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Offline Deano8888

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Anti-epileptic drugs for anxiety
« on: January 29, 2011, 01:00:42 PM »
After doing some research I found that some anti-epileptic drugs are being used for anxiety. These include Pregabalin, Gabapentin and valproic acid. I spoke to my GP and she knew nothing about them. Has anyone tried any of these drugs and what are your thoughts?

There is loads of research on the internet about the drugs that all seem to support the use.

Like many people I am desperate for some relief from anxiety, and these drugs seem to offer the benefits of benzo's  without the horrible side-effects of dependency and withdrawal
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Offline wiegehts

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Re: Anti-epileptic drugs for anxiety
« Reply #1 on: January 29, 2011, 03:55:47 PM »
my doctor gave me lorazepam to calm me down when i have a panic attack.it used to work really well with 1 mg, but i guess i got used to it and now i dont feel any different when i take one pill.
also you can get very addictive to it apparently so you have to watch out.
sometimes i just take it as a placebo.
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Offline sixpack

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Re: Anti-epileptic drugs for anxiety
« Reply #2 on: January 29, 2011, 03:58:18 PM »
anti-epileptics are being used for anxiety trileptal, depakote ....

no they are not benzoes but they are not without issues.  My daughter has taken many anti-seizure meds over the years---carbatrol, tegretol, keppra, trileptal, depakot, vimpat, lamictal.  Many are sedating and cause weight gain.  All need to be titrated up slowly when going on and titrated down slowly when coming off just like SSRIs. If not significant side effects will occur.  Benzoes are or can be habiting forming, that's true.  They also don't correct chem imbalances etc.  If you would like to get good info on anti-seizure meds for anxiety use, you would probably get good info from a psychiatrist or perhaps a neurologist.
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MOST anxiety occurs on a subconscious level.  JUST because you don't feel consciously anxious or had a day or two of calm doesn't mean your mind & body are relaxed.  It can take months of reduced anxiety before a body goes back to a more non-reactive state

Offline forever young

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Re: Anti-epileptic drugs for anxiety
« Reply #3 on: January 29, 2011, 04:50:33 PM »
dean,
I get info from natural drs and one said that there was an old seizure drug that worked well for panic attacks. IT was called dillitan I may not be spelling it right. there was a book about it called A REMARKABLE DRUG HAS BEEN OVER LOOKED by Jack Dreyfus I thought about trying to find the book but never did it may be on line.

I like you am always looking for something with fewer side effects. I have been on an anti depressant for 25  yrs have done pretty good but never faced my phobias so I have limitations that I need to work on.
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Offline Roses

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Re: Anti-epileptic drugs for anxiety
« Reply #4 on: January 29, 2011, 06:59:54 PM »
Hey!

I've been doing my research as well and I'm mostly drawn to Lyrica which is approved in the UK for GAD and only in the US for fibromyalgia.  Research has shown great success and I hear it either works wonders or causes you to be a drowsy mess.. I as well am desperate to find a long term GAD help without sacrificing my sex life.  I suppose it's worth a try :) Good luck!
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Offline sixpack

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Re: Anti-epileptic drugs for anxiety
« Reply #5 on: January 30, 2011, 08:02:47 AM »
My post was quick as I was going out the door.  I also forgot to mention that my daughter took Zonegran briefly.

SO: 

yep some anti-seizures are used for anxiety issues.  As I mentioned, though, they ALL have a list of potential issues but here are a few that some pretty well know issues.  Some with little nicknames:

*keppra-- (not sure this would be considered to help with anxiety) has a nickname called "kepprage" because it messes with behavior.
*Topamax---known as dopamax--you can surmise it can make you "dopey".  One of the bigger issues is an increase risk of glaucoma.  My eldest is already legally blind SO that keeps us from trying that one.
*Dilantin---my sister took this after she had a brain tumor removed to prevent seizures for a while (she isn't on it anymore.  The big issue here is that it causes (can cause) significant gum issues.  Anyone taking this medication should make sure they are very good with gum care and keep up with the dentist appointments.
*Depakote---is known as depabloat and is quite sedating.

