Psycho-Babble Medication Thread 3352

Shown: posts 1 to 25 of 39. This is the beginning of the thread.

 

MAOI Parnate

Posted by David on March 2, 1999, at 17:55:36

Hi --

I have Panic anxiety and depression, and am curious about experiences with Parnate. This is the next step for me after failures with Prozac, Paxil, Zoloft, Luvox, Serzone and Remeron -- mostly all due to side effect issues. I am scared silly about the food and drug interactions but need something to work. Anyone out there had sucesss with Parnate with bearable effects? Is the diet really that difficult? Thanks for any info.

David

 

Re: Parnate

Posted by Elizabeth on March 2, 1999, at 18:50:25

In reply to MAOI Parnate, posted by David on March 2, 1999, at 17:55:36

David, I take Parnate for depression + panic disorder. I had a spontaneous hypertensive episode each time I tried to raise the dose to 30mg, so I am only taking 20. This is an unusual reaction, I gather, at such a low dose.

The only side effects Parnate seems to cause for me are insomnia (although I already had that, it's been worse) and dry mouth (and this got better after I'd taken it for a while). I tried several tricyclics but I could not tolerate their side effects so I never was able to give them an adequate trial, but they might be worth a try for you. Imipramine was the first drug used for panic disorder, and nortriptyline and some (though not all) of the other tricyclics also work.

The MAOI diet is over-hyped. It's really not that bad, and it doesn't need to be that restrictive. Research has actually been done on which foods contain tyramine (the stuff that you're supposed to avoid), and they found that many of the allegedly bad ones don't have any (or only contain tyramine if they are spoiled/overripe). They've also found that a lot of foods are listed as off-limits based on nothing but a single poorly-documented case report. This is bad because when people discover they can "cheat" (because some of the items they were told not to eat are really not dangerous), they may disregard the parts of the diet that really are important (such as aged cheeses).

Overall I think Nardil was better than Parnate for anxiety, but it stopped working after a few months. I think they were both about equally effective for my depression.

Well anyway, good luck.

 

Re: MAOI Parnate

Posted by alli on March 19, 1999, at 19:19:18

In reply to MAOI Parnate, posted by David on March 2, 1999, at 17:55:36

After many many trials of other antidepressants I've found that Parnate is the only one that helps my depression. Parnate tends to be a bit more activating than Nardil, and I guess Nardil is more common. The side effects have been kind of a pain for me because I had blood pressure problems before I started and parnate just makes them worse. On the other hand, as long as it works for my depression it could turn my skin bright blue for all I'd care. Parnate also has the benefit of taking away my social anxiety.
The diet isnt too bad. The only thing I really miss is pizza. I've found that the same foods I need to avoid to prevent migraines are the ones that interact with MAOIs, so I'm used to it. The problem I have is that when I'm depressed I dont mind keeping the diet because I know the MAOI will help me feel better, but once my depression is gone the diet seems much more irritating.
I have had a problem with really low blood pressure on Parnate, but my BP was unstable to begin with. Now I'm taking dexedrine to control tbe low pressure (and to treat a sleep disorder) and it seems to help.

 

Re: MAOI Parnate

Posted by Ruth on March 20, 1999, at 15:04:26

In reply to Re: MAOI Parnate, posted by alli on March 19, 1999, at 19:19:18

I started on parnate after trying multiple other medications. I had a good response to it. As for side effects, the only problem I had was feeling very sedated and lethargic. I would wake up in the morning still exhausted. (I subsequently learned that the reason for this is that parnate eliminates REM (dream) sleep, one of the stages of sleep necessary for a good nights sleep.
As for the diet, it is really something you get used to. You know that there are just certain things you can't eat. Sometimes it gets frustrating at restaurants because there can be a number of things off limits (you need to ask lots of questions). But in trade off I'd take the parnate.

> After many many trials of other antidepressants I've found that Parnate is the only one that helps my depression. Parnate tends to be a bit more activating than Nardil, and I guess Nardil is more common. The side effects have been kind of a pain for me because I had blood pressure problems before I started and parnate just makes them worse. On the other hand, as long as it works for my depression it could turn my skin bright blue for all I'd care. Parnate also has the benefit of taking away my social anxiety.
> The diet isnt too bad. The only thing I really miss is pizza. I've found that the same foods I need to avoid to prevent migraines are the ones that interact with MAOIs, so I'm used to it. The problem I have is that when I'm depressed I dont mind keeping the diet because I know the MAOI will help me feel better, but once my depression is gone the diet seems much more irritating.
> I have had a problem with really low blood pressure on Parnate, but my BP was unstable to begin with. Now I'm taking dexedrine to control tbe low pressure (and to treat a sleep disorder) and it seems to help.

