Psycho-Babble Medication Thread 472726

Shown: posts 1 to 23 of 23. This is the beginning of the thread.

 

Medications and sleep, specifically REM sleep

Posted by Sarah T. on March 19, 2005, at 3:09:22

It has been known for over thirty years that release of norepinephrine, serotonin, and histamine completely ceases during REM sleep. We still don't know the purpose of REM sleep, but because the cells that make norepinephrine, serotonin and histamine completely stop discharging during REM sleep, several scientists have hypothesized that one function of REM sleep is to allow the neurotransmitters' receptors to rest. When receptors are constantly "bombarded" with neurotransmitters, they become desensitized. Only during REM sleep does the bombardment cease, and the receptors regain sensitivity. If this hypothesis is correct, then how does that explain the theory that sleep deprivation can treat depression? Sleep deprivation has never worked for me. I feel horrid when I don't get enough sleep, but some people report that sleep deprivation has an antidepressant effect. Further, if the purpose of REM is to allow the receptors to rest, recover and regain sensitivty, then how can most antidepressants work? Most of the currently available antidepressants suppress REM sleep, and some doctors believe that REM suppression is essential to antidepressant efficacy (again, that has not worked for me, but then those doctors aren't talking about me).

If it is true that REM sleep allows receptors to rest and regain sensitivity, that would explain why I have done so poorly on antidepressants, most of which suppress REM sleep. Further, certain stages of sleep, including REM sleep, are critical for learning and memory. If AD's suppress REM sleep, that might explain why I had such a tough time learning while on AD's. In fact, I'm convinced that if I'd been on AD's when I was in college, I probably wouldn't even have a Bachelor's degree yet. Memory impairment and amotivational syndromes are not what you want when you're trying to get through school.

In any event, I'm interested to hear what others have to say about the above-mentioned hypotheses on REM sleep.

 

Re: Medications and sleep, specifically REM sleep Sarah T.

Posted by SLS on March 19, 2005, at 8:19:44

In reply to Medications and sleep, specifically REM sleep, posted by Sarah T. on March 19, 2005, at 3:09:22

Hi Sarah.

This was a great post.


> It has been known for over thirty years that release of norepinephrine, serotonin, and histamine completely ceases during REM sleep.

Is it global throughout the brain or regionally specific? I imagine the visual cortex in the occipital lobes are exempt.

> We still don't know the purpose of REM sleep, but because the cells that make norepinephrine, serotonin and histamine completely stop discharging during REM sleep, several scientists have hypothesized that one function of REM sleep is to allow the neurotransmitters' receptors to rest.
>
> When receptors are constantly "bombarded" with neurotransmitters, they become desensitized. Only during REM sleep does the bombardment cease, and the receptors regain sensitivity.

I have spoken to my doctor about this. It makes for a good theory. I think the way to think of it is not that they regain lost sensitivity, but rather that sleep prevents a reduction in sensitivity in the first place. Changes in receptor sensitivity take days to weeks to develop and depends on second messengers and nuclear events within the neuron.

> If this hypothesis is correct, then how does that explain the theory that sleep deprivation can treat depression?

> Sleep deprivation has never worked for me. I feel horrid when I don't get enough sleep, but some people report that sleep deprivation has an antidepressant effect.

Sleep deprivation allows me to feel improved for the first half of the day after. Of course, I pay for this the following day.

> Further, if the purpose of REM is to allow the receptors to rest, recover and regain sensitivty, then how can most antidepressants work?

> Most of the currently available antidepressants suppress REM sleep, and some doctors believe that REM suppression is essential to antidepressant efficacy (again, that has not worked for me, but then those doctors aren't talking about me).

REM sleep might not be as important as once thought. Perhaps it is more a marker of neuronal activity than a participant. It is a fact that antidepressants downregulate certain receptors. This might be because the exposure to neurotransmitter is elevated enough and chronic enough to elicit the second messenger system and gene transcription events to a degree that would not be suppressed by REM sleep anyway. This could explain the efficacy of trimipramine, mirtazapine, bupropion, and nefazodone. These drugs do not suppress REM sleep and sometimes increase it. Have you tried any of these?

> If it is true that REM sleep allows receptors to rest and regain sensitivity, that would explain why I have done so poorly on antidepressants, most of which suppress REM sleep.

People who profit from sleep deprivation might be particularly apt to respond to Wellbutrin and MAOIs.

> Further, certain stages of sleep, including REM sleep, are critical for learning and memory. If AD's suppress REM sleep, that might explain why I had such a tough time learning while on AD's.

