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Esroar's Cymbalta Taper


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#31 ESRoar

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Posted 05 November 2020 - 08:21 PM

I wonder if FH and IUN would agree with me, but your symptoms sounds an awful lot like excess adrenaline causing fight or flight panic type effects. I dealt with this A LOT and it slowly improved over a long period of time (I've been off for about a year). If that is indeed the case then Prozac and that type of stuff won't help. They don't have anything to do with adrenaline, only serotonin. You want to focus instead on addressing the excess adrenaline. If you're able to, one thing that helps with excess adrenaline is exercise. No intense cardio or that will just increase the adrenaline but some mild to moderate activity depending on what your fitness level is actually burns up extra stress hormones in the body like adrenaline and cortisol and also releases mood elevating chemicals! Easy win. 

 

You can also look into some medications that block you from feeling the effects of the adrenaline. So while your body might continue to overproduce, it won't make you feel crazy. I think the clonidine FH mentioned would work in that way. Beta blockers help with this too. When I was experiencing terrible daily panic attacks I was taking Propranolol twice a day to calm things down. It's a blood pressure drug so be careful if you're on any other blood pressure reducing drugs or if you have low pressure already, but you should be able to take it as needed and it has little to no withdrawal if you wean off of it when you're ready. You can only get these through a prescription though.  

Frog - yes, what you're described sounds right to me.  Is this the brain overcompensating for the missing Cymbalta, overshooting and producing more norepinephrine?  I am guilty of not getting enough exercise, besides chasing my daughter around.  I've been putting in a lot of hours working at my desk.  

 

Psychiatrist #2 prescribed propanolol as a PRN for anxiety.


#32 ESRoar

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Posted 05 November 2020 - 08:31 PM

Psychiatrist #2 - Thought Psychiatrist #1's suggestions were crazy.

 

He suggested tapering off the Cymbalta and onto Zoloft, which I was on for years before Cymbalta.  He said I shouldn't be taking Cymbalta at night because it's a stimulant.  He said to take Cymbalta and Zoloft together for 1 week.  2nd week - drop Cymbalta dose by half.  3rd week - drop Cymbalta dose in half again, and do this each week until I'm off of it.  He said if I can't tolerate those drops, to go as slow as I want with the taper.

 

He then prescribed Propanolol as a PRN for anxiety.  He said all of these are safe for breastfeeding and I can keep nursing if I want to.  

 

He was not a fan of the Remeron - mainly because of it being an appetite stimulant and he thought Gabapentin was a terrible idea.

 

Has anyone heard of Gaba Max supplement?  Psychiatrist #1 recommended it.  Here's a link to it.  I've been meaning to check the e-book for this.  https://www.drvitami...0-grams-powder/


#33 fishinghat

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Posted 06 November 2020 - 08:21 AM

Psych dr #2 wins the debate in my book. 

 

Gaba Max supplement contains some of the same supplements that many of our members have tried. My only concern would be the Gabatrol which i9s also more commonly called Phenibut.  It does not cross the blood brain barrier and has been shown in numerous research articles to have no effect on anxiety. The main problem with Gabatrol is the significant withdrawal in coming off of it. I am sure that IUN will chip in and tell you about his experiences with that compound. 


#34 ESRoar

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Posted 06 November 2020 - 10:52 AM

Psych dr #2 wins the debate in my book. 

 

Gaba Max supplement contains some of the same supplements that many of our members have tried. My only concern would be the Gabatrol which i9s also more commonly called Phenibut.  It does not cross the blood brain barrier and has been shown in numerous research articles to have no effect on anxiety. The main problem with Gabatrol is the significant withdrawal in coming off of it. I am sure that IUN will chip in and tell you about his experiences with that compound. 

 

I certainly don't want to take anything else that has withdrawals.  Cymbalta is worse enough!  Do you think the cross-taper plan with Zoloft is slow enough, or should I keep bead counting Cymbalta?  

 

This morning I'm feeling a lot of what Frog was describing with having excess adrenaline.  My mind feels somewhat calm, but my body is a mess (nausea, jittery, chest heaviness, diarrhea).


#35 fishinghat

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Posted 06 November 2020 - 05:47 PM

Sorry to take so long to respond.

 

Most drs follow about the same schedule that this dr recommended to go from Cymbalta to Zoloft. In general about 3 to 5 week switch depending on the antidepressant you are going onto. Be aware there is a lot of adjustment your body has to make in order to adapt to the new antidepressant so you will have several weeks of further discomfort until the Zoloft kicks in.