 

Re: MAOI Parnate

Posted by Elizabeth on March 24, 1999, at 14:07:50

In reply to Re: MAOI Parnate, posted by Ruth on March 20, 1999, at 15:04:26

> I started on parnate after trying multiple other medications. I had a good response to it. As for side effects, the only problem I had was feeling very sedated and lethargic. I would wake up in the morning still exhausted. (I subsequently learned that the reason for this is that parnate eliminates REM (dream) sleep, one of the stages of sleep necessary for a good nights sleep.

I really don't think this is why you are feeling tired. Most people spend very little time in REM sleep while on Parnate (or Nardil), but feeling unrested is very uncommon with these drugs. (Also, it may or may not be true that all dreaming occurs in REM sleep.)

> As for the diet, it is really something you get used to. You know that there are just certain things you can't eat. Sometimes it gets frustrating at restaurants because there can be a number of things off limits (you need to ask lots of questions). But in trade off I'd take the parnate.

I think Alli makes a good point that once you're feeling better, it can be hard to remember that the tradeoff is worth it.

Also, I hope everyone is aware that many of the "MAOI diets" that are floating around are overly restrictive - that is, they list as "restricted" foods that are just fine. (Often, an item used to get included just because an interaction had been reported, even if the report was based on a single case which was not well documented and the food was later found to contain no tyramine. In other words, based on a rumor!) Compare two "restricted foods" lists and notice how many items are on one but not the other - this should tell you something!

 

Re: MAOI Diet

Posted by Dr. Bob on March 24, 1999, at 22:10:14

In reply to Re: MAOI Parnate, posted by Elizabeth on March 24, 1999, at 14:07:50

> I hope everyone is aware that many of the "MAOI diets" that are floating around are overly restrictive - that is, they list as "restricted" foods that are just fine.

But remember that what's "just fine" for one person could be a real problem for someone else...

Bob

 

Re: MAOI Diet

Posted by Elizabeth on March 26, 1999, at 3:06:14

In reply to Re: MAOI Diet, posted by Dr. Bob on March 24, 1999, at 22:10:14

Dr. Bob says:
> But remember that what's "just fine" for one person could be a real problem for someone else...

Yes. Obviously I'm not talking about foods that might be fine for some people, but rather, about foods that have never been shown to be harmful to *anyone*. Specifically, what I meant was, there is no evidence that the foods in question were responsible for the reactions described in the case reports (if they were indeed reactions - panic attacks, migraine headaches, etc. can mimic hypertensive episodes to varying degrees, and often the documentation has been very poor), no reason to suppose that these foods *might* be harmful (they don't contain significant amounts of tyramine, dopa, etc.), and no rise in BP is observed experimentally.

One harmful thing about diets that list safe foods as being unsafe is that when patients discover they can "cheat" and eat a safe food, they stop taking the diet seriously, which can be dangerous, obviously, since some of the foods listed really can interact with the MAOI in a serious way.

Another harm caused by overly restrictive diets is that they scare people away from these potentially useful drugs.

 

Re: MAO Parnate

Posted by Margo on May 6, 1999, at 16:36:01

In reply to Re: MAOI Parnate, posted by alli on March 19, 1999, at 19:19:18

> After many many trials of other antidepressants I've found that Parnate is the only one that helps my depression. Parnate tends to be a bit more activating than Nardil, and I guess Nardil is more common. The side effects have been kind of a pain for me because I had blood pressure problems before I started and parnate just makes them worse. On the other hand, as long as it works for my depression it could turn my skin bright blue for all I'd care. Parnate also has the benefit of taking away my social anxiety.
> The diet isnt too bad. The only thing I really miss is pizza. I've found that the same foods I need to avoid to prevent migraines are the ones that interact with MAOIs, so I'm used to it. The problem I have is that when I'm depressed I dont mind keeping the diet because I know the MAOI will help me feel better, but once my depression is gone the diet seems much more irritating.
> I have had a problem with really low blood pressure on Parnate, but my BP was unstable to begin with. Now I'm taking dexedrine to control tbe low pressure (and to treat a sleep disorder) and it seems to help.