The most common seizure meds I've heard being used for anxiety around here are:  depakote (valporic acid), trileptal (oxcarbazepine) and Lamictal (lamotrigine)

Here is some general info on anti-seizure meds.  None meant to scare you.  I just want you to know that while anti-seizure meds are IMPORTANT and necessary meds for those with epilepsy, they carry some potential issues.  Also want to mention, my daughter has been on a number of these meds and has never had any serious issues other than weight gain or loss or behavior changes.  Presently she is on vimpat (300mg), Depakote ER (1000mg), and Trileptal (1200mg).  I don't know if you have done this already but, personally I would try the SSRI (ie zoloft, paxil...) class of meds before going to anti-seizure meds. 

Quote
Individual Antiepileptic Drugs (AEDs), alphabetically
carbamazepine (Tegretol, Carbatrol): A favorite partial seizure medicine in the developed world. Carbamazepine affects sodium channels, and inhibits rapid firing of brain cells. Long-acting forms such as Carbatrol or Tegretol-XR can be given once a day. Potential side effects include GI upset, weight gain, blurred vision, low blood counts, low blood sodium (hyponatremia). Carbamazepine causes a rash rate of a few percent, sometimes even the dangerous rash called Stevens-Johnson syndrome. People of Asian descent with HLA-B*1502 antigen are more at risk. Typical adult dose is 400 mg tid. I start my patients with 200 mg bid and each week, and increase by 200 mg daily to about 400 mg three times a day.

clonazepam (Klonopin): Clonazepam is a member of the drug class known as benzodiazepines, to which diazepam (Valium), lorazepam (Ativan), clorazepate (Tranxene), alprazolam (Xanax) also belong. Benzodiazepines are used as anti-seizure drugs, sedatives, tranquilizers and muscle relaxants. Benzodiazepines increase the effectiveness of GABA, the brain’s main inhibitory neurotransmitter. Clonazepam is more long-acting against seizures than are diazepam or lorazepam. Side effects of clonazepam include sedation, thinking/memory impairment, mood changes, addiction. More so than most, its effects wear off over time. A typical adult dose is 0.5-1.0 mg three times a day. I usually start my patients with 0.5 mg at night, and if they are not too sleepy the next day, increase to 0.5 mg twice a day. A week later, if seizures persist, I will increase to 0.5 mg three times a day.

gabapentin (Neurontin): Gabapentin has the reputation of being a safe but not particularly powerful AED. The effectiveness criticism probably is because it is often prescribed at too low a dose. The drug probably works by influencing transport of GABA and effects on calcium channels. It has no drug interactions, is not metabolized in the liver and it does not bind to blood proteins. Side effects are unsteadiness, weight gain, fatigue, dizziness. Typical adult dose is 300-600 mg three times a, but doses can be up to 1200 mg three times a day. I often start at 300 mg per day, sometimes in one dose or with 100 mg pills, and increase over a month or two to the full dose. Gabapentin often is used also for chronic pains of certain types.

lacosamide (Vimpat): Lacosamide is a new (2009) antiepileptic drug , for partial and secondarily generalized seizures. It is chemically related to the amino acid, serine. Vimpat blocks sodium channels (but in a different way from other seizure medicines), and this block reduces brain excitability. Side effects include dizziness, headache, nausea or vomiting, double vision, fatigue, memory or mood problems. Vimpat may affect the internal organs, blood counts or heart rhythm, but these potentially serious side effects are infrequent. The recommended starting dose is 50 mg twice daily, increased each week by an extra 100 mg, to the recommended maintenance dosage of 100-200 mg twice a day. See information on Vimpat.