#36 ESRoar

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Posted 07 November 2020 - 04:53 PM

I took Zoloft 50mg at 11am today.  Soon after I started feeling awful.  I got a wave of nausea and then felt awful physically (heart fluttering, jittery, dizzy, tired).  My brain itself feels OK.  I took a propanolol and it helped calm my heart down.  I still feel nauseous and "not right", but I'm managing.  Tomorrow I'm going to try taking the Zoloft in the evening.  I'm gradually moving the Cymbalta from evening to morning.  

 

After a week, I'm thinking about attempting a 10% cymbalta drop.  I am SO SCARED of doing the 50% drop the Dr. advised, considering I could only handle 2% drops prior to starting Zoloft.  Is a week long enough to hold after a drop?

 

Thank y'all so much for your responses and support.  I have a good family support system, but they don't understand what it's like to be on these drugs.  :(


#37 fishinghat

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Posted 07 November 2020 - 06:05 PM

Be aware ESRoar, Each time there is a change in dose with Zoloft you will have gastric issues like nausea and sometimes diarrhea. It only lasts for typically 3 or 4 days so hang in there. Many many members used ginger products to halt the nausea. Things like ginger root, ginger tea, ginger gum... Just be sure it contains ginger and not just ginger flavoring.

 

The balance in cross tapering from one antidepressant is a delicate one. If the old antidepressant is weaned too slowly and the new one too too fast you can develop serotonin syndrome which is a very serious condition. If you come off the old antidepressant too fast and the new one too slow you can really develop a set of serious withdrawal symptoms. The timing is important. Most drs taper over a 4 to 6 week period. At the end of the period you should be completely off the old antidepressant and fully  on the new depressant. As it takes Zoloft 6 weeks to fully kick in you normally have some withdrawal until fully on the Zoloft for 6 weeks.


#38 ESRoar

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Posted 09 November 2020 - 09:08 AM

Yesterday was ok.  I took Cymbalta 39mg at 3:30pm (I'm gradually moving it to the AM).  I took Zoloft 50mg at 7pm.  I was very tired and went to bed early.

 

I woke up at sunrise with lots of anxiety:  nausea, jittery, diarrhea.  I took Propanolol 10mg at 8am.

 

The Dr. doesn't have me building up on Zoloft at all.  He prescribed 50mg, which I'm to stay on.  Years ago before I was on Cymbalta, I was on Zoloft for years and I was on 50mg.


#39 fishinghat

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Posted 09 November 2020 - 10:44 AM

Makes sense.


#40 frog

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Posted 09 November 2020 - 02:03 PM

Hi again!

Glad you got a little relief from the Propranolol. I was taking 2 at a time twice a day when I was taking it so don't be afraid to increase a bit and see if that helps more. It should take care of the heart pounding and the jittering and usually that was enough to help me calm down and not turn into a full blown panic attack. (Just be aware that if you increase the Propranolol you may occasionally feel dizzy and lightheaded because it does slow down your BP). The Zoloft won't help with all that physical kind of stuff because it doesn't do anything for adrenaline so I think it makes sense to keep taking the Propranolol to help manage those symptoms while you transfer. The Zoloft will help you to not have to worry about serotonin issues though on TOP of the adrenaline issues as you get off the Cymbalta and I think getting off the Cymbalta should definitely still be your primary goal. I think once you're off the Cymbalta for good things will probably become clearer and at least you will be managing one neurotransmitter at a time. Right now you're sort of... stuck. It sounds like this second doctor has you on a safer and slower path which is great to see :) 

 

I know how hard it is to get people to understand even if they support and love you so we are always here if you need to vent or need any reassurance


#41 ESRoar

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Posted 10 November 2020 - 09:20 AM

Hi again!

Glad you got a little relief from the Propranolol. I was taking 2 at a time twice a day when I was taking it so don't be afraid to increase a bit and see if that helps more. It should take care of the heart pounding and the jittering and usually that was enough to help me calm down and not turn into a full blown panic attack. (Just be aware that if you increase the Propranolol you may occasionally feel dizzy and lightheaded because it does slow down your BP). The Zoloft won't help with all that physical kind of stuff because it doesn't do anything for adrenaline so I think it makes sense to keep taking the Propranolol to help manage those symptoms while you transfer. The Zoloft will help you to not have to worry about serotonin issues though on TOP of the adrenaline issues as you get off the Cymbalta and I think getting off the Cymbalta should definitely still be your primary goal. I think once you're off the Cymbalta for good things will probably become clearer and at least you will be managing one neurotransmitter at a time. Right now you're sort of... stuck. It sounds like this second doctor has you on a safer and slower path which is great to see :)

 

I know how hard it is to get people to understand even if they support and love you so we are always here if you need to vent or need any reassurance

Yesterday I took the Propanolol when I woke up because I was feeling anxious, jittery, and nauseous.  After taking it, my chest felt very heavy; almost like a rock was sitting on my heart.  That kind of freaked me out, so I'm just trying to deal with the anxiety this morning.

