![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 53 to 77 of 125. Go back in thread:
Posted by SLS on March 18, 2006, at 18:00:27
In reply to Re: Never thought I'd hear this....., posted by SLS on March 18, 2006, at 10:21:19
Hi Linkadge.
I was able to contact Dr. Manji.
He had some interesting things to say regarding the phenomenology of bipolar disorder and recurrent depressive disorders.
Anyway, I asked him the following question:
"Does experiencing a manic reaction to an antidepressant indicate bipolarity or
can someone be unipolar and display such a reaction?"
His response:"I don't believe that there is a definitive answer, but I tend to treat individuals with antidepressant-induced manias as having a bipolar diathesis."
I imagine we both could have guessed at the answer he was to give.
I continue to find the question of antidepressant-induced manias as having tremendous heuristic value in coming to a better understanding of mood illness. I still have much to ponder.
Thanks again for sharing so much of your knowledge and hypotheses.
- Scott
Posted by SLS on March 18, 2006, at 18:19:07
In reply to Re: Never thought I'd hear this....., posted by SLS on March 18, 2006, at 10:21:19
Posted by linkadge on March 19, 2006, at 9:21:31
In reply to Re: Never thought I'd hear this..... » SLS, posted by SLS on March 18, 2006, at 18:00:27
Hey, good for you! That rules! You actually emailed "the" Dr. Manji.
He really seems like a down to earth kind of guy.
Linkadge
Posted by linkadge on March 19, 2006, at 9:34:10
In reply to Re: Never thought I'd hear this..... » SLS, posted by linkadge on March 19, 2006, at 9:21:31
I wonder what Dr. Bob's response would be to that question :) ???
Linkadge
Posted by SLS on March 19, 2006, at 10:13:52
In reply to Re: Never thought I'd hear this..... » linkadge, posted by linkadge on March 19, 2006, at 9:34:10
Dear Linkadge,
This is a bit off topic, but...
I would strongly urge you to continue your formal education with the same ferocity that you pursue your personal interest in neuroscience while your brain and mind are young, strong, and resilient. You are truly gifted. I hope you come to resolve soon those obstacles and the pain that you currently suffer and that detract from your quality of life.
I had to drop out of school after my sophomore year. I was 20 at the time. I could no longer read, learn, and remember. Most of what I have come to learn has been through selective skimming and repetition. Something has to be of great interest to me in order to focus hard enough to comprehend what I'm reading. Caffeine has helped. I imagine you have some difficulties too, but to the extent that you are still able to, you should use what you have to further your formal education. My lack of formal education denies me the foundation to understand more fully the medical literature and limits my ability to synthesize new ideas. Knowledge is the framework from which comes understanding, and, hopefully, the achievement of the goals you have set for yourself.
- Scott
Posted by linkadge on March 19, 2006, at 11:47:03
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 19, 2006, at 10:13:52
Hey, thanks for the compliment, though I don't know if I can agree with it all:) I really tend to get into arguments about things I have recently read about.
I hope that your decision doesn't haunt you for the rest of your life. Formal education is a forced rat swim test.
Narrowminded professers and teachers often automatically equate "I can't handle this emotionally" with "I can't handle this intelectually", and nothing can be farther from the truth.
Linkadge
Posted by SLS on March 19, 2006, at 12:19:56
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 19, 2006, at 11:47:03
> Hey, thanks for the compliment, though I don't know if I can agree with it all:) I really tend to get into arguments about things I have recently read about.
That's OK. I tend to get into arguments about things I don't have enough recent information about.
- Scott
Posted by tom_traubert on March 19, 2006, at 18:02:17
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 16, 2006, at 9:45:03
> Its my own personal experiement to prove this thing wrong. Maybe I will fail, and then I will accept treatment. I am going to proove that a single manic episode in responce to an antidepressant does not imply bipolar. So far (over 1 year off all treatment) has said to me that I don't cycle at all, but those are strong drugs.
>
>
> LinkadgeI support you fully, and understand the difficulties.
I was correctly diagnosed ocd pure obsessionial in 1992. No doubt there, the meds anafranil and klonopin saved my life.