lamotrigine (Lamictal): A broad-spectrum alternative to VPA, with a better side effect profile. However, LTG may not be as effective for myoclonic seizures. Lamotrigine works by several mechanisms including blocking release of glutamate, the brain’s main excitatory neurotransmitter. It has the usual side effects of dizziness and fatigue, usually mild cognitive (thinking) impairment. Severe medical side effects are unusual. The practical side effect issue is rash, occurring in several percent of people who take it, especially if the dose is increased too fast. Therefore, it takes a couple of months to get up to the typical adult dose of 200 mg twice a day. I usually start my patients at low doses, adding one 25 mg pill daily each week on a two-times-a-day schedule until taking 100 mg twice a day. If there is no rash at that time, one is unlikely. I then switch my patients to 100 mg pills and increase to 200 mg twice a day over the next few weeks. This is slower than the package insert suggested starting dose, however, a slow starting dose is especially important if the patient also takes valproic acid (Depakote), to reduce risk for rash. Lamotrigine is also used for mood stabilization. See information on Lamictal.

levetiracetam (Keppra): Levetiracetam is one of the more used medicines in seizure clinics because it probably is effective for a broad-spectrum of seizures types, has a relatively low incidence of causing thinking/memory problems, and can be started at 500 mg twice a day, which is an effective dose. It has no drug interactions, is not metabolized in the liver and it does not bind to blood proteins. The most common side effects are dizziness, fatigue, insomnia, but the more troublesome problem can be irritability and mood changes. This may occur to some degree in up to a third of those taking the medicine. A typical adult dose is 500 - 1500 mg twice a day. I usually start my patients with 250 mg twice a day and increase the next week to 500 mg twice a day, then the next week to 1000 mg in the am plus 500 mg in the pm, then the week after to 1000 mg twice a day. This is slower than the package insert suggested starting dose. See information on Keppra.

lorazepam (Ativan): Lorazepam is similar to clonazepam in dosage and action, but it is not as long-acting. It is usually used as a ‘rescue medication’ for patients who frequently have clusters of seizures. It works reasonably quickly when taken orally and anti-seizure effect lasts for 2-6 hours. Typical adult dose is 0.5-2.0 mg orally or as needed. A lorazepam concentrate, 2 mg per ml, can be taken as 1 ml liquid under the tongue in urgent situations.

oxcarbazepine (Trileptal): Slightly different from carbamazepine, it is at least as effective, and may have fewer side effects, except for more risk for low blood sodium (hyponatremia). It is more expensive than generic carbamazepine. A typical adult dose is 600 mg twice a day. I start my patients with 150 mg twice a day, and increase by 150 mg daily each week. This is slower than the package insert suggested starting dose. An immediate switch from carbamazepine to full-dose oxcarbazepine is possible in some cases. See information on Trileptal.

phenobarbital (Luminal): The old-timer: very inexpensive and effective in a single daily dose. Phenobarbital increases the effect of GABA, the main inhibitory neurotransmitter in the brain. Watch for sedation, thinking/memory problems and depression. Phenobarbital can cause long-term bone problems. Phenobarbital is mildly addictive and requires slow withdrawal. During pregnancy, there is a significant rate of birth defects. Typical adult dose is around 100 mg per day. I start my patients with 30 mg pills, 2 or 3 at bedtime, to allow for future dosage flexibility. The target serum level is 10-40 mcg per ml. See information on phenobarbital.

phenytoin (Dilantin): The most used AED by general physicians in the US, less so by epilepsy doctors, because of the side effects. Phenytoin alters brain cell sodium channels, which has the effect of limiting rapid firing of the brain cells. It is inexpensive. Common side effects are unsteadiness and moderate cognitive problems. There are long-term potential cosmetic (body/face hair growth, skin problems), and bone problems (osteoporosis). Phenytoin causes a rash rate of a few percent, sometimes even the dangerous rash called Stevens-Johnson syndrome. Typical adult dose is 300-400 mg per day, usually with 100 mg pills. Phenytoin can be started quickly in an emergency with intravenous administration, or a large dose of capsules if an immediate effect is required. Small changes in phenytoin dose can cause large changes in serum drug levels, so the blood levels can be hard to regulate. The target serum level is 10-20 mcg per ml. See information on phenytoin.

