of anxiety (I’m on elavil for depression), jitteriness. Could >this be related to going off the neurontin? >Michele

I had mood problems when I went off Neurontin (rage mostly), so my personal response is yes it "could" be related.  I’ve seen others post of mood disturbances when coming off too, though most don’t seem to have the problem. – Jen

Response:

From what I’ve experienced (myself and with my kids),  about all of the neurologic (including psychiatric) medications should not be discontinued suddenly. Interesting note.  About a year ago, I had to take an antibiotic for a week or so that looked kind of like the Prozac that I take daily.  For two days, I didn’t realize that I wasn’t taking my dose of prozac in the morning with my other meds. (I’d look in my hand, see the green and white pill and I figured that I was okay, still not awake enough to realize that it was the antibiotic, not the prozac.)  I got pretty depressed after just two days, then at night after those days, as I was taking the antibiotic I realized that I’d missed the prozac.  This wasn’t a placebo affect thing – I didn’t know that I wasn’t taking it – but I did notice that I was really down.  I hurried and took my prozac and haven’t missed a day since. I talked to my psychiatrist and told him of the event.  Researchers have noticed a change in mood with just one day being missed of the SSRIs like Prozac.  Kind of wild – it takes 4-6 weeks to work, but the small change in blood level from just one day being missed. To me it was just more evidence of my body’s need for the medicine. Depression is a physical illness. Sorry for rambling.  Be careful with the meds.  We’ve all done what you have done.  (I did it with blood pressure medicine when first married – wanted to wait until payday.  My wife got pretty upset with me – I guess she wanted me to stick around.) Sorry to ramble. Martin

– Hide quoted text — Show quoted text -> For the past 3 months I’ve been taking 300 mg of neurontin twice a > day, to help with pain related to a compressed nerve. I haven’t taken > the neurontin over the past 4 days- scrip ran out and I didn’t fill it > until today. Over the weekend, I had some terrible crying jags, > feelings of anxiety (I’m on elavil for depression), jitteriness. Could > this be related to going off the neurontin? > Michele

Response:

>For the past 3 months I’ve been taking 300 mg of neurontin twice a >day, to help with pain related to a compressed nerve. I haven’t taken >the neurontin over the past 4 days- scrip ran out and I didn’t fill it >until today. Over the weekend, I had some terrible crying jags, >feelings of anxiety (I’m on elavil for depression), jitteriness. Could >this be related to going off the neurontin? >Michele

It certainly could have been the neurontin Michele.  Neurontin is one of those medicines a person should not stop taking all at once.  I know you couldn’t help it this time. Neurontin should be tapered slowly to withdraw from.  I guess the worst thing it can cause is seizures.  Seems rather odd since it is an anti-seizure medicine huh? I take 600mg of neurontin 2 x’s a day and then 900mg at bedtime.  My doctor rx’d 900mg 3 times a day, but I couldn’t handle feeling sleepy without being able to sleep, so I talked with him and we changed it to the 600mg and 900 mg. Still get sleepy during the day, but with my weird sleeping habits any more, it doesn’t really matter. Sue We survive together or not at all.

Response:

I think that the big seizure risk for many of these medicines in ceasing them is because they are used  by people with epilepsy to control seizures. Without the seizure control medication, there is nothing to control the epilepsy, therefore the risk of seizures becomes higher. Some medications (such as Klonopin – aka clonazepam – benzodiazapine used for anxiety but also for seizures) will cause anybody seizures if stopped suddenly after being used for awhile. Key is to not run out of the medicine and to not cease it without medical supervision.  (I’m not being judgemental – I certainly have done that before!!  In a perfect world the medical supervision would be available without judgement and the financial worries wouldn’t exist.)  Same holds true for the long term pain meds – but how many of us have been left stranded by our docs – but that is a different subject. Martin

– Hide quoted text — Show quoted text ->For the past 3 months I’ve been taking 300 mg of neurontin twice a >day, to help with pain related to a compressed nerve. I haven’t taken >the neurontin over the past 4 days- scrip ran out and I didn’t fill it >until today. Over the weekend, I had some terrible crying jags, >feelings of anxiety (I’m on elavil for depression), jitteriness. Could >this be related to going off the neurontin? >Michele > It certainly could have been the neurontin Michele.  Neurontin is one of those > medicines a person should not stop taking all at once.  I know you couldn’t > help it this time. > Neurontin should be tapered slowly to withdraw from.  I guess the worst thing > it can cause is seizures.  Seems rather odd since it is an anti-seizure > medicine huh? > I take 600mg of neurontin 2 x’s a day and then 900mg at bedtime.  My doctor > rx’d 900mg 3 times a day, but I couldn’t handle feeling sleepy without being > able to sleep, so I talked with him and we changed it to the 600mg and 900 mg. > Still get sleepy during the day, but with my weird sleeping habits any more, it > doesn’t really matter. > Sue > We survive together or not at all.

Response:

>I think that the big seizure risk for many of these medicines in ceasing >them is because they are used  by people with epilepsy to control seizures. >Without the seizure control

Actually it is simpler than that….these meds "lower the seizure threshold"…ie makes it "easier" for one to have a seizure …don’t ask me the mechanism..cuz I surely don’t understand it either!!!  So once your brain gets "used to" these anti seizure meds (even if you were never prone to seizures)…if you stop abruptly…boom..you may well have a seizure!!!  so the gradual taper is the way to avoid..hopefully the risk of having seizure!!! phew…talk about creating a problem where one never existed!! rb Hawki

Response:

I can not take prozac.  It makes me paranoid.  Man I thought my world was coming to an end.  I thought I was faking my pain and everything.  I thought I was going to jail. I was confessing I was faking everything.  I was plain an simple not faking at all.  I started throwing up come to find out my gallbladder needed to be removed.  They put me in the hospital because I was dehydrated.  I could not remember to ask the doc for my prozac.  When I did the nurse’s would say they would call him.  On the 3rd day my paranoia started to let up.  Now they will not give me any AD drugs in fear it will bring it on again.  To some it is a God sent drug to some it is a suicide drug.  I truly can see why it got the bad publicity it did when it first came out.  I used to think it was a great pill.  If you ever start feeling paranoid talk to your doc immediately PLEASE.  I mean drive as fast as u can to the doctor or ER.  It is one bad drug for me.  I took that drug for years and felt great.  Then all of sudden it hit me like a ton of bricks.  It was not a pleasant experience. Bonner – Hide quoted text — Show quoted text -> From what I’ve experienced (myself and with my kids),  about all of the > neurologic (including psychiatric) medications should not be discontinued > suddenly. > Interesting note.  About a year ago, I had to take an antibiotic for a week > or so that looked kind of like the Prozac that I take daily.  For two days, > I didn’t realize that I wasn’t taking my dose of prozac in the morning with > my other meds. (I’d look in my hand, see the green and white pill and I > figured that I was okay, still not awake enough to realize that it was the > antibiotic, not the prozac.)  I got pretty depressed after just two days, > then at night after those days, as I was taking the antibiotic I realized > that I’d missed the prozac.  This wasn’t a placebo affect thing – I didn’t > know that I wasn’t taking it – but I did notice that I was really down.  I > hurried and took my prozac and haven’t missed a day since. > I talked to my psychiatrist and told him of the event.  Researchers have > noticed a change in mood with just one day being missed of the SSRIs like > Prozac.  Kind of wild – it takes 4-6 weeks to work, but the small change in > blood level from just one day being missed. > To me it was just more evidence of my body’s need for the medicine. > Depression is a physical illness. > Sorry for rambling.  Be careful with the meds.  We’ve all done what you have > done.  (I did it with blood pressure medicine when first married – wanted to > wait until payday.  My wife got pretty upset with me – I guess she wanted me > to stick around.) > Sorry to ramble. > Martin > For the past 3 months I’ve been taking 300 mg of neurontin twice a > day, to help with pain related to a compressed nerve. I haven’t taken > the neurontin over the past 4 days- scrip ran out and I didn’t fill it > until today. Over the weekend, I had some terrible crying jags, > feelings of anxiety (I’m on elavil for depression), jitteriness. Could > this be related to going off the neurontin? > Michele

Response:

Question:

Anyone know of an on-line pharmacy where I can get prozac (generic) w/o a prescription?  I’ve been taking it for years, but don’t currently have health insurance.

Response:

> Anyone know of an on-line pharmacy where I can get prozac (generic) > w/o a prescription?  I’ve been taking it for years, but don’t > currently have health insurance.

Those online pharmacies that will prescribe for you will end up costing you more than a doctor’s visit without insurance. They have a high "consultation fee", charge more (in most cases) for the drug than your local pharmacy, and there are rumors that often they are selling outdated meds. ALSO, if you go to a doctor, they may be able to hook you up with a program for reduced cost meds. All the drug companies have some kind of program.

Response:

> Anyone know of an on-line pharmacy where I can get prozac (generic) > w/o a prescription?  I’ve been taking it for years, but don’t > currently have health insurance.

healthcarepharma.com has 30 caps x 20 mg fluoxetine for $31. Is that a good price?

Response:

> > Anyone know of an on-line pharmacy where I can get prozac (generic) > w/o a prescription?  I’ve been taking it for years, but don’t > currently have health insurance. > healthcarepharma.com has 30 caps x 20 mg fluoxetine for $31. Is that a good > price?

Yes, that’s a good price.  Have you ever used them? The Dr.’s consult alone would cost me $180.  Some of the on-line places do it w/o consult or prescription.  That is if they’re legitimate.

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> healthcarepharma.com

Hmmm I dunno, I don’t trust any site I can’t find any contact info on.

Response:

> healthcarepharma.com has 30 caps x 20 mg fluoxetine for $31. Is that a good > price? > Yes, that’s a good price.  Have you ever used them?

Yes, they’re an offshore supplier, mostly European pharmaceutical products, based on what I’ve gotten from them. Guaranteed delivery, and they seem to bend over backwards on the customer service side. That said, there’s a risk with any importation. I believe there’s a discussion of the issues, and their experience with US customers on the site, after you register. – Hide quoted text — Show quoted text -> The Dr.’s consult alone would cost me $180.  Some of the on-line > places do it w/o consult or prescription.  That is if they’re > legitimate.

Response:

Not all online pharmacies charge a consultation fee. I’ve used two of them. One from Mexico and one from India. Neither charged a consult fee. The one from Mexico is www.medsmex.com. – Hide quoted text — Show quoted text -> Those online pharmacies that will prescribe for you will end up costing you > more than a doctor’s visit without insurance. They have a high "consultation > fee", charge more (in most cases) for the drug than your local pharmacy, and > there are rumors that often they are selling outdated meds. > ALSO, if you go to a doctor, they may be able to hook you up with a program > for reduced cost meds. All the drug companies have some kind of program.

Response:

I’ve bought several prescriptions at www.medsmex.com. You can pay with Paypal and they’re shipped promptly. No prescription needed. Generic Prozac is $29.95 for 28 pills of 20 mg. strength.

– Hide quoted text — Show quoted text -> Anyone know of an on-line pharmacy where I can get prozac (generic) > w/o a prescription?  I’ve been taking it for years, but don’t > currently have health insurance.

Response:

Here’s another online pharmacy that does not require a consultation to order meds: www.1drugstore-online.com They have brandnames and generics. They carry Prozac, Paxil, Buspar, Wellbutrin, Celexa, etc.

– Hide quoted text — Show quoted text -> Anyone know of an on-line pharmacy where I can get prozac (generic) > w/o a prescription?  I’ve been taking it for years, but don’t > currently have health insurance.

Response:

Here’s another one. Try www.1drugstore-online.com No prescription needed. They have Prozac, Buspar, Wellbutrin, Celexa, Paxil, etc. both brand names and generics. 100 tabs of Prozac, 20 mg each, is about $75. You don’t need an online consultation to order.

– Hide quoted text — Show quoted text -> Anyone know of an on-line pharmacy where I can get prozac (generic) > w/o a prescription?  I’ve been taking it for years, but don’t > currently have health insurance.

Response:

http://www.medicinedrugstore.com/ Kills www.xenu.net

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Question:

Here is a link to the 7 May 2002 article in The Washington Post regarding placebos versus antidepressants. http://www.washingtonpost.com/wp-dyn/articles/A42930-2002May6.html Cut and paste it into the address spot in your Internet browser.