However, I was diagnosed bipolar in 1994 after experiencing a major manic episode that directly followed abrupt withdrawal of 275mg Anafranil and 1.5 mg Klonopin. After a few terrible months, I was back on the same medications and was able to finish school, but then in 1998 it happenend again, another manic episode that followed the withdrawal. After that, I was put on Zyprexa to bring me down (did it ever!) as well as Depakote, Zoloft,and klonopin etc etc and it made me a zombie, a depressed suicidal zombie. 2 months later I tapered myself off all the drugs and stayed off all drugs for over 6 years. Now, those 6 years were a lot of work, and the anxiety levels didn't stop, I wrote and wrote and wrote, fillled the spiral notebooks, exercised, did everything I could trying to manage, and I did, to a point. But the whole time, I was (and am) terrified of another manic episode. What kept me going was the description of withdrawal effects in the book "Your Drug May Be Your Problem" which I'm sure this board is familiar with. I disagree categorically with the authors total dismissal of all psychotropic medications, but it was reassuring to know that some people experienced manic episodes as a result of tricyclic (Anafranil) withdrawal.
Last year, though, it became too much, I thought I was having another manic episode and the panic would not relent. (you can refer to my exasperated posts) I started and am currently on 1 mg of Klonopin/day and hooked up with a brilliant CBT therapist. The pdoc suggested Lamictal, but I wanted to see what Klonopin and CBT alone could do. I didn't take it out of the equation, but I haven't gone up in dosage on the Klonopin or taken anything else. So far, pretty good for almost a year.
I am intrigued, to say the least, of this board's opinion of "Bipolar III" (maybe I should start a new thread) as my pdoc was the first person to bring it to my attention. The real interesting angle, which I never thought of, is this: which came first, the manic episode, or the withdrawal? Meaning, I started drinking, smoking pot, missing dosages, becoming hypomanic, then going off meds completely and plunging into a major psychotic manic episode. It happened the exact same way both times. Did the antidepressants bring about the hypomanic behavior that served as a catalyst for withdrawal that served as a further catalyst for mania? If I stayed on the meds would I have gone manic nonetheless?
I am still terrified of another manic episode, it is my number 1 anxiety-causing issue, and I'm working on it, and I'm making progress. But it would sure be nice to know that the meds had a larger part in my mania than anything else. I just want a clearer reference point.
Thanks for listening, and any feedback is much appreciated,
tt
Posted by linkadge on March 19, 2006, at 19:28:15
In reply to Re: Never thought I'd hear this..... » linkadge, posted by tom_traubert on March 19, 2006, at 18:02:17
>However, I was diagnosed bipolar in 1994 after >experiencing a major manic episode that directly >followed abrupt withdrawal of 275mg Anafranil >and 1.5 mg Klonopin. After a few terrible >months, I was back on the same medications and >was able to finish school, but then in 1998 it >happenend again, another manic episode that >followed the withdrawal. After that, I was put >on Zyprexa to bring me down (did it ever!) as >well as Depakote, Zoloft,and klonopin etc etc >and it made me a zombie, a depressed suicidal >zombie. 2 months later I tapered myself off all >the drugs and stayed off all drugs for over 6 >years. Now, those 6 years were a lot of work, >and the anxiety levels didn't stop, I wrote and >wrote and wrote, fillled the spiral notebooks, >exercised, did everything I could trying to >manage, and I did, to a point. But the whole >time, I was (and am) terrified of another manic >episode. What kept me going was the description >of withdrawal effects in the book "Your Drug May >Be Your Problem" which I'm sure this board is >familiar with. I disagree categorically with the >authors total dismissal of all psychotropic >medications, but it was reassuring to know that >some people experienced manic episodes as a >result of tricyclic (Anafranil) withdrawal.
You raise some very interesting points. I have had a very similar course of illness. My first major "break" came when I abruptly came off celexa 20mg. The accounts you detail are true. Mania has been a doctumented side effect of antidepressant withdrawl. I remember reading acounts of SSRI withdrawl manias that were so strong they were unresponsive to multiple mood stabilizers. They subsided over time.