pregabalin (Lyrica): A relative of gabapentin, it may be better, and can be given twice a day. Some believe that it is more effective against seizures than is gabapentin. Pregabalin has no drug interactions, no liver metabolism, no protein binding, and similar side effects to gabapentin. Typical adult dose is 150 - 600 mg bid. I usually start my patients with 50 mg daily, adding 50 mg each week on a twice a day basis until taking 300 - 600 mg per day. This is slower than the package insert suggested starting dose, but avoid sedation. Pregabalin often is used also for chronic pains of certain types. See information on Lyrica.

rufinamide (Banzel, Inovelon in Europe): Banzel works on sodium channels in brain cells, in a way to make them less excitable. Common side effects include headache, dizziness, fatigue and sleepiness, double vision and tremor (trembling). People who have the “short QT syndrome,” a rare heart rhythm irregularity, should not take Banzel. The drug comes as 200 and 400 mg tablets. Children will usually be started at doses of approximately 10 mg/kg/day administered in two equally divided doses. Dosing can increase by adding additional 10 mg/kg amounts every two days, until the child is taking 45 mg/kg/day or a maximum of 3200 mg/day, divided into two doses each day. See information on Banzel.

topiramate (Topamax): A good broad-spectrum AED (i.e., treats all types of seizures). Topiramate has several mechanisms, including blocking the enzyme carbonic anhydrase, which affects the acidity of brain tissue. More acidity (to a point) suppresses seizures. Side effects include thinking and memory problems in about 1/3rd, renal stones in 1-2%, rare cases of glaucoma (increased eye pressure) and weight loss. Typical adult dose is 150-200 mg twice a day. I usually start my patients with one 25 mg pill daily, adding another pill each week on a two-times-a-day schedule until taking 100 mg twice a day. If there are no significant side effects, I then switch my patients to 100 mg pills and increase to 200 mg twice a day over the next few weeks. Topiramate also is used for migraine headache prevention. See information on Topamax.

valproic acid (Depakote): This is the standard broad-spectrum AED (treats all types of seizures) and no other AED is more effective for generalized seizure types. VPA has effects on GABA (at least in very high doses), and a neurotransmitter called NPY to block seizures, and maybe also on calcium channels. VPA has significant side effects: weight gain, tremor, hair loss, GI upset, blood count decreases, hepatic or pancreatic injury, bone weakness over time (osteoporosis), birth defects in up to 10% (folic acid can help to prevent them). Typical adult dose is 250 mg - 500 mg three times a day, but dose can be higher. An extended release form can be taken once a day. See information on valproic acid.

vigabatrin (Sabril): At time of this writing, vigabatrin is approved in the US, but official package insert information has not become available. Vigabatrin is a “designer drug,” made to block metabolism of GABA, the brain’s main inhibitory neurotransmitter. Sabril has been used for over a decade in many countries, and it is effective for partial seizures, with or without secondary generalization. It also may be very effective for infantile spasms, a serious type of seizures in young children. Release in the US was delayed because the drug is toxic to the retina of the eye in up to 30% of people who take it long-term. This toxicity can result in permanent loss of peripheral vision. Regular vision testing is recommended for all people on this drug. A typical regimen begins with 500 mg twice a day, and can increase over a month or two to 1500 mg twice a day.

zonisamide (Zonegran): Zonisamide is rather similar in its coverage and side effects to topiramate, except glaucoma is not usually listed. Some find less cognitive impairment than with topiramate but this is individual and dose-dependent. Typical adult dose is 100-300 mg twice a day. I usually start my patients with one 25 mg pill daily, adding 25 mg each week on a two-times-a-day schedule until taking 100 mg twice a day. If there are no significant side effects, I then switch my patients to 100 mg pills and increase to 200 mg twice a day over the next few weeks. See information on zonisamide.