 

Overall, not doing very well.  This weekend is when I would start reducing the Cymbalta, but I'm not sure if I should since I'm not stabilized.  I saw the 2nd psychiatrist through MDLive, which is a telehealth app that my insurance covers.  I asked about following-up with him and he said he's booked out for 6 months and to "just grab a psychiatrist on MDLive if you run into problems".  I'd rather be established with someone who knows me.

 

Then I can't even get a receipt out of the 1st psychiatrist I saw, so I'm out $300. until I can get a receipt and submit to Insurance.  


#42 fishinghat

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Posted 10 November 2020 - 10:04 AM

Don't let this freak you out. It is to be expected. As frog mentioned the Zoloft will only help control the serotonin when it kicks in but you will still have issues with adrenaline. Propranolol helps control the adrenaline but only physical symptoms as it does not pass through the blood brain barrier. so control of the emotion of anxiety is minimal. In addition propranolol is a bronchoconstrictor which means that it contracts the airways in the lungs. This often corresponds to a feeling of weight or pressure in the chest. It can also cause some shortness of breath and faster and shallower breathing. This can often be relieved by doing deep breathing exercises. There is a section in the ebook which describes how to do these exercises with videos.


#43 frog

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Posted 10 November 2020 - 06:12 PM

FH Propranolol does pass the blood brain barrier but I think generally at higher doses. I think some beta blockers do and some don't. 

 

ESROAR:

I had a lot of chest tightness when I was on propranolol but I don't think it was related to the drug itself for the most part. After I weaned off it was mostly still there and has just improved on its own over time. For me it is more related to all the adrenaline issues. Adrenaline causes muscles to tighten. I think everyone experiences this somewhat differently but there are muscles in your chest so frequently anxiety attacks result in chest tightness which in turns feels like you can't breathe/aren't getting enough oxygen. You are... but it feels like you're not which adds to the anxiety/panic and becomes a cyclical thing. If you try the propranolol again and feel your chest tighten, try some deep breathing exercises like breathing in for 5 counts with your nose and out 7 counts for a few minutes to help calm down and see if that makes a difference?

 

If you're sure that the propranolol is what made your chest feel tight then you should definitely bring that concern up to a doctor and see if there's an alternative medication. I just wonder if it's not adrenaline/anxiety (possibly about taking the medication in the first place) that might have made things feel worse. I know a couple of the things I took to help with Cymbalta problems took a little getting used to


#44 fishinghat

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Posted 11 November 2020 - 08:52 AM

That is a good point about the chest tightness/pressure frog. Whether it is from adrenaline or propranolol the symptoms would be essentially the same. 


#45 fishinghat

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Posted 11 November 2020 - 08:57 AM

Wow!! I learned something today for sure.

 

https://pubmed.ncbi....ih.gov/6115665/

These three lipophilic beta-adrenoceptor blockers (propranolol, oxprenolol and metoprolol) appeared in brain tissue at concentrations 10-20 times greater than that of hydrophilic atenolol. The approximate brain/plasma ratio for propranolol was 26, for oxprenolol 50, for metoprolol 12 and for atenolol 0.2. 2 The low concentration of atenolol in brain tissue is possibly responsible for the low incidence of central nervous system-related side effects in patients on this agent compared to lipophilic beta-adrenoceptor blockers.

 

Thanks frog.


#46 frog

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Posted 11 November 2020 - 12:23 PM

FH my understanding is that beta blockers that work on beta 2 receptors (like propranolol) cross the blood brain barrier and the newer beta blockers that are selective for beta 1 (like atenolol) generally do not unless you get to high doses at which point they stop being selective. The only problem is that beta 1 blockers are not as effective for anxiety issues because they pretty much just focus on the heart, but they are great for those who take them for heart conditions!

 

I remember reading about all this stuff when I was first taking propranolol and similarly to ESRoar felt like my chest was so tight I couldn't breathe right. It made me feel less anxious and more in control to read about how all of this stuff works. I wish doctors would explain to me the methods of action for any drugs they prescribe but I'm sure most people do not want to hear about any of that LOL!