There are plenty of possible reasons for this. First you're probably going to experience significant rem rebound and cholinergic activation, which can cause psychosis it itself. Secondarily you are going to go through a major realignment of serotonin and dopamine. Coming off clomipramine probaby shot dopamine relase very high for a while, since SSRI's can dam up dopamine release. Thirdly SSRI's, and I believe clomipramine also affect a powerfull gabergic neurosteroid called allopregnalone (sp.) So coming off of them abruptly can lead to a rebound in excitory neurotransmission.
By the way your experience sounds, I am guessing that it was not pleasant. Ie not a euphoric mania, but (if it was anything like mine) a fearfull, dysphoric mania. The fact that you are scared to death of this happening again sends me a message. One psychitrist told me that if you "fear" becoming manic, then it is probably not bipolar.
>Last year, though, it became too much, I thought >I was having another manic episode and the panic >would not relent. (you can refer to my >exasperated posts) I started and am currently on >1 mg of Klonopin/day and hooked up with a >brilliant CBT therapist. The pdoc suggested >Lamictal, but I wanted to see what Klonopin and >CBT alone could do. I didn't take it out of the >equation, but I haven't gone up in dosage on the >Klonopin or taken anything else. So far, pretty >good for almost a year.
Glad you're doing better. I've had some bad panic attacks that involved near psychosis. The fact that you're experiencing this cluster of manic/panic symtpoms also sends a message. Most manic people are out spending a lot of money in kind of a state of fearlessness. Sounds to me more like a "mixed state".
>I am intrigued, to say the least, of this >board's opinion of "Bipolar III" (maybe I should >start a new thread) as my pdoc was the first >person to bring it to my attention. The real >interesting angle, which I never thought of, is >this: which came first, the manic episode, or >the withdrawal? Meaning, I started drinking, >smoking pot, missing dosages, becoming >hypomanic, then going off meds completely and >plunging into a major psychotic manic episode. >It happened the exact same way both times. Did >the antidepressants bring about the hypomanic >behavior that served as a catalyst for >withdrawal that served as a further catalyst for >mania? If I stayed on the meds would I have gone >manic nonetheless?
Good question. It has been my contention this year to simply test it out. If I am bipolar then I will go manic anyway, without drugs. Well, so far no manic episodes no cyling, no nothing, just back to my original problems, dysthemia, insomnia, anxiety etc. I think it is fully possible for a bipolar person to get prescribed AD's and for a whole lot of bad things to result, but I just never "believed" that was me. Its funny you mention some of the other substances. Yes when I was on AD's I was doing a lot of strange things too. Coffee galore, benzo's, some marajuanna, but a lot of that has subsided after discontinuation. I began to think that a lot of this was simply self medication to try and break with the medication's side effects.
I know that SSRI's gave me some really bad apathy, and akathesia, and that perhaps I was trying to counteract these feelings.
>I am still terrified of another manic episode, >it is my number 1 anxiety-causing issue, and I'm >working on it, and I'm making progress. But it >would sure be nice to know that the meds had a >larger part in my mania than anything else. I >just want a clearer reference point.No, the way you describe it, your "experiences" happened directly after sudden changes in medication. I would personally atribute it to that. These meds are very powerfull, and can do many things upon initiation and withdrawl.
If you have to "wrack your brain" for hints of past bipolarity, then I would personally lean away from that diagnosis.
I have another theory that SSRI's may acutally increase the desire to do illegal substances, to try and restore some ballance in to the dopaminergic system.
Just some thoughts, you thoughts ?
Linkadge
Posted by tom_traubert on March 19, 2006, at 19:57:27
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 19, 2006, at 19:28:15
> I have another theory that SSRI's may acutally increase the desire to do illegal substances, to try and restore some ballance in to the dopaminergic system.
>
>
>
> Just some thoughts, you thoughts ?Thanks for the informed response. Yes, I should have mentioned coffee. Caffeine junkie, actually working in a coffeehouse at the time of the 2nd episode, and smoking cigarettes. I'm not learned in the specific brain chemistry, although I probably should be, but everyone I know who is on high levels of meds smokes and drinks coffee like a fiend. I've quit both, except for the occasional cigar.
But Anafranil is a tricyclic, yes? Are SSRI and tricyclic interchangeable terms?