I have taken Nardil (like Parnate) for years and it is a wonderful medication for me. However, I have gained a lot of weight despite exercising and trying to watch my weight which is difficult because nardil causes carbohydrate craving. Does anyone have any tips on how to lose some of this weight?

 

To Margo - Re: Nardil Weight Gain

Posted by Judy on May 8, 1999, at 16:36:54

In reply to Re: MAO Parnate, posted by Margo on May 6, 1999, at 16:36:01

I too have taken Nardil several times over the past dozen years. It is truly the only drug that works for my depression, but the side effects eventually make me give it up until I'm totally desperate again. Weight gain - almost immediate and unrelenting - is one of them; and I never found a way to stop it.

Please E-Mail me if you wouldn't mind. I'd like to compare notes with you on other side-effects and possible remedies.

 

Re: To Margo - Re: Nardil Weight Gain

Posted by Elizabeth on May 9, 1999, at 0:02:09

In reply to To Margo - Re: Nardil Weight Gain, posted by Judy on May 8, 1999, at 16:36:54

I think a lot of people have had this problem (Nardil works great but causes massive weight gain). I know I gained around 50lbs (23kg) on it.

I'd be interested to discuss ways to deal with this problem also.

 

Re: To Margo - Re: Nardil Weight Gain

Posted by Annie on May 9, 1999, at 9:47:35

In reply to Re: To Margo - Re: Nardil Weight Gain, posted by Elizabeth on May 9, 1999, at 0:02:09

Having been on just about every AD and gaining weight on most of them, I find it interesting that I lost 45 pounds on Nardil! My appetite totally disappeared. I became obsessive about losing weight. Interesting fact, if I ate more than 600 calories a day, I would gain weight. So possibly the obsessiveness caused by the drug counteracted its weight gain potential.


> I think a lot of people have had this problem (Nardil works great but causes massive weight gain). I know I gained around 50lbs (23kg) on it.
>
> I'd be interested to discuss ways to deal with this problem also.

 

Annie - weight gain

Posted by Elizabeth on May 11, 1999, at 14:35:21

In reply to Re: To Margo - Re: Nardil Weight Gain, posted by Annie on May 9, 1999, at 9:47:35

> Having been on just about every AD and gaining weight on most of them, I find it interesting that I lost 45 pounds on Nardil! My appetite totally disappeared. I became obsessive about losing weight. Interesting fact, if I ate more than 600 calories a day, I would gain weight. So possibly the obsessiveness caused by the drug counteracted its weight gain potential.

I take it that you were using it for depression, so this makes me wonder: what kind of appetite changes, if any, did you have associated with the depression?

(I've heard of people losing weight on Nardil who been gaining weight while depressed.)

 

Re: Annie - weight gain

Posted by Annie on May 12, 1999, at 14:40:11

In reply to Annie - weight gain, posted by Elizabeth on May 11, 1999, at 14:35:21

> > Having been on just about every AD and gaining weight on most of them, I find it interesting that I lost 45 pounds on Nardil! My appetite totally disappeared. I became obsessive about losing weight. Interesting fact, if I ate more than 600 calories a day, I would gain weight. So possibly the obsessiveness caused by the drug counteracted its weight gain potential.
>
> I take it that you were using it for depression, so this makes me wonder: what kind of appetite changes, if any, did you have associated with the depression?
>
> (I've heard of people losing weight on Nardil who been gaining weight while depressed.)

I am not certain I understand your question. Yes, I am diagnosed with uni-polar depression. I have not presented any obssessive behavior prior to or subsequent to my use of Nardil(my fifth drug trial). I did experience some increase in appetite and signicant weight gain with the onset of depression and prior to any drug treatment. If I had eaten my pre-depression healthy diet while on Nardil, I still would have gained weight. The effect of the drug on my depression was not dramatic.

 

Re: Annie - weight gain

Posted by Elizabeth on May 14, 1999, at 10:43:11

In reply to Re: Annie - weight gain, posted by Annie on May 12, 1999, at 14:40:11

Right, that's what I was curious about. It seems that some people who *gain* weight while depressed may lose weight on Nardil because it treats the depression.