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As if you didn’t know?

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> But hasn’t EACH ONE of these anti depressants undergone trials for > effectiveness before approval and use by the general public? Part of that is > to be better than placebo. What am I missing?

Evidently the FDA requires that the drug manufacturer furnish data from at least 2 studies (so usually only data from 2 studies are provided) showing the drug to be better than placebos.  Sometimes manufacturers must conduct 5 studies (maybe even more!) to obtain 2 that show their drug has qualities that exceed those of the placebo. The studies not sent to the FDA to gain approval for the drug may show that the placebo performed better than the drug, or that the drug was not found to be better than the placebo with suitable statistical significance (based on the number of patients involved in the study, etc.). Evidently patients who learn they improved using the placebo are prone to sudden reversal of the gains of the non-drug placebo!  So how much of "getting better" is in the mind of the patient, that "thinking one has gotten better" is a major part of "getting better"?  We must all wonder…

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But hasn’t EACH ONE of these anti depressants undergone trials for effectiveness before approval and use by the general public? Part of that is to be better than placebo. What am I missing?

– Hide quoted text — Show quoted text -> Placebos & Antidepressants Work the same Way > Antidepressants also cause additional brain changes > http://mentalhealth.about.com/library/weekly/aa050502a.htm > We have known for some time that patients given placebos (pills with no > active ingredient) often respond the same way that patients given > antidepressants. Their depression often lifts as a result of either > treatment. A new study (5/02) shows us that these two treatments both > cause similar changes in the brain. > Helen Mayberg, M.D., and her colleagues at the University of Texas > Health Science Center, San Antonio, used functional brain imaging to > study glucose metabolism in different parts of the brain following > treatment with either fluoxetine or placebo. The study was a > randomized, double-blind trial of 17 middle-aged men who were > hospitalized for unipolar depression. The researchers found that their > depressed male subjects who got better (four in each condition) > responded with increased cortical activity and decreased limbic > activity after six weeks of either treatment. Patients receiving > fluoxetine also showed changes in lower parts of the brain – in the > brainstem, striatum and hippocampus. These changes were not seen in > patients who received placebo. > A graphic illustration of the changes shows the similarities and > differences between the two conditions. > Composite PET (positron emission tomography) scan data, superimposed on > MRI (magnetic resonance imaging) scans, show brain areas that increased > (red) or decreased (yellow) in activity in men who responded to placebo > (top row) and fluoxetine (bottom row). Both groups shared a pattern of > increased activity in the cortex (e.g., prefrontal, posterior > cingulate) and decreased activity in limbic regions (e.g., subgenual > cingulate), which the researchers suggest is necessary for therapeutic > response. Men who responded to the active medication, in addition, > experienced decreased activity in certain lower brain areas (e.g., > hippocampus, anterior insula) thought to sustain the cortical/limbic > changes and prevent relapse. (Graphic and key courtesy of NIMH, 2002) > What does this all mean? There are several ways to think about this > study. One conclusion that we can draw is that the placebo effect is > real – and that the act of taking an inert substance (along with other > aspects of a hospital treatment program) can trigger certain changes in > the brain. In an interview with NIMH Dr. Mayberg cautioned against > equating antidepressants and placebos. "Our findings do not support > the notion that antidepressants work merely via a placebo effect. > Patients on active medication who failed to improve did not sustain the > brainstem, striatal and hippocampus changes unique to antidepressant > responders." Rather, the authors speculate that "clinical improvement > in the group receiving placebo as part of an inpatient study is > consistent with the well-recognized effect that altering the > therapeutic environment may significantly contribute to reducing > clinical symptoms. The additional subcortical and limbic metabolism > decreases seen uniquely in fluoxetine responders may convey additional > advantage in maintaining long-term clinical response and in relapse > prevention" (Mayberg, et.al., 2002). > This study is important because it helps us begin to understand how > antidepressants and other treatment techniques change the brain. We > are just beginning to understand the brain at this level, and further > research will undoubtedly build upon this foundation. We already know > that both psychiatric medications and psychotherapy result in changes > in the brain. This study begins to tell us how the brain changes. > Reference: > Helen S. Mayberg, J. Arturo Silva, Steven K. Brannan, Janet L. Tekell, > Roderick K. Mahurin, Scott McGinnis, and Paul A. Jerabek, The > Functional Neuroanatomy of the Placebo Effect, Am J Psychiatry 2002 > 159: 728-737. [Abstract available Online]

Response:

This surprises me. Worries me for some reason also. On one hand I think that my anti depressant probably works for me. (Indeed, speculation is that too much antidressants can set off a manic cycle.) On the other hand I KNOW that my other medications do control my mania.