The smoking pot and the drinking were definitely part of trying to connect with a "normal" life, i.e. what I felt my youth was missing out on due to my illness. There was also a deep deep shame of feeling how I felt, as if I could have/should have been stronger or better equipped to handle my emotions. That lasted a long time and it's such vile garbage, but it's a tough one too. You don't want to fall into a powerless victim's mentality but you don't want to delude yourself either. Those are semantics, but either way, shame is a silent killer--causes you to engage in patterns/behaviors that will make it worse. I've let go of that.
So, it seems that it's a constant guessing game, a measuring of emotions to see where they fall. Am I too happy? Am I too upset? Am I hypomanic or am I just busy? It's exhausting and the search, the analysis can cause what it's trying to correct, or at least perpetuate it. The ocd and anxiety kick in, but CBT really cuts through a lot of the b.s.
Thank you for your support--just hearing the opinion that the mania is more meds-related unleashes so much emotion for me. The difficulty is that the mania was fantaastic at first, then pure delusional with frightened paranoid spells and fits of uncontrollable anger. And the first time it lasted a good 2 months after withdrawal, which would lean my thoughts in the other direction, that since it lasted so long, I am truly bipolar. But like you said, if it comes it comes, and you have to take it from there. I've agreed with myself that I'll go on other meds if necessary, but man I'm got to try every other safe avenue first.
Good luck and please write any and all thoughts, this topic never ever bores me.
Thanks again.
tom
Posted by SLS on March 19, 2006, at 20:10:59
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 19, 2006, at 19:28:15
> Thirdly SSRI's, and I believe clomipramine also affect a powerfull gabergic neurosteroid called allopregnalone
How does allopregnalone work? Does it act to increase the sensitivity of GABA-A receptors?
Thanks.
- Scott
Posted by linkadge on March 19, 2006, at 20:28:51
In reply to Re: Never thought I'd hear this....., posted by tom_traubert on March 19, 2006, at 19:57:27
Again, I would say that 2 months does not mean anything. If this was a witdrawl reaction, it can take a long time for the brain to reset itself.
Sometimes the drugs bottle a lot of things up. They are emotional anesthetics. Many people actually consider the SSRI's to be like mood stabilizers since they can tend to make people feel flat, apathetic, and zombie like.
Coming off a SSRI (or TCA in your case) can be emotionally liberating. I went a little loopy coming off an SSRI simply because there were so many bottled up emotions that were suddenly unleashed. Anger, fear, rebound obsessivness, joy, love. I also had a rebound sexual desire that was very strong, since I very little sexual desire on the medications.
My withdral reactions lasted about 2 months after which I began to feel more normal. The brain just can't reset itself overnight. Coming of SSRI's was hard. After a drop in 10mg, I was so angry, I just wanted to smash everything in my room. They bottle up a lot.Its like that Seinfeld Episode..."serenity now.....insanity later" :)
Thats just my oppinion. But I do know that such reactions are not totally uncommon, I have a few friends that went totally loopy too coming off antidepressants. But it did subside, and they got better.
Take Care
Linkadge
Posted by linkadge on March 19, 2006, at 20:34:26
In reply to Re: Never thought I'd hear this....., posted by SLS on March 19, 2006, at 20:10:59
Not exactly sure:
There's an article here:
http://pub.ucsf.edu/newsservices/releases/2004010612
Linkadge
Posted by SLS on March 19, 2006, at 20:59:24
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 19, 2006, at 20:28:51
> Again, I would say that 2 months does not mean anything. If this was a witdrawl reaction, it can take a long time for the brain to reset itself.
For someone who is not bipolar, I would expect a "reset" to take less than 2 months. More like 2 weeks. It takes about 2 weeks for receptor turnover and a change in the expression of genes encoding for certain cytosolic enzymes and membrane proteins.
> My withdral reactions lasted about 2 months after which I began to feel more normal. The brain just can't reset itself overnight.My first mania lasted for 2 months after the discontinuation of antidepressants. It is interesting that all three of us should have experienced a mania lasting for the same period of time. I would say that there developed an inertia of bipolar dysregulation. Unfortunately, when the mania subsided, I was left in a depressed state.
I guess what I'm saying is that there might be a bipolar thing going on here. Sorry...