Also, of course, the "weight gain" side effect doesn't happen to everybody (though it's extremely common).

 

Re: Annie - weight gain

Posted by Dwight on May 26, 1999, at 6:39:41

In reply to Re: Annie - weight gain, posted by Elizabeth on May 14, 1999, at 10:43:11

> Right, that's what I was curious about. It seems that some people who *gain* weight while depressed may lose weight on Nardil because it treats the depression.
>
> Also, of course, the "weight gain" side effect doesn't happen to everybody (though it's extremely common).

I've been taking Nardil off an on for several years. Most of you sound like you take for depression, but it also works very well for social anxiety. I have the same problem with weight gain. I'm thinking about trying this new drug Celexa or maybe Remeron. I can't imagine any drug causes as much weight gain as Nardil. I only wish something else worked as well on my social anxiety.

 

Nardil - Dwight

Posted by Elizabeth on May 27, 1999, at 4:46:24

In reply to Re: Annie - weight gain, posted by Dwight on May 26, 1999, at 6:39:41

> I've been taking Nardil off an on for several years. Most of you sound like you take for depression, but it also works very well for social anxiety. I have the same problem with weight gain. I'm thinking about trying this new drug Celexa or maybe Remeron. I can't imagine any drug causes as much weight gain as Nardil. I only wish something else worked as well on my social anxiety.

Hi Dwight. I take Parnate, but it doesn't seem to be as good for anxiety (in general, or social) as Nardil was. I wonder if Marplan - apparently this has become available in the U.S. again lately - would be a nice happy medium.

I have trouble imagining anything causing as much weight gain as Nardil either. :-}

 

Re: nardil - Elizabeth

Posted by Dwight on May 27, 1999, at 12:18:05

In reply to Nardil - Dwight, posted by Elizabeth on May 27, 1999, at 4:46:24

> > I've been taking Nardil off an on for several years. Most of you sound like you take for depression, but it also works very well for social anxiety. I have the same problem with weight gain. I'm thinking about trying this new drug Celexa or maybe Remeron. I can't imagine any drug causes as much weight gain as Nardil. I only wish something else worked as well on my social anxiety.
>
> Hi Dwight. I take Parnate, but it doesn't seem to be as good for anxiety (in general, or social) as Nardil was. I wonder if Marplan - apparently this has become available in the U.S. again lately - would be a nice happy medium.
>
> I have trouble imagining anything causing as much weight gain as Nardil either. :-}


--Thanks for the response, Elizabeth. I'll look into Marplan. I tried Parnate one time, but it seemed to make me more anxious. Sometimes I use the herb Kava Kava for anxiety - it works almost as well as the benzodiazapines, like Klonipan, but it doesn't make you spacey for forgetful. Ginseng is good for energy.

 

Re: MAOI Diet

Posted by Erin on May 28, 1999, at 2:10:00

In reply to Re: MAOI Diet, posted by Elizabeth on March 26, 1999, at 3:06:14

I'm starting MAOI Parnate on Monday and have heard that chicken is on the restricted list- is this true? Also, what are "aged" meat and cheeses (as opposed to "regular" meat and cheeses? Thanks, Erin

 

Re: MAOI Diet

Posted by dwight on May 28, 1999, at 3:01:12

In reply to Re: MAOI Diet, posted by Erin on May 28, 1999, at 2:10:00

> I'm starting MAOI Parnate on Monday and have heard that chicken is on the restricted list- is this true? Also, what are "aged" meat and cheeses (as opposed to "regular" meat and cheeses? Thanks, Erin


I've been taking high doses of Nardil (another MAOI) for a several years, and I have never had any problem with the diet. Chicken is absolutely fine. Red wine and many over-the-counter cold medications are the real dangers. Coffee, chocolate, fine. I have never had a problem with cheese.

 

Re: MAOI Diet

Posted by dwight on May 28, 1999, at 3:03:54

In reply to Re: MAOI Diet, posted by Erin on May 28, 1999, at 2:10:00

> I'm starting MAOI Parnate on Monday and have heard that chicken is on the restricted list- is this true? Also, what are "aged" meat and cheeses (as opposed to "regular" meat and cheeses? Thanks, Erin

Erin, aged meat and cheeses. Smoked salmon, for instance. Anything "smoked" probably isn't very good. Although I have never had a problem with cheddar cheese, e.g. pizza, you might want to be careful. Especially if you take the meds at the same time.