Others: acetazolamide (Diamox), diazepam rectal gel (Diastat), ethosuximide (Zarontin), felbamate (Felbatol), primidone (Mysoline), tiagabine (Gabitril) can be searched individually


 


Another avenue to look at for anxiety meds are the atypical anti-psychotic meds.  I've seen prescribed around here for people:

risperdol (risperodone)
geodon (ziprasidone)
seroquel (quetiapine)

my daughter took geodon for several years for behavior.  She no longer takes that.  She now takes risperdone.  Like ALL meds, they, too, have their own banks of potential side effects. 

Bottom line, IMO,  a psychiatrist or neurologist would be your best bet on informing/prescribing any med considered "off label".

     
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MOST anxiety occurs on a subconscious level.  JUST because you don't feel consciously anxious or had a day or two of calm doesn't mean your mind & body are relaxed.  It can take months of reduced anxiety before a body goes back to a more non-reactive state

Offline wiegehts

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Re: Anti-epileptic drugs for anxiety
« Reply #6 on: February 02, 2011, 04:20:56 AM »
from today on i will be taking lyrica we see how it goes and i will keep you updated!
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Offline Roses

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Re: Anti-epileptic drugs for anxiety
« Reply #7 on: February 02, 2011, 08:45:09 PM »
oh please do!  Wish you the best of luck
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Offline constantmover

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Re: Anti-epileptic drugs for anxiety
« Reply #8 on: February 03, 2011, 01:08:43 AM »
Well, I might as well weigh in here on what I know about anti-seizure medications considering one that was mentioned in the initial post is one my daughter has been on for 29 years.  The medication is valproic acid. As she has grown we have increased the dose and now we only increase it when she has her menses.  This is not unusual for adult epileptics.   Looking at it strictly from an epilepsy point of view, it has been a very good drug for her.  She has not experience any of the side effects listed.  It is not the only medication she takes for seizure control, the other is lamotrigine (Lamictal).  After many year being on valproic acid to make sure we didn't overdose my daughter on that drug, her neurologist recommended lamictal because she was experiencing a new form of seizure that she hadn't had before.  Basically, my daughter has had every type of seizure and in combination with other seizures since she was born.  Now at age 33, after trying many drugs, the first being Dilantin, which is the only medication that she has taken where she experienced just about every side effect possible.  Gum growth is just one of the many that she experienced on that medication.  It is my opinion and that of her doctors, that Dilantin set her back in development.  The prescribing doctor at that time (the top pediatric specialist in our area), simply didn't notice and we were too young and dumb with her being our first child to realize.  It was the general practitioner who finally figured out that she should be taken off that drug and we were referred to another specialist.  Since then, I have made it my mission to make sure I know all I can about medication that every member of my family takes and my philosophy about doctors in general is, if I need a specialist, don't give me the number one doctor in the city. I want number two or three, because they tend to try harder and not sit back smugly telling young mothers that they know it all or at least act like they do.  We didn't live in a large city at that time and boy what an attitude that doctor had!  Lesson learned!

I know that sixpack suggested gong on Zoloft or Paxil  and I do know that many have great results with these drugs, but because we are talking about alternatives here, as much as I like to support whatever medication works for an individual, is great by me...BUT I wouldn't be honest if I didn't mention what my neurologist told me about SSRIs.  I was sent to him because my endocrinologist suspected I had Parkinson's.  What a shock that was!  She immediately offered to refer me to a neurologist and instead I went to my GP and got the referral through him.  The neurologist took one look at me and even before I did any of the tests, said, "You definitely don't have Parkinson's but I believe you probably have essential tremor....what a relief!!!!!  Essential tremor is nothing compared to Parkinson's.   But the most interesting tidbit of information is that he immediately took me off Paxil and switched me to a beta blocker and clonazepam.  He was so peeved that my GP had put me on an SSRI especially Paxil because he was sick and tired of being sent patients who developed essential tremor from SSRIs.  Now I had essential tremor before I started on Paxil but what Paxil did was enhance it to the point that I looked like I had an extreme case of Parkinson's rather than the mild case of essential tremor that I had prior to the drug.  I didn't know that it was essential tremor which I had been hiding from everyone for about 10 years because I was afraid that it was something serious and when it developed further and I didn't put two and two together, plus the endo thinking it was Parkinson's, well it sort of confirmed what I had suspected.  What a relief to find out she was wrong. 