Then again, it's hard to argue with Linkadge. His rationales are quite compelling. He's got me re-thinking things.
- Scott
Posted by SLS on March 19, 2006, at 21:12:07
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 19, 2006, at 20:34:26
> Not exactly sure:
>
> There's an article here:
>
> http://pub.ucsf.edu/newsservices/releases/2004010612
>
> Linkadge
Thanks.Forgive me. I was too lazy to Google it for myself.
:-)
- Scott
Posted by tom_traubert on March 19, 2006, at 21:17:22
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 19, 2006, at 20:28:51
> Coming off a SSRI (or TCA in your case) can be emotionally liberating. I went a little loopy coming off an SSRI simply because there were so many bottled up emotions that were suddenly unleashed. Anger, fear, rebound obsessivness, joy, love. I also had a rebound sexual desire that was very strong, since I very little sexual desire on the medications.
Absolutely. Most heightened libido ever experienced, in addition the heightening of every emotion. When the crash came, it crashed real hard, which made a stronger case for bipolar dx. But if the brain is going to right itself, settle etc, I'm sure that depression is expected, just as sleep follows waking hours. There has been no major depression apart from directly after the manic episodes. There's been depression, but not like that.
Looking forward to Bipolar III becoming something more probable, something researched to a greater extent.
tt
Posted by SLS on March 19, 2006, at 21:33:40
In reply to Re: Never thought I'd hear this....., posted by tom_traubert on March 19, 2006, at 21:17:22
> Looking forward to Bipolar III becoming something more probable, something researched to a greater extent.
Bipolar III might end up as the official designation for what is now labelled as cyclothymic disorder. In this case, it is proposed that bipolar IV represent depression with antidepressant-induced mania.
-------------------------------------
One proposed scheme:
THE BIPOLAR SPECTRUMBIPOLAR I: Both mania and major depression
BIPOLAR II: Major depression and hypomania
BIPOLAR III: Cyclothymia. Mild depression and hypomania
BIPOLAR IV: Depression and usually no mania. Mania may be triggered by some antidepressants.
BIPOLAR V: Depression and no mania. Some blood relatives have had mania
BIPOLAR VI: Mania and no depression
http://www.bipolarworld.net/Bipolar%20Disorder/Diagnosis/dis.html
---------------------------------------
- Scott
Posted by tom_traubert on March 19, 2006, at 21:39:04
In reply to Re: Never thought I'd hear this..... » tom_traubert, posted by SLS on March 19, 2006, at 21:33:40
That's really interesting, thanks!
Posted by Phillipa on March 19, 2006, at 21:40:58
In reply to Re: Never thought I'd hear this..... » tom_traubert, posted by SLS on March 19, 2006, at 21:33:40
Scott does this mean that if I'm on luvox and increasing the dose is making me more depressed amd the fact that I have taken a bezo for 30 some odd years mean I should stop the antidepressants and stay on what used to work just fine? Love Phillipa
Posted by JahL on March 19, 2006, at 22:00:19
In reply to Re: Never thought I'd hear this..... » tom_traubert, posted by SLS on March 19, 2006, at 21:33:40
>
> One proposed scheme:
>
>
> THE BIPOLAR SPECTRUM
>
> BIPOLAR I: Both mania and major depression
>
> BIPOLAR II: Major depression and hypomania
>
> BIPOLAR III: Cyclothymia. Mild depression and hypomania
>
> BIPOLAR IV: Depression and usually no mania. Mania may be triggered by some antidepressants.
>
> BIPOLAR V: Depression and no mania. Some blood relatives have had mania
>
> BIPOLAR VI: Mania and no depression
>
>
> http://www.bipolarworld.net/Bipolar%20Disorder/Diagnosis/dis.htmlThanks Scott.
It took me three years to have my dx recognised (I had always known what it was) - the main reason being my illness doesn't match any of the traditional descriptions of Bipolar - and I had a particularly nasty response to Lithium. Anything with 5HT action can get me switching however. So I guess I'm BP IV. Cool.
How 'official' is this scheme? Can I go and impress pdocs by quoting a dx they've never even heard of (this is England remember)?
Ta,
J.