Consolidation of memory and LPT can occur in the absence of REM sleep.

> In fact, I'm convinced that if I'd been on AD's when I was in college, I probably wouldn't even have a Bachelor's degree yet. Memory impairment and amotivational syndromes are not what you want when you're trying to get through school.

Were you depressed in school? I had to drop out of college when I could no longer read, learn, and remember. These things became problematic when my depression worsened. I was naive to antidepressants at the time.

Currently, there is some research that calls into question the role that REM sleep plays in either antidepressant efficacy or memory consolidation.

I think your hypothesis regarding your own illness might be correct. I am less responsive now to those medications that had once been effective and at that time suppressed dreaming and produced discontinuation dreaming rebound. These same drugs do not work or suppress dreaming. I would assume that dreaming had been a marker of REM sleep. However, dreaming and REM are not mutually inclusive. You can dream without REM and have REM without dreaming. How do you know that you do not experience a suppression of REM sleep?

Which drugs have produced the most improvement for you? Which drugs made you feel worse?


- Scott

 

Re: Medications and sleep, specifically REM sleep

Posted by Phillipa on March 19, 2005, at 18:24:04

In reply to Re: Medications and sleep, specifically REM sleep Sarah T., posted by SLS on March 19, 2005, at 8:19:44

I also feel much better with a good night's sleep. I don't think valium supresses my REM, as I've been dreaming a lot lately. Fondly, Phillipa

 

Re: Medications and sleep, specifically REM sleep

Posted by gardenergirl on March 19, 2005, at 20:08:24

In reply to Re: Medications and sleep, specifically REM sleep, posted by Phillipa on March 19, 2005, at 18:24:04

That is an interesting theory. I am on Nardil, which does suppress REM sleep. I find that when I am feeling more depressed, despite the Nardil, I start dreaming again. And I start sleeping more. Sleeping excessively was always a symptom of depression for me. I have atypical depression.

Hmmmm,
gg

 

Re: Medications and sleep, specifically REM sleep gardenergirl

Posted by Phillipa on March 19, 2005, at 20:13:57

In reply to Re: Medications and sleep, specifically REM sleep, posted by gardenergirl on March 19, 2005, at 20:08:24

It's the opposite for me. I want to dream as my dreams are usually adventurous and happy. I usually don't want to wake from them. It means that I'm relaxed. Fondly, Phillipa

 

Re: Medications and sleep, specifically REM sleep gardenergirl

Posted by SLS on March 19, 2005, at 22:16:18

In reply to Re: Medications and sleep, specifically REM sleep, posted by gardenergirl on March 19, 2005, at 20:08:24

> That is an interesting theory. I am on Nardil, which does suppress REM sleep. I find that when I am feeling more depressed, despite the Nardil, I start dreaming again.

Does the dreaming then disappear again without making any medication adjustments?

Thanks.


- Scott

 

Re: Medications and sleep, specifically REM sleep SLS

Posted by gardenergirl on March 19, 2005, at 22:26:30

In reply to Re: Medications and sleep, specifically REM sleep gardenergirl, posted by SLS on March 19, 2005, at 22:16:18

Hmmm, I think so, but I'm not sure. It might be that it comes back when I go to 45 mg and then it goes away again when I go back up to 60 mg.

I do like my dreams. I miss them when they are gone. I tend to dream vividly. And I used to dream quite a bit in the a.m. between snooze alarms so I would remember quite a bit of them.

gg

 

Re: Medications and sleep, specifically REM sleep Sarah T.

Posted by jay on March 19, 2005, at 22:37:05

In reply to Medications and sleep, specifically REM sleep, posted by Sarah T. on March 19, 2005, at 3:09:22

> It has been known for over thirty years that release of norepinephrine, serotonin, and histamine completely ceases during REM sleep. We still don't know the purpose of REM sleep, but because the cells that make norepinephrine, serotonin and histamine completely stop discharging during REM sleep, several scientists have hypothesized that one function of REM sleep is to allow the neurotransmitters' receptors to rest. When receptors are constantly "bombarded" with neurotransmitters, they become desensitized. Only during REM sleep does the bombardment cease, and the receptors regain sensitivity. If this hypothesis is correct, then how does that explain the theory that sleep deprivation can treat depression? Sleep deprivation has never worked for me. I feel horrid when I don't get enough sleep, but some people report that sleep deprivation has an antidepressant effect. Further, if the purpose of REM is to allow the receptors to rest, recover and regain sensitivty, then how can most antidepressants work? Most of the currently available antidepressants suppress REM sleep, and some doctors believe that REM suppression is essential to antidepressant efficacy (again, that has not worked for me, but then those doctors aren't talking about me).
>
> If it is true that REM sleep allows receptors to rest and regain sensitivity, that would explain why I have done so poorly on antidepressants, most of which suppress REM sleep. Further, certain stages of sleep, including REM sleep, are critical for learning and memory. If AD's suppress REM sleep, that might explain why I had such a tough time learning while on AD's. In fact, I'm convinced that if I'd been on AD's when I was in college, I probably wouldn't even have a Bachelor's degree yet. Memory impairment and amotivational syndromes are not what you want when you're trying to get through school.
>
> In any event, I'm interested to hear what others have to say about the above-mentioned hypotheses on REM sleep.
>
>