#47 ESRoar

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Posted 11 November 2020 - 05:16 PM

Thank you for explaining about the Propoanolol.  What you're describing is exactly what I was feeling.

 

I'm still feeling a lot of jitteriness, nausea, hopelessness.

 

I saw a psychiatrist that seemed to understand Cymbalta withdrawal back in March.  He gave me a call yesterday and said he can see me on an ongoing basis.  He told me not to start tapering the Cymbalta until I'm feeling more stable.  He also prescribed Zofran for the nausea and Buspar 10mg 3x per day.  All these meds....sigh.  I hope I start feeling more like myself soon.  


#48 fishinghat

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Posted 11 November 2020 - 05:58 PM

Zofran decreases serotonin production but most members who used it did not express any worsening of withdrawal symptoms. It did cause constipation for some members. Zofran has been linked to serotonin syndrome when taken with antidepressants.

 

Buspar is a good choice. It is a very weak ssri and does a pretty good job of simply producing a better attitude. You will have wean off of it over a few weeks but the withdrawal is typically very mild.


#49 frog

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Posted 11 November 2020 - 09:13 PM

FH do you think Zofran would help with nausea that's caused by adrenaline? Dr. Google says Zofran is prescribed for nausea caused by chemo or cancer treatments. Just curious because I definitely dealt with nausea and loss of appetite for the first handful of months after Cymbalta. The withdrawal also gave me horrible bowel issues. To this day I still take 1/2 of an Imodium every night and fiber supplements morning and night because I was so traumatized by that. 

 

ESRoar I know it's counterintuitive to take medications to treat withdrawal from a medication but as long as what you're taking isn't going to result in more terrible withdrawals down the line I think it's worth a shot! At the height of everything I was taking Propranolol, Gabapentin and Seroquel, but the doses were all small and I had little trouble getting off Propranolol and Gaba. I'm not sure what typical dosages for Buspar are, but if you're worried you should always start low and go slow :) Maybe take it once a day for a few days to see how you react and then up from there. 

 

My only concern is that Buspar still will not help with the physical anxiety you're experiencing so you will probably still be jittery, heart poundy, etc but maybe it'll spare you the emotional rollercoaster on top of everything. 


#50 fishinghat

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Posted 12 November 2020 - 09:25 AM

The nausea is not primarily from adrenaline, it is from the serotonin imbalance. By far the greatest amount of serotonin in the body is located in the digestive tract. Zofran reduces the production of serotonin in the GI tract and usually provides good relief from the nausea. It should be noted that ginger products work almost as well as Zofran.

 

Buspar (generic buspirone) has little to no interaction with the adrenal system but primarily helps control serotonin and increase dopamine action thus the general positive improvement in attitude.

 

I do strongly agree with frog on starting slow and working up on dosage. that is always a wise approach when taking any new medication. Just as an example there are some people who are allergic to simple aspirin, commonly considered a safe drug. When these people take aspirin they can go into anaphylactic shock which can be fatal. Start slow and work your way up.


#51 ESRoar

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Posted 12 November 2020 - 10:02 AM

My buspar prescription is for 10mg 3x per day, but he dr. said to split them in half and start with 5mg, which is what I've been doing.

 

I ordered some ginger root capsules to try for the nausea.  My concern with the Zofran was that it may work against the antidepressants?  But I may be misunderstanding how it works.  I spoke to the pharmacist when I picked up the meds and she said to just watch for symptoms of serotonin syndrome.


#52 fishinghat

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Posted 12 November 2020 - 01:58 PM

I agree with your logic but my experience is that most members had no issues with the Zofran. I would try the ginger first for sure. 


#53 ESRoar

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Posted 16 November 2020 - 09:54 AM

Hi All,

 

I had a difficult weekend with anxiety.  This morning I woke up at 4am feeling TERRIBLE.  I can't get out of bed.  I'm dizzy, shaky, lots of sweating, extreme nausea, diarrhea, arms feel strange (biceps feel sore and my forearms feel tingley), chest feels heavy, crying.  I'm starting to wonder if the meds are making me worse, or if this is serotonin syndrome.  I messaged my psychiatrist through the telehealth app.  I haven't heard back yet.  I guess I should've asked for a phone number in case of crisis.


#54 fishinghat

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Posted 16 November 2020 - 12:46 PM

Serotonin syndrome is almost always associated with a fever. You might check that. If not SS then it seems likely that your zoloft has not kicked in yet (4 to 6 weeks) and you need to hang in there until it does. Your pdoc should be able to give you some good input as well. I am interested to see what he says.