 

Re: MAOI Diet

Posted by Elizabeth on May 28, 1999, at 15:14:32

In reply to Re: MAOI Diet, posted by dwight on May 28, 1999, at 3:03:54

Actually there has never been a documented interaction with red wine, nor has any researcher ever found a significant amount of dangerous stuff (tyramine or related amines) in a red wine.

Most pizza doesn't have cheddar cheese - it's made with mozzarella, which is much milder.
Best to be careful when dealing with "gourmet" pizza, ask the waiter or consult the ingredients list.

Chicken, as long as it's been stored properly and hasn't been contaminated, is just fine. Maybe it was chicken *liver* that you were told not to eat - liver seems to be especially prone to bacterial contamination.

 

Re: MAOI Diet

Posted by Erin on May 28, 1999, at 17:34:44

In reply to Re: MAOI Diet, posted by dwight on May 28, 1999, at 3:03:54

Thanks Dwight and Elizabeth for your replies- Is all cheddar cheese off limits or is it just smoked cheddar cheese (I'm lactose intolerant so I don't eat cheese all that often but like to indulge on occasion? Also, I've seen beer listed on one of the many MAOI restricted diet lists I've read. I rarely drink but am wondering if you know more about this? Thanks again, Erin

 

Re: MAOI Diet - Erin

Posted by Elizabeth on May 29, 1999, at 0:29:25

In reply to Re: MAOI Diet, posted by Erin on May 28, 1999, at 17:34:44

There are some researchers - Kenneth Shulman and colleagues - at the U of Toronto who have been looking into the MAOI diet for about the last decade. They've found a lot of the restrictions to be unnecessary. Most recently, they did a study of (get this) pizza and found it to be safe. They've also looked at a number of different American and Canadian bottled beers.

Tap or draft beer may not be okay, however.

Cheddar cheese is one of the more aged cheeses, and you pretty much need to stay away from it. The less aged the cheese, the more you can eat, although you still should limit cheese consumption to small amounts (15g in a sitting).

Ricotta, cream, cottage, and American cheeses are all just fine - they're not aged. In general, the more aged a cheese is, the more dangerous it is likely to be.

 

Re: MAOI Diet

Posted by Gretchen on May 29, 1999, at 9:22:07

In reply to Re: nardil - Elizabeth, posted by Dwight on May 27, 1999, at 12:18:05

Help Please! This is a long post -- I apologize, but I am so scared.

I would never have even read MAOI diet posts before because I never had a problem with this aspect. I follow the diet rather strictly and always have -- anything is better than how I feel not on a MAOI (and I have tried full trials of over fifteen other anti-depressants.)

I have taken both Nardil and Parnate a number of times (side effects mainly having to do with my already low blood pressure and increases in the meds have necessitated "breaks".)

I started Parnate again after yet another "break" -- about two years of misery trying other anti-depressants. I feel a million times better emotionally and I can actually get myself to do things during the day. I plan things and complete them - a miracle.

Then suddenly -- in one month -- I have had two tyramine reactions to "safe" food. This has never happened in the probably four years (adding together the separate trials) that I have been on Parnate or Nardil.

Both times I had chicken that was cooked and ready to eat from a grocery store (two reputable chains.) _I can not understand it._

The pain of the reactions is so intense that I am ready to break down and give up MAOI's (and be suicidal) for the rest of my life. I also feel so guilty, like I don't deserve to take Parnate if I can't take it responsibly. I hate ER's and I have a horrible problem with doctors in general (childhood trauma stuff.) Having to go to the ER is a nightmare.

Neither reaction was "classic" and so it was hours the first time and one hour the second time before the ER doc broke down and treated the reaction like a tyramine problem. Once I was given anti-hypertensives, the pain magically dissolved, in both cases.

Parnate makes life bearable. I drink a lot of caffeine (6-8 dt. Mountain Dews a day)with the OK of my doctor because it acts as a pressor agent to increase my blood pressure and I don't have so many dizzy, tunnel vision to complete loss of vision, fainting spells.