– Hide quoted text — Show quoted text -> Placebos & Antidepressants Work the same Way > Antidepressants also cause additional brain changes > http://mentalhealth.about.com/library/weekly/aa050502a.htm > We have known for some time that patients given placebos (pills with no > active ingredient) often respond the same way that patients given > antidepressants. Their depression often lifts as a result of either > treatment. A new study (5/02) shows us that these two treatments both > cause similar changes in the brain. > Helen Mayberg, M.D., and her colleagues at the University of Texas > Health Science Center, San Antonio, used functional brain imaging to > study glucose metabolism in different parts of the brain following > treatment with either fluoxetine or placebo. The study was a > randomized, double-blind trial of 17 middle-aged men who were > hospitalized for unipolar depression. The researchers found that their > depressed male subjects who got better (four in each condition) > responded with increased cortical activity and decreased limbic > activity after six weeks of either treatment. Patients receiving > fluoxetine also showed changes in lower parts of the brain – in the > brainstem, striatum and hippocampus. These changes were not seen in > patients who received placebo. > A graphic illustration of the changes shows the similarities and > differences between the two conditions. > Composite PET (positron emission tomography) scan data, superimposed on > MRI (magnetic resonance imaging) scans, show brain areas that increased > (red) or decreased (yellow) in activity in men who responded to placebo > (top row) and fluoxetine (bottom row). Both groups shared a pattern of > increased activity in the cortex (e.g., prefrontal, posterior > cingulate) and decreased activity in limbic regions (e.g., subgenual > cingulate), which the researchers suggest is necessary for therapeutic > response. Men who responded to the active medication, in addition, > experienced decreased activity in certain lower brain areas (e.g., > hippocampus, anterior insula) thought to sustain the cortical/limbic > changes and prevent relapse. (Graphic and key courtesy of NIMH, 2002) > What does this all mean? There are several ways to think about this > study. One conclusion that we can draw is that the placebo effect is > real – and that the act of taking an inert substance (along with other > aspects of a hospital treatment program) can trigger certain changes in > the brain. In an interview with NIMH Dr. Mayberg cautioned against > equating antidepressants and placebos. "Our findings do not support > the notion that antidepressants work merely via a placebo effect. > Patients on active medication who failed to improve did not sustain the > brainstem, striatal and hippocampus changes unique to antidepressant > responders." Rather, the authors speculate that "clinical improvement > in the group receiving placebo as part of an inpatient study is > consistent with the well-recognized effect that altering the > therapeutic environment may significantly contribute to reducing > clinical symptoms. The additional subcortical and limbic metabolism > decreases seen uniquely in fluoxetine responders may convey additional > advantage in maintaining long-term clinical response and in relapse > prevention" (Mayberg, et.al., 2002). > This study is important because it helps us begin to understand how > antidepressants and other treatment techniques change the brain. We > are just beginning to understand the brain at this level, and further > research will undoubtedly build upon this foundation. We already know > that both psychiatric medications and psychotherapy result in changes > in the brain. This study begins to tell us how the brain changes. > Reference: > Helen S. Mayberg, J. Arturo Silva, Steven K. Brannan, Janet L. Tekell, > Roderick K. Mahurin, Scott McGinnis, and Paul A. Jerabek, The > Functional Neuroanatomy of the Placebo Effect, Am J Psychiatry 2002 > 159: 728-737. [Abstract available Online]

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Question:

August 2, 1996. This date will forever be engraved upon my mind. Prozac is responsible for the rape of my soul. I am struck with horror at the pain, the despair… the physical and mental torture that I experienced. And yet, even these words do not adequately describe the suffering that I endured from the effects of Prozac (fluoxetine).  

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Question:

>However the bad thing is that the cogentin is extremely sedating >and makes me get out of breath faster,

So much for wanking it at porn sites.

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>Who has heard of adding anti-cholinergics like Cogentin to their SSRIs to get >them to activate decently again?

You’re the usenut Pdoc – tell us!

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– Hide quoted text — Show quoted text -> Ive been taking the anti-parkinsons/EPS drug Cogentin for the past week. I find > its quite sedating. It has gotten rid of all tight muscle related problems Ive > been having. I didnt like it until today. Today I realized suddenly, > unexpectely I began getting that old familiar "SSRI activation" real strongly. > Like when my SSRIs used to activate good. Took me by total surprise. Starting > to get nausea too, like when SSRIs used to activate good for me and give me > nausea, akathisia, dizziness, anxiety, etc. the first two weeks. > Who has heard of adding anti-cholinergics like Cogentin to their SSRIs to get > them to activate decently again? I cant believe this, this has totally take me > by surprised. However the bad thing is that the cogentin is extremely sedating > and makes me get out of breath faster, even though I feel relaxed.

It’s a double miracle!! First the dreaded anti-cholinergics make Eric feel better, then he recovers enough from his depression that he does not need ECT. Praise the lord, you better tithe 20% of whatever salary this miracle the lord has wrought enables you to make, Eric.  How about that, huh the lord surely do act in strange and mysterious ways, huh?

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>First the dreaded anti-cholinergics make Eric feel better, then he recovers >enough from his depression that he does not need ECT.

Gee – I see you were as surprised as myself. Cogentin is the answer!

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- Hide quoted text — Show quoted text – > Thanks Peter, I actually dont have that many side effects  with the ACE. Its > kind of hard to describe, its  just that the ACE interferes with the Luvox. I > seriously doubt Id have any better luck with another blood pressure pill. Its a > hard to explain problem. I think what I am going to have to do is add some low > dose atypial anti-psychotic to get the SSRI fully activated, then perhaps throw > in an anticonvulsant on top of it all to help get rid of the "numbess."

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YEAAAAAAAAA!! i am rejoicing with you!! cal

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>Zoloft. Stopped taking the Cogentin cause it was revving my BP up, guess it was >those anti-cholinergic side effects.

BP no doubt meaning Bipolar after the manic posting of wav files. Is the shock jock still on? Why waste 3 years talking about it – you could have had relief 3 years ago! Attention seeker?

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Question:

> All the good treatments get rejected. What we are left with is halfassed SSRIs. > Makes me disgusted. > Eric

I totally agree. On Esquire, February issue, there is a whole page advertisement of Paxil. A public add for a psychotropic substance? What kind of shit is this? Why doesn’t US ban it? It says that millions suffer from chronic anxiety, and gives the symptoms: Fatigue, irritability, sleep problems, restlessness, etc. etc. So GSK wants US citizens to self-diagnose themselves, go to a psychiatrist and ask him/her to prescribe Paxil! That’s wonderful! cem

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– Hide quoted text — Show quoted text ->I totally agree. On Esquire, February issue, there is a whole page >advertisement of Paxil. A public add for a psychotropic substance? What kind >of shit is this? Why doesn’t US ban it? It says that millions suffer from >chronic anxiety, and gives the symptoms: Fatigue, irritability, sleep >problems, restlessness, etc. etc. >So GSK wants US citizens to self-diagnose themselves, go to a psychiatrist >and ask him/her to prescribe Paxil! That’s wonderful! >cem > why dont you go fuck yourself? Paxil is a great drug. > Eric

If one was a stockholder in GSK I would agree with Eric, however the point raised in this post, a point which seems to be well over the head of our poor lost boy is that advertising of drugs might not be the best way to deal with health issues.  By selling a little pill for every problem the doctor patient relationship is replaced by the consumer drug company relationship. Naturally for anti psychiatry activists like Eric that is a quite acceptable outcome.