Well, if you are coming out of a major depression, those rem-less nights of little dreaming and such can take the terror of it all away. But, down the road, if you want to get some rem sleep (or more of it) I believe certain atypical antipsychotics, and even mood stabalizers, can help generate a bit more rem sleep.

Jay

 

Re: Medications and sleep, specifically REM sleep Sarah T.

Posted by Minnie-Haha on March 20, 2005, at 19:29:17

In reply to Medications and sleep, specifically REM sleep, posted by Sarah T. on March 19, 2005, at 3:09:22

> If it is true that REM sleep allows receptors to rest and regain sensitivity, that would explain why I have done so poorly on antidepressants, most of which suppress REM sleep. Further, certain stages of sleep, including REM sleep, are critical for learning and memory. If AD's suppress REM sleep, that might explain why I had such a tough time learning while on AD's. In fact, I'm convinced that if I'd been on AD's when I was in college, I probably wouldn't even have a Bachelor's degree yet. Memory impairment and amotivational syndromes are not what you want when you're trying to get through school.

I was on antidepressants (and mood stabilizers -- I'm BP2) for the first three years I was getting my bachelor's degree, and I did fine. I went on a "drug holiday" (I hate that term) the last year and almost didn't make it... and I'd drop from 4 classes a semester to 2!


> In any event, I'm interested to hear what others have to say about the above-mentioned hypotheses on REM sleep.

Before I got on Cymbalta in December, I'd gone through 15 months of hell. Anxiety, insomnia, and depression. When I did sleep (I was lucky to get 4 hours) I never dreamed (that I remember, anyway). Now, I dream just about every night.

I think it's a great hypothesis, but FWIW, my experience doesn't support it. Great thinking, though.

 

Re: Medications and sleep, specifically REM sleep SLS

Posted by Sarah T. on March 21, 2005, at 2:01:40

In reply to Re: Medications and sleep, specifically REM sleep Sarah T., posted by SLS on March 19, 2005, at 8:19:44

> > > > Is it global throughout the brain or regionally specific? I imagine the visual cortex in the occipital lobes are exempt.

I will have to do more reading on this to answer you as thoroughly as I'd like. From what I know now, I believe that it is regionally specific. For example, most, but not all, of the body's motorneurons are inactive during REM sleep, so the neurotransmitters affecting those particular motorneurons are not released at that time; however, there are other motor neurons, such as the motor neurons controlling the muscles around the eyes, that are very active during REM and, therefore, the neurotransmitters activating those motorneurons are being released during REM sleep.

> > >> Sleep deprivation allows me to feel improved for the first half of the day after. Of course, I pay for this the following day.

I wonder whether sleep-deprivation-induced improvement is as short-lived for others who experience some improvement. It makes sense that you might feel a bit better because if several neurotransmitters are not released during REM, and you're not experiencing REM because you haven't slept, then you won't have the decline in neurotransmitter levels that occurs during REM. That also makes me wonder whether I have too much of a decline in NT levels during REM sleep. I tend to feel pretty awful in the morning, and I feel better as the day progresses. Perhaps I experience too much of a decline, so it takes longer to build up to a therapeutic concentration of neurotransmitters.

> > > > REM sleep might not be as important as once thought. Perhaps it is more a marker of neuronal activity than a participant. It is a fact that antidepressants downregulate certain receptors. This might be because the exposure to neurotransmitter is elevated enough and chronic enough to elicit the second messenger system and gene transcription events to a degree that would not be suppressed by REM sleep anyway. This could explain the efficacy of trimipramine, mirtazapine, bupropion, and nefazodone. These drugs do not suppress REM sleep and sometimes increase it. Have you tried any of these?