Yes, the side effects are major. My psychiatrist doesn't really want me taking Parnate either to add to the problem. Luckily, I am married now and my husband can provide her with a very definite, to her a more objective opinion of how much Parnate helps me emotionally. In fact, that was the only reason I was able to keep taking it after the first reaction.

I feel terrible. It's like she thinks I did it on purpose or at least was horribly negligent. Both times though, Craig was with me and could vouch for exactly what I ate.

But I am ready to give up. I am scared -- chicken is supposed to be safe. I eat McDonalds Chicken McNuggets without a problem. I don't understand.

Sorry this is so long, but I guess these are my questions:

If anyone has had more than one trial on an MAOI, did you ever find that you suddenly became super-sensitive? All of my side-effects are worse and I am taking a relatively low dose for me (40mg vs. 50mg or 60mg at other times.)

I don't want to give grocery store ready-made chicken a bad name, but it is the only linking food. Has anyone ever heard of something that is in ready-to-eat supermarket chicken -- preservatives, etc???

Finally, the only other factor that is different this time, is instead of taking Ortho Cyclen birth control, I am trying the Depo Provera. One shot lasts three months, so it is in my system one more month like it or not. My regular doctor, concerned about my depression also and knowing some types of birth control cause depression more than others, was trying to help me out with that angle. Has anyone heard any type of caution regarding mixing these two meds?

Any advice would be appreciated. I dread telling my psychiatrist about last night's reaction. MAOI's are the _only_ meds that have ever, ever helped me.

Finally, to try and be a little helpful, I did read all of your posts. To share my experience, if you think Nardil causes weight gain and carbo cravings -- for me, Remeron was much worse. It has a 27% chance of weight gain and a greater incidence of carbo cravings. My Mom, who is a RN at a nursing home, says that they don't give Remeron to patients for depression, but to those who won't eat. **However, I have a history of eating disorders, so perhaps that made me more vulnerable to that particular side-effect. Also, I did not complete a three month trial, because I was binging so badly, the threat of full blown Bulimia episode became too dangerous.**

Everyone reacts differently though, if I have learned anything in the past eleven years it is that.

If anyone has read this far thank you for listening. I feel very alone and confused. Why is this happening with the only meds that work? WHY?


> > > I've been taking Nardil off an on for several years. Most of you sound like you take for depression, but it also works very well for social anxiety. I have the same problem with weight gain. I'm thinking about trying this new drug Celexa or maybe Remeron. I can't imagine any drug causes as much weight gain as Nardil. I only wish something else worked as well on my social anxiety.
> >
> > Hi Dwight. I take Parnate, but it doesn't seem to be as good for anxiety (in general, or social) as Nardil was. I wonder if Marplan - apparently this has become available in the U.S. again lately - would be a nice happy medium.
> >
> > I have trouble imagining anything causing as much weight gain as Nardil either. :-}
>
>
> --Thanks for the response, Elizabeth. I'll look into Marplan. I tried Parnate one time, but it seemed to make me more anxious. Sometimes I use the herb Kava Kava for anxiety - it works almost as well as the benzodiazapines, like Klonipan, but it doesn't make you spacey for forgetful. Ginseng is good for energy.

 

Re: MAOI Diet & hypertensive chicken

Posted by JD on May 29, 1999, at 10:47:18

In reply to Re: MAOI Diet , posted by Gretchen on May 29, 1999, at 9:22:07

Hi Gretchen,

I'm going to take a wild stab at a hypothesis here...I could be totally off base. Is it possible that the cooking procedures and especially the marinades used in making certain kinds of store-bought chicken cause sufficient changes to cause a tyramine reaction in some people (as with aged foods)? This comes to mind because I remember the brief health flare-up (bad pun, I know) last year about the effects of chargrilling food -- A couple studies found that such high-temperature grilling of foods including chicken could create low levels of some not-so-healthful chemcials (i.e., potential carcinogens), but were also surprised that meat that had been marinated in advance seemed to have a very different chemical "profile." If I remember correctly, both of these effects were attributed to the breakdown of certain proteins, so there's at least a *possible* connection.

Are there ever warnings in MAOI diets about marinated food? High-temperature grilled food? Just what kind of chicken was it that caused the problem in the first place? Whatever you end up deciding, I hope you can find a way to live with the hypertensive wiles of Parnate one way or another--though note the recent interest on this board over the reintroduction of Marplan too...

Best,
JD



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