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Dear Eric, You miss the point, as always! It is not the point if Paxil is a good drug or not! It is the public advertisement of a drug I oppose here. …and for the "go fuck yourself" business, all I have to say is, you have serious personality problems, and you have revealed them here on the Usenet for quite a long time. I suggest, you go and get some help!… cem

– Hide quoted text — Show quoted text ->I totally agree. On Esquire, February issue, there is a whole page >advertisement of Paxil. A public add for a psychotropic substance? What kind >of shit is this? Why doesn’t US ban it? It says that millions suffer from >chronic anxiety, and gives the symptoms: Fatigue, irritability, sleep >problems, restlessness, etc. etc. >So GSK wants US citizens to self-diagnose themselves, go to a psychiatrist >and ask him/her to prescribe Paxil! That’s wonderful! >cem > why dont you go fuck yourself? Paxil is a great drug. > Eric > Maneuver warfare is a warfighting philosophy that seeks to shatter the enemy’s > cohesion through a variety of rapid, focused, and unexpected actions which > create a turbulent and rapidly deteriorating situation with which the enemy > cannot cope.

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– Hide quoted text — Show quoted text ->Dear Eric, >You miss the point, as always! >It is not the point if Paxil is a good drug or not! It is the public >advertisement of a drug I oppose here. >…and for the "go fuck yourself" business, all I have to say is, you have >serious personality problems, and you have revealed them here on the Usenet >for quite a long time. I suggest, you go and get some help!… > There is big money in psychotropic drug advertisements. The costs are > nothing compared to the benefits to the drug companies of someone > suggesting that med, and the years of income it will bring them. > Advertising specific medications and medications in general is a > shameless act which can possibly harm people. I’m surprised someone > who thinks they are insane because psychiatry made them that way would > object.

It is amazing how I can find no points of agreement with you in one post, and agree with you by and large in another. No.Spam, you are a interesting study in contradictions

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- Hide quoted text — Show quoted text -> >I totally agree. On Esquire, February issue, there is a whole page > >advertisement of Paxil. A public add for a psychotropic substance? What >  kind > >of shit is this? Why doesn’t US ban it? It says that millions suffer from > >chronic anxiety, and gives the symptoms: Fatigue, irritability, sleep > >problems, restlessness, etc. etc. > >So GSK wants US citizens to self-diagnose themselves, go to a >  psychiatrist > >and ask him/her to prescribe Paxil! That’s wonderful! > >cem > why dont you go fuck yourself? Paxil is a great drug. > Eric > If one was a stockholder in GSK I would agree with Eric, however the point > raised in this post, a point which seems to be well over the head of our > poor lost boy is that advertising of drugs might not be the best way to deal > with health issues.  By selling a little pill for every problem the doctor > patient relationship is replaced by the consumer drug company relationship. > Naturally for anti psychiatry activists like Eric that is a quite acceptable > outcome.

whats wrong with this business couldn`t the fuckers just approve it I mean just for the feeling that somethings good is going to happen

Response:

–

– Hide quoted text — Show quoted text -> >Dear Eric, > >You miss the point, as always! > >It is not the point if Paxil is a good drug or not! It is the public > >advertisement of a drug I oppose here. > >…and for the "go fuck yourself" business, all I have to say is, you > have > >serious personality problems, and you have revealed them here on the > Usenet > >for quite a long time. I suggest, you go and get some help!… > There is big money in psychotropic drug advertisements. The costs are > nothing compared to the benefits to the drug companies of someone > suggesting that med, and the years of income it will bring them. > Advertising specific medications and medications in general is a > shameless act which can possibly harm people. I’m surprised someone > who thinks they are insane because psychiatry made them that way would > object. > It is amazing how I can find no points of agreement with you in one post, > and agree with you by and large in another. > No.Spam, you are a interesting study in contradictions

one day maybe intelligent mutifaceted personalities will be able to come out of the closet.. till then we have….. did you ever see the movie or read the book "King Rat" ? – Hide quoted text — Show quoted text –

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Question:

Depression Meds: Rigging the definition to boost profits New Statesman (London) 11 March 2002 The  New  Statesman  Special  Report  -  The  rebranding  of a disease Should  we  trust  the scientific data on the effects of drugs? Not if the case of depression, for which pharmaceutical companies found a new definition, is anything to go by. Jerome Burne reports If  the  directors  of drug companies are in the habit of taking their own   medicines,   then   consumption  of  anti-depressants  in  their boardrooms should have soared last month. Not least to show solidarity in  the  face  of  growing  concerns  that Prozac-type anti-depression drugs,  one  of the biggest pharmaceutical success stories of the past decade, may be not only dangerous to some, but also addictive. The magazine Health, Which came out with a warning that patients being offered  anti-depressants  were  often  not told "about issues such as withdrawal  problems  or  .  . . a possible risk of increased suicidal behaviour",   and  the  Royal  College  of  Psychiatrists  issued  new guidelines,  saying  that  only 50 per cent of patients would be "much improved" after taking anti-depressants, which is little better than a placebo.  Meanwhile,  in the United States, the issue of addiction was highlighted  when the Food and Drug Administration ordered the company GlaxoSmithKline to warn doctors prescribing the drug Seroxat about the possibility of dependency. The company was also found in breach of the industry code by describing problems with withdrawal as "very rare". All of this came in the wake of a court case last June, brought by the family  of  a  man  who,  a  few  days after being put on the drug for sleeping  problems,  had shot his daughter, his grandchildren and then himself. The court agreed with the family’s claim that Seroxat (one of a  class of drugs known as selective serotonin reuptake inhibitors, or SSRIs)  had contributed to his behaviour, and awarded them $6.4m. This was  the  second case linking SSRIs with suicide to come to court, but more than 200 have been settled out of court. What  makes  this all the more alarming is that the drugs involved are so widely used – prescriptions for all SSRIs in the UK run at about 10 million.  They  are  increasingly  prescribed  for  a  wide variety of conditions,  such  as  skin complaints, pre- menstrual tension, weight loss  and  attention-deficit  disorder.  But  it  also raises the more important  and  wider question: can we trust the drug companies? Or is there  a  strong possibility that their business practices could leave both  doctors  and  patients  with  no way of telling just how safe or effective our medications are? When  it  comes  to  spin, the drug companies make the government look clumsy  and  amateurish. At the heart of the worries over SSRIs is the growing  belief  that the drug companies have been less than honest in their account of the risks involved. But it is not just SSRIs that are given  a  positive  gloss  when  the evidence points the other way. In January, for instance, Swiss prosecutors began a criminal inquiry into the pharmaceutical giant Bayer AG, "on suspicion of fraud and grievous bodily  damage",  following  the  recall last year of the cholesterol- lowering  drug  cerivastatin (otherwise known as Lipobay in Europe and Baycol  in  the US). The prosecutors are accusing Bayer of suppressing vital  information about the drug’s potentially fatal interaction with another drug, which has been linked to more than 50 deaths. Could  the  drug companies do such a thing? The editors of the world’s top  11  medical  journals,  including the Lancet, the British Medical Journal  and  the New England Journal of Medicine, certainly think so. Last September, the International Committee of Medical Journal Editors issued  a  joint  statement  calling for more openness in the way drug companies report their results and less readiness to hide unfavourable ones.  The  editors  declared  that  they will now "require authors to attest that they had full access to all of the data in [a] study and . .  .  [to]  take complete responsibility for the integrity of the data and the accuracy of the data analysis". The  point  about  having "full access to all of the data" is crucial, because  it  lies  at  the root of how science works. Only if they can look at the raw data are other scientists able to judge how reasonable is the interpretation. But all too often, the results from drug trials are  presented  in  the  form of tables, and the drug companies refuse access  to  the  raw  data  on  the  grounds  that  it is commercially sensitive. However,  the  concerns  of  the  journal  editors  on this point were clearly  not  enough.  In  February,  the  UK’s  National Institute of Clinical   Excellence   (Nice)   claimed  that  "drug  companies  have successfully  withheld important data". Gauging the efficacy of a drug is  fraught  with  problems, declared Dr Iain Chalmers of the Cochrane Centre,  an  organisation  set  up to evaluate the efficacy of medical treatments,  "because negative results are rarely published in medical journals". The moral vacuum that results from constant spinning is threatening to suck  in  not  just the academics who are paid to do the work for drug companies, but the whole process of scientific medicine. In an article last  September  entitled  "Dancing  with the porcupine", the Canadian Medical  Association Journal attempted to set out some principles that ought  to  apply  when pharmaceutical companies are funding academics. The  authors  start  by recognising that such alliances are inherently tricky:  "The  duty of the universities is to seek the truth. The duty of  the  pharmaceutical  companies is to make money." But, and this is the  important  bit,  "if  either abandons its fundamental mission, it ultimately  fails".  A broke drug company or a discredited academic is no use to anyone. The  attempt to hammer out some sort of guidelines was set against the background of at least two highly publicised Canadian cases where drug companies   had  used  "intimidating  tactics"  that  had  "profoundly affected"  researchers’ lives. One involved a lawsuit by Bristol-Myers Squibb against the Canadian Co-ordinating Office for Health Technology Assessment  to  suppress  a  report  on the cholesterol-lowering drugs statins.  The  other  was  the  legal  threat by AstraZeneca against a researcher   at  Ontario’s  McMaster  University  for  her  review  of medications for stomach disorders. Even  if  matters  don’t  get  as far as the courts, "industry funding creates  an  incentive  to  promote  the  positive  and  suppress  the negative",  says  the  journal.  An  example is the "landmark article" showing  that  industry-sponsored research into certain heart drugs is more likely to be supportive of their use than is independently funded research.  The  conclusion  argues  for the drawing up of some sort of industry/university  contract  containing clauses giving academics the right  to "disclose potentially harmful clinical effects immediately", for  a  surcharge  on  contracts  to  fund  a regulatory body, for the setting up of an ombudsman, and so on. All  very  well  and good, but getting regulatory bodies to respond to concerns  about  some drugs can be hard work. That, at least, has been the experience of the psychiatrist Dr David Healy who, since 1999, has been  engaged  in  extensive  correspondence  with  the UK’s Medicines Control  Agency  (MCA)  over  the  links  between  SSRIs,  suicide and addiction.  Their exchange of letters now runs to more than 100 pages, with  the  majority  of  that coming from Healy. As of last month, the agency’s  position  is that there is no cause for concern and that all the warnings that are needed are in place. What  makes  Healy’s  campaign  of particular interest is, first, that he’s  no maverick, driven by a belief in herbs or the healing power of madness.  He  is  a mainstream biological psychiatrist and director of the North Wales Department of Psychological Medicine in Bangor, he has written   a   highly  acclaimed  history  of  anti-depressants  -  The Anti-depressant Era, published by Harvard University Press – and he is the  author  of  more  than 100 scientific papers. But he is concerned that  patients  and  the profession are not being told the truth about the risks. His  campaign also gains added weight from his experience as an expert witness  in two American court cases involving suicide and SSRIs. As a result,  he has seen previously unpublished data on trials carried out by  the  drug  companies  on  healthy  volunteers. His analysis of the secret  data,  the sort that drug companies usually refuse to release, shows  that about 25 per cent of healthy volunteers given the drug had some  sort  of  unpleasant psychological reaction. "That suggests that the  likelihood of someone committing suicide during their first month of  treatment  with  Prozac  is  ten  times  greater than if they were untreated,"  he  says.  "That is a level of risk approaching that of a smoker’s likelihood of developing lung cancer." This  suggests  an astonishing gap between what the drug companies say publicly  and what their own data shows. As a striking illustration of this gap between secret and public knowledge, Healy is fond of quoting a  story  from an American newspaper, the Boston Globe, which appeared in May 2000. It concerned a new form of Prozac, known as R-fluoxetine, which had been patented in 1993 (US patent no 5,708,035) and which Eli Lilly  planned  to  market when the existing patent ran out in 2002. A patent  application  requires  that you say why your new version is an improvement.  So  what were the benefits of R-fluoxetine? "It will not produce several existing side effects, including akathsia [agitation], suicidal thoughts and self-mutilation . . . one of its [Prozac's] more … read more »

Response:

> Depression Meds: Rigging the definition to boost profits > New Statesman (London) > 11 March 2002 > The  New  Statesman  Special  Report  -  The  rebranding  of a disease

Very good article – thank you – hope it gets replays Squiggles

Response:

Question:

> First, Reglan does not produce tardive diskenesia.  It isn’t even a > psychotropic drug.