#55 ESRoar

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Posted 16 November 2020 - 03:16 PM

I spoke to a nurse, who was trying to reach the psych doc.  She was concerned with some of my cardiac symptoms and wanted me to go to the ER.  I went and all of my heart tests and bloodwork came back normal.  Dr. there thought I was possibly reacting to increasing the buspar from 5mg TID to 10mg TID over the weekend.  He said to take it back down to 5mg TID and wait to hear from my Dr.  If I don't hear back from the psych dr., I may just stop the buspar until I discuss with him.  They gave me a bag of fluids and a small dose of IV Ativan at the ER and that stopped my shaking and allowed me to relax.  To be continued.


#56 fishinghat

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Posted 16 November 2020 - 06:11 PM

Whew. I read back over your symptoms. A few can be attributed to adrenaline but not most of them. The dizzy, shaky, sweating, extreme nausea, diarrhea,  soreness sounds like a serotonin issue and I think the dr who told you to drop the buspar back to 5 mg may be right. Hang in there and keep us posted.


#57 ESRoar

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Posted 17 November 2020 - 09:32 AM

Yes, I was wondering if I was OD'ed on serotonin.  I didn't have a fever, but I had a bunch of the other symptoms.  This morning I woke up with my usual anxiety and nausea, but I didn't have all of the other awful physical symptoms that I had yesterday morning.  I just got CBD oil to try and I used that for the first time this morning.  It seemed to help minimize the nausea and help me to rest so I was able to go back to sleep.

 

I'm not sure if I should try the 5mg buspar again.  I haven't heard back from the psych dr.


#58 frog

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Posted 17 November 2020 - 01:38 PM

These symptoms minus the soreness, crying and chest tightness all sound like when I had a major nervous system collapse after stopping Cymbalta and then doing that intense cardio workout. I always assumed it was related to adrenaline deregulation. Now I wonder what it actually was. 


#59 ESRoar

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Posted 18 November 2020 - 08:44 AM

Frog - did you do a slow taper off Cymbalta?

 

Yesterday morning, soon after I wrote here, my arms started feeling very hot.  I look down and they're turning red and itchy.  My husband said my face and neck were red too.  I called my Mom because she's a nurse and she said to take an antihistamine.  I took an Allegra and it cleared up shortly thereafter.  I was thinking I was allergic to the CBD, but my Mom said that rashes can be common with Ativan.  I took the CBD oil again this morning and so far no rash.

 

Woke up with my usual bad anxiety, jittery/shaky feeling and nausea.  For a year I thought this was due to taking Cymbalta at night, but now I'm taking Cymbalta in the AM and Zoloft at night, so I guess it's just my crazy self.  

 

I haven't restarted the buspar.  I still haven't heard anything back from the psych dr. about that.


#60 frog

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Posted 18 November 2020 - 06:57 PM

I would not call it slow no lol

 

I did a really wonky wean off Cymbalta based on bad advice from my doctor and then no advice/support toward the end. I started by alternating 60s and 30s for 2 or 3 weeks which was actually fine. Then from 30mg I was weighing out the beads and dropping 5mg or so every week I think? I might be misremembering this, it was over a year ago and I've somewhat blocked out this whole thing. I think even at 25mg I was starting to notice side effects. I was extremely short tempered, cranky, and getting brain zaps and feeling foggy a lot. In retrospect that was obviously because my brain was feeling the absence of Cymbalta already and I needed to slow down and give it a chance to adjust before dropping again, but at the time I just thought I had probably gotten to a low enough dosage that it wasn't working anymore so it was just as well to just stop taking it completely. So when I got to around 18mg that's what I did. Just stopped cold turkey. For about 3 weeks I was doing ok. Still cranky and foggy and zappy but it was improving bit by bit. Then I had the bright idea to do a workout class one Friday, and literally all hell broke loose the next day. Nauseous, jittery, sweaty, anxious, diarrhea, the works. I could barely leave my bed for a week. The following week I had to start a brand new job! It was truly a nightmare. 

 

It's been a little over a year now. I'm 95% back to normal I would say. I'm still struggling with heart pounding, especially when I'm reclined or lying down. And I've wondered if that's related to the chest tightness/heaviness that I get that also causes the shortness of breath. I've been wondering if I should speak to a doctor to get that checked out just to be sure. 

 

Hope you get in touch with your doc soon. I spent many many mornings with anxiety, dread, agitation, etc. I wish I could tell you what exactly is going on in your body right now that is causing this but I can't :( It did get better over time though





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