My long winded point here is, there is no magic pill, but there is hope that you can find something that can help and none of us are exactly alike.  Zoloft or Paxil could very well be the drugs for you.  The fear of a long acting benzo may be a concern for some but a Godsend for others.  It turned out I couldn't take the beta blocker which by the way is also great for some people who have anxiety, so all I was left with is the clonazepam (klonopin).  That is the one medication that lets me walk, write, and talk without a tremor or a very slight one at worst and the bonus is it works really well for my anxiety disorder.  So when you decide which medication you want to try and there are tonnes of choices out there, we have only touched on a few, take into consideration that there can be side effects to every drug but some are tolerable and others not or you may find that you don't have any side effects.  All the drugs we have mentioned on this thread, one has to wean off if you decide it isn't for you.  All of the drugs.  So don't pick or dismiss a drug that could be the right choice for you based on whether you would be addicted to it because no matter what, weaning is a process for all these drugs and it has been my experience that the weaning process seriously sucks no matter what drug you are on.  Some people breeze through it, others don't.  I have a very good friend who slowly under her doctor's supervision weaned off of a benzo and she had no problem what so ever.  I've known people who have done just as well going off SSRIs, but on the flip side, I had a rough time...Everyone is different.  Do you homework, don't take just our word for what these meds are like, but go into whatever you decide with a positive attitude and I'm sure your will find something that will help alleviate the anxiety.
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Offline Housekat

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Re: Anti-epileptic drugs for anxiety
« Reply #9 on: May 26, 2014, 09:10:31 PM »
That was some Good information about all the medications.  I've been on them for 58 years.  Dilantin, Depakene, Clonopin, Tegretol, Tegretol XR,  Mysoline, Carbamezapine, Oxycarbamezapine, and others. 

Right now the Keppra and Oxycarbamezapine are my meds.  Keppra 2000 mgs twice a day and Oxycarbamezapine 300 mgs two in morn and two at night.

I was told my recent Doctors that I have ADHD,  Anxiety and a lesser form of Depression that I had in the past.  Depression they used to give me Haldol, Elavil, Valium, and Triavil.  Right now Celexa I've been on for the last 15 years but I think I've become so used to it, it doesn't work anymore. A Dr at a place called "The Advanced Center for Psychotherapy" gave it to me.  I need a new one.  A few persons who witnessed some of my panicking said to me I have anxiety. Can't sleep, feeling of Fear rush over me and I wake up and try to leave the house as if I'm trying to get away from the feeling. I can't sleep.  So I will be asking my Dr for Anxiety meds also soon.  Nice to know I'm not alone in the world of Epilepsy, Depression, Anxiety, ADD, and other issues.
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Re: Anti-epileptic drugs for anxiety
« Reply #10 on: May 27, 2014, 12:36:18 AM »
I was told my recent Doctors that I have ADHD,  Anxiety and a lesser form of Depression that I had in the past.  Depression they used to give me Haldol, Elavil, Valium, and Triavil.  Right now Celexa I've been on for the last 15 years but I think I've become so used to it, it doesn't work anymore

Welcome to AnxietyZone,

I urge you see see a qualified psychiatrist to get a proper diagnosis, and then, if necessary, effective medication for it. I do not think you have been well served by some of the meds prescribed in the past, especially the Haldol, and perhaps also by the ones that weren't and should have been. And I do mean a psychiatrist, not a PCP/GP, not a psychotherapist (unless you want therapy), not an intern, but a psychiatrist.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

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