Um – sorry to disagree but Reglan blocks dopamine and so can have all the same side effects as Haldol and the other antipsychotics. Usually the symptoms go away when the drug is stopped. It is one of the drugs that is recommended to not be used in the elderly but unfortunately the people with the problems for which it is used are usually older. This is especially true since they took Propulsid off the market. — CBI, MD

Response:

> > First, Reglan does not produce tardive diskenesia.  It isn’t even a > psychotropic drug. > Um – sorry to disagree but Reglan blocks dopamine and so can have all the > same side effects as Haldol and the other antipsychotics.

and if you’d do your homework, you’d learn that it was through prolonged use of dopaminergic medications that TD develops.  Sure, you can get some dyskinesias but that is not, I repeat not, TD as the symptoms go away when the med stops.  TD doesn’t. > Usually the > symptoms go away when the drug is stopped.

Then it isn’t TD > It is one of the drugs that is > recommended to not be used in the elderly but unfortunately the people with > the problems for which it is used are usually older. This is especially true > since they took Propulsid off the market. > — > CBI, MD

– No medicine is more valuable, none more efficacious, none better suited to the cure of all our temporal ills than a friend to whom we may turn for consolation in time of trouble, and with whom we may share our happiness in time of joy.                Saint Ailred of Rivaulx (1109 – 1166)                Historian and abbot http://home.gwi.net/~mdmpsyd/index.htm remove peterhood69 for mail

Response:

….. >and if you’d do your homework, you’d learn that it was through prolonged >use of dopaminergic medications that TD develops.  Sure, you can get >some dyskinesias but that is not, I repeat not, TD as the symptoms go >away when the med stops.  TD doesn’t.

Prolonged use or one shot of Prolixin the dopaminergic drug from Hell. -George – Hide quoted text — Show quoted text ->> First, Reglan does not produce tardive diskenesia.  It isn’t even a >> psychotropic drug. >Um – sorry to disagree but Reglan blocks dopamine and so can have all the >same side effects as Haldol and the other antipsychotics. Usually the >symptoms go away when the drug is stopped. It is one of the drugs that is >recommended to not be used in the elderly but unfortunately the people with >the problems for which it is used are usually older. This is especially true >since they took Propulsid off the market. >– >CBI, MD

Response:

ONce a doKtor puts someone on an anti psychotic they expect them to use it indefinately.. – Hide quoted text — Show quoted text – >….. >and if you’d do your homework, you’d learn that it was through prolonged >use of dopaminergic medications that TD develops.  Sure, you can get >some dyskinesias but that is not, I repeat not, TD as the symptoms go >away when the med stops.  TD doesn’t. >Prolonged use or one shot of Prolixin the dopaminergic drug from Hell. >-George >>> First, Reglan does not produce tardive diskenesia.  It isn’t even a >>> psychotropic drug. >>Um – sorry to disagree but Reglan blocks dopamine and so can have all the >>same side effects as Haldol and the other antipsychotics. Usually the >>symptoms go away when the drug is stopped. It is one of the drugs that is >>recommended to not be used in the elderly but unfortunately the people with >>the problems for which it is used are usually older. This is especially true >>since they took Propulsid off the market. >>– >>CBI, MD

— I have a ten year old son who was diagnosed with ADHD before the age of three. The more drugs they gave him, the sicker he got. Bipolar by the age of six then schizophrenia by the time he was almost nine. We found out he was actually suffering from drug  induced mental and emotional deterioration after being drugged for six and a half years. The doctors  knew the drugs had caused brain damage but didn’t bother to share that information with us and continued to drug him. We intend to see that they are held accountable for their mistakes. Carol Hall

Response:

 Bullshit… I got all manner of EPS from friggin SSRI’s …

– Hide quoted text — Show quoted text – > ….. >and if you’d do your homework, you’d learn that it was through prolonged >use of dopaminergic medications that TD develops.  Sure, you can get >some dyskinesias but that is not, I repeat not, TD as the symptoms go >away when the med stops.  TD doesn’t. > Prolonged use or one shot of Prolixin the dopaminergic drug from Hell. > -George >>> First, Reglan does not produce tardive diskenesia.  It isn’t even a >>> psychotropic drug. >>Um – sorry to disagree but Reglan blocks dopamine and so can have all the >>same side effects as Haldol and the other antipsychotics. Usually the >>symptoms go away when the drug is stopped. It is one of the drugs that is >>recommended to not be used in the elderly but unfortunately the people with >>the problems for which it is used are usually older. This is especially true >>since they took Propulsid off the market. >>– >>CBI, MD

Response:

115. Jerry Goldsmith (husband of Margie) My wife has Tardive Dyskinesia because a Psychiatrist overloaded her with Benzos,while under his care in a Psychiatric Hospital. TD, like AIDS is for LIFE. So folks, be careful what you let a Shrink give you. BE INFORMED and don’t believe everything they say! – Hide quoted text — Show quoted text – > Bullshit… I got all manner of EPS from friggin SSRI’s >… > ….. > >and if you’d do your homework, you’d learn that it was through prolonged > >use of dopaminergic medications that TD develops.  Sure, you can get > >some dyskinesias but that is not, I repeat not, TD as the symptoms go > >away when the med stops.  TD doesn’t. > Prolonged use or one shot of Prolixin the dopaminergic drug from Hell. > -George > >>> First, Reglan does not produce tardive diskenesia.  It isn’t even a > >>> psychotropic drug. > >>Um – sorry to disagree but Reglan blocks dopamine and so can have all >the > >>same side effects as Haldol and the other antipsychotics. Usually the > >>symptoms go away when the drug is stopped. It is one of the drugs that >is > >>recommended to not be used in the elderly but unfortunately the people >with > >>the problems for which it is used are usually older. This is especially >true > >>since they took Propulsid off the market. > >>– > >>CBI, MD

— I have a ten year old son who was diagnosed with ADHD before the age of three. The more drugs they gave him, the sicker he got. Bipolar by the age of six then schizophrenia by the time he was almost nine. We found out he was actually suffering from drug  induced mental and emotional deterioration after being drugged for six and a half years. The doctors  knew the drugs had caused brain damage but didn’t bother to share that information with us and continued to drug him. We intend to see that they are held accountable for their mistakes. Carol Hall