Posted by SLS on March 19, 2006, at 22:05:13
In reply to Re: Never thought I'd hear this..... » SLS, posted by Phillipa on March 19, 2006, at 21:40:58
> Scott does this mean that if I'm on luvox and increasing the dose is making me more depressed amd the fact that I have taken a bezo for 30 some odd years mean I should stop the antidepressants and stay on what used to work just fine? Love Phillipa
I really don't know.
If you are having such a bad depressive reaction to Luvox, you might want to consider returning to your previous dosage and contacting your doctor.
The question that inevitably enters one's mind is whether or not an increase in depression is a temporary state that will disappear and be replaced with an antidepressant response. I can't think of a time when that has happened to me. If something made me feel worse early in treatment, I would stay worse until the drug was discontinued.
"Feel worse before feeling better?" I can't say for sure. You are not me (in case you were ever in doubt). With depression, I really haven't seen this happen to anyone, I don't think. That doesn't mean that it never does happen. What I have seen is an increase in anxiety early in treatment with some SSRIs that eventually disappears and is followed by an anti-anxiety effect and/or antidepressant effect. Prozac and Lexapro are probably the two drugs most likely to do this. Of course, Luvox is an SSRI as well.
Questions:
• What are you being treated for?
• What do you experience with your illness?
• What treatment worked best?Hang in there.
- Scott
Posted by SLS on March 19, 2006, at 22:19:58
In reply to Re: Never thought I'd hear this....., posted by JahL on March 19, 2006, at 22:00:19
Hi JahL.
This schema is not at all official. However, it is accepted among some authors and is derived from the work of Young and Klerman (1992).
http://www.mentalhealth.com/rx2/bp-can1.html#Head_3
I think Hagop Akiskal, MD promotes a similar classification system.
- Scott
> > One proposed scheme:
> >
> >
> > THE BIPOLAR SPECTRUM
> >
> > BIPOLAR I: Both mania and major depression
> >
> > BIPOLAR II: Major depression and hypomania
> >
> > BIPOLAR III: Cyclothymia. Mild depression and hypomania
> >
> > BIPOLAR IV: Depression and usually no mania. Mania may be triggered by some antidepressants.
> >
> > BIPOLAR V: Depression and no mania. Some blood relatives have had mania
> >
> > BIPOLAR VI: Mania and no depression
> >
> >
> > http://www.bipolarworld.net/Bipolar%20Disorder/Diagnosis/dis.html
>
> Thanks Scott.
>
> It took me three years to have my dx recognised (I had always known what it was) - the main reason being my illness doesn't match any of the traditional descriptions of Bipolar - and I had a particularly nasty response to Lithium. Anything with 5HT action can get me switching however. So I guess I'm BP IV. Cool.
>
> How 'official' is this scheme? Can I go and impress pdocs by quoting a dx they've never even heard of (this is England remember)?
Posted by Phillipa on March 19, 2006, at 22:31:15
In reply to Re: Never thought I'd hear this..... » Phillipa, posted by SLS on March 19, 2006, at 22:05:13
Scott 1. Anxiety and panic. 2. Anxiety panic now fatigue 3. Benzos have been on all of them. Never could tolerate an Ad. Love Jan
Posted by Phillipa on March 19, 2006, at 22:33:32
In reply to Re: Never thought I'd hear this..... » JahL, posted by SLS on March 19, 2006, at 22:19:58
Ps Scott what I'd do just for one day of energy. Love Jan let alone hypomania or mania.
Posted by SLS on March 19, 2006, at 22:39:01
In reply to Re: Never thought I'd hear this..... » SLS, posted by Phillipa on March 19, 2006, at 22:31:15
>
> 1. Anxiety and panic.
>
> 2. Anxiety panic now fatigue
>
> 3. Benzos have been on all of them. Never could tolerate an Ad. Love JanAs has been suggested along another thread, you might be experiencing extreme anxiety and agitation as a reaction to the Luvox. It might subside over the next few days. The addition of fatigue is probably a side effect of the Luvox. You might be feeling depressed as an emotional reaction to your current discomfort and treatment uncertainty. Are you obsessing over things that might be going wrong inside your body? Is that why Luvox was chosen?
What is it about antidepressants that you cannot tolerate?
- Scott
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