Response:

>  Bullshit… I got all manner of EPS from friggin SSRI’s

which ones? not all side effects are extra pyramidal and SSRIs are not known to produce extra pyramidal symptoms; what else were you on? – Hide quoted text — Show quoted text -> … > ….. > >and if you’d do your homework, you’d learn that it was through prolonged > >use of dopaminergic medications that TD develops.  Sure, you can get > >some dyskinesias but that is not, I repeat not, TD as the symptoms go > >away when the med stops.  TD doesn’t. > Prolonged use or one shot of Prolixin the dopaminergic drug from Hell. > -George > >>> First, Reglan does not produce tardive diskenesia.  It isn’t even a > >>> psychotropic drug. > >>Um – sorry to disagree but Reglan blocks dopamine and so can have all > the > >>same side effects as Haldol and the other antipsychotics. Usually the > >>symptoms go away when the drug is stopped. It is one of the drugs that > is > >>recommended to not be used in the elderly but unfortunately the people > with > >>the problems for which it is used are usually older. This is especially > true > >>since they took Propulsid off the market. > >>– > >>CBI, MD

– No medicine is more valuable, none more efficacious, none better suited to the cure of all our temporal ills than a friend to whom we may turn for consolation in time of trouble, and with whom we may share our happiness in time of joy.                Saint Ailred of Rivaulx (1109 – 1166)                Historian and abbot http://home.gwi.net/~mdmpsyd/index.htm remove peterhood69 for mail

Response:

> >  Bullshit… I got all manner of EPS from friggin SSRI’s > which ones? > not all side effects are extra pyramidal and SSRIs are not known to > produce extra pyramidal symptoms; what else were you on?

You need to READ the inserts come with the SSRI’s… Even the manufacturers finally admit..SSRI’s cause all manner of EPS! – Hide quoted text — Show quoted text -> … > > ….. > > >and if you’d do your homework, you’d learn that it was through prolonged > > >use of dopaminergic medications that TD develops.  Sure, you can get > > >some dyskinesias but that is not, I repeat not, TD as the symptoms go > > >away when the med stops.  TD doesn’t. > > Prolonged use or one shot of Prolixin the dopaminergic drug from Hell. > > -George > > >>> First, Reglan does not produce tardive diskenesia.  It isn’t even a > > >>> psychotropic drug. > > >>Um – sorry to disagree but Reglan blocks dopamine and so can have all > the > > >>same side effects as Haldol and the other antipsychotics. Usually the > > >>symptoms go away when the drug is stopped. It is one of the drugs that > is > > >>recommended to not be used in the elderly but unfortunately the people > with > > >>the problems for which it is used are usually older. This is especially > true > > >>since they took Propulsid off the market. > > >>– > > >>CBI, MD > — > No medicine is more valuable, none more efficacious, > none better suited to the cure of all our temporal > ills than a friend to whom we may turn for consolation > in time of trouble, and with whom we may share our > happiness in time of joy. >                Saint Ailred of Rivaulx (1109 – 1166) >                Historian and abbot > http://home.gwi.net/~mdmpsyd/index.htm > remove peterhood69 for mail

Response:

>don’t expect a reasonable response from mark d morin.. he is a troll

If Dr. Morin is a troll, he’s one with a rather different approach than any others I’ve ever seen. For one thing, trolls tend not to ask relevant questions, nor to substantiate anything they say.   Joe Parsons – Hide quoted text — Show quoted text – >GMT, in alt.support.depression.manic "Eve" >

Question:

I can’t ejaculate with this Paxil.  Anyone else experiencing this problem?

Response:

> I can’t ejaculate with this Paxil.  Anyone else experiencing this problem?

Nope. Squiggles (hee hee hee)

Response:

> I can’t ejaculate with this Paxil.  Anyone else experiencing this problem?

Can’t say that I’ve ever had this problem, but then I couldn’t before Paxil either. Sorry, bad joke. More seriously, "sexual side effects" like this are fairly common on SSRIs — including Paxil — there may be something you can do about this, perhaps some of the men here or your doctor could help. It’s a good sign that you’re interested in doing it though! Fiona — If we had no winter, the spring would not be so pleasant: if we did not sometimes taste the adversity, prosperity would not be so welcome.      – Anne Bradstreet, Meditations Divine and Moral, 1664

Response:

> Gigco Biloba can help with the Paxil side effect until you can wean yourself off > the paxil

I have no intention of going off Paxil in the near future, unless my doctor decides it’s best to try something else for a while. I have no complaints about Paxil, it doesn’t solve all my problems — but no pill can — and it’s keeping me from killing myself while I work on the problems. I also have no intention of taking herbal supplements — and I think you meant ginko biloba. Besides, I don’t need to ejaculate to feel quite completely satisfied. So follow-up to the poster who needs your advice for a change. Fiona — If we had no winter, the spring would not be so pleasant: if we did not sometimes taste the adversity, prosperity would not be so welcome.      – Anne Bradstreet, Meditations Divine and Moral, 1664

Response:

> I can’t ejaculate with this Paxil.  Anyone else experiencing this problem?

I had it, but after discontinuing the paxil it went away, maybe talk to your doc about welbutrin it has low occurence of sexual side effects, btw the babes liked the paxil :-

Duloxetine is a medication used to treat depression and anxiety. Buy duloxetine fibromyalgia and feel better today!

Question:

has  anyone heard of that new anti-depressant on the radio?i was trying to remember what it was called.thanks

Response:

.."that" new antidepressant on the radio? Geez, you’re not giving us much to go on. I haven’t heard of anything new available here in the US, sadly.

Response:

>: Re: new anti-depressant?

The only new one I’ve heard about recently is Duloxetine and, quite frankly, I don’t think it’s much to get excited about, but you be the judge. I think Eli Lilly markets it, and that would make sense because their Prozac patent just ran out and generic companies have scooped up generic prozac (fluoxetine), so that is that much less money in Eli Lilly’s pockets. Interesting that they timed the news about Duloxetine right after the prozac patent ran out.

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