Hmmm. Thank you for mentioning those. I did take bupropion for a long time. I had terrible insomnia on it. I have tried the other medicines only briefly. I will probably try trimipramine again some day.

As for the importance of REM sleep, just a few weeks ago, I came across an article by an ophthalmologist who believes that the purpose of REM sleep is to oxygenate the cornea. The aqueous humor needs to circulate in order to bring oxygen from the blood vessels in the iris back to the cornea. When the eyelids are closed, circulation in the aqueous humor stops unless the eyes are moving. The ophthalmologist believes this explains why periods of REM get longer as the night progresses.


> > > Consolidation of memory and LPT can occur in the absence of REM sleep.
>

Yes, I am coming across more articles indicating that REM sleep is not necessary for memory consolidation. Dolphins have almost no REM sleep, yet they learn very well.


> >> Were you depressed in school? I had to drop out of college when I could no longer read, learn, and remember. These things became problematic when my depression worsened. I was naive to antidepressants at the time.
>

I think I've probably been depressed most of my life, but I didn't really become aware of it until I was in my mid to late twenties. In other words, I felt bad, but I didn't place a diagnostic label on those feelings until many years later.

>
> I think your hypothesis regarding your own illness might be correct. I am less responsive now to those medications that had once been effective and at that time suppressed dreaming and produced discontinuation dreaming rebound. These same drugs do not work or suppress dreaming. I would assume that dreaming had been a marker of REM sleep. However, dreaming and REM are not mutually inclusive. You can dream without REM and have REM without dreaming. How do you know that you do not experience a suppression of REM sleep?
>

Yes, dreaming can occur during non-REM sleep as well. A few months ago, I read about a woman who lost the ability to dream after she had a stroke deep in the back part of the brain, around the posterior communicating artery. Her vision was also affected temporarily. Her dreams did not return for at least a year, and they were never again as frequent, vivid or intense as they had been before the stroke. In spite of losing the ability to dream, her REM sleep was absolutely normal. This led the researchers to confirm what they'd already suspected: that REM and dreaming are controlled by different brain systems.

How do I know that I do not experience suppression of REM sleep? I don't know that for a fact. I just know that when I've been on medicines that are known to suppress REM, I don't do well. I don't feel as if I've slept. On most AD's, I don't feel rested or refreshed after sleeping. I feel as if I've been unconscious, but not asleep.

Now, speaking of sleep, I think I'd better get some. To be continued. . .

 

Re: Medications and sleep, specifically REM sleep Phillipa

Posted by Sarah T. on March 21, 2005, at 2:10:54

In reply to Re: Medications and sleep, specifically REM sleep, posted by Phillipa on March 19, 2005, at 18:24:04

Hi Phillippa. That's interesting that you are taking Valium and doing well. I didn't even know that Valium was being used much anymore. I thought that many newer benzodiazapines had "replaced" it.

 

Re: Medications and sleep, specifically REM sleep gardenergirl

Posted by Sarah T. on March 21, 2005, at 2:14:03

In reply to Re: Medications and sleep, specifically REM sleep, posted by gardenergirl on March 19, 2005, at 20:08:24

Hi GG. I'm beginning to think that Nardil must be a better AD than Parnate. The only MAOI I've ever taken is Parnate, and that turned my circadian rhythms upside down and inside out. It was not a good drug for me, although I gave it several more-than-adequate trials. Have you ever tried Selegiline?

 

Re: Medications and sleep, specifically REM sleep jay

Posted by Sarah T. on March 21, 2005, at 2:17:24

In reply to Re: Medications and sleep, specifically REM sleep Sarah T., posted by jay on March 19, 2005, at 22:37:05

Hi Jay. Thank you for your suggestions. I will keep those in mind. I've never tried the AP's, although I'm interested in trying trimipramine which, oddly enough, shares some properties with some AP's. So far, I haven't had much success with mood stabilizers, but that might be because I just haven't found the right one yet. Hope springs eternal!

 

Re: Medications and sleep, specifically REM sleep Minnie-Haha

Posted by Sarah T. on March 21, 2005, at 2:20:33

In reply to Re: Medications and sleep, specifically REM sleep Sarah T., posted by Minnie-Haha on March 20, 2005, at 19:29:17

Hello Minnie-haha. What an unusual screen name. May I ask what antidepressants you were on when you were in college? You said that were on AD's and mood stabiizers. Also, I'm interested to know whether you are still on Cymbalta and, if so, how are you doing on it? How many milligrams do you take each day?

 

Re: Medications and sleep, specifically REM sleep Sarah T.

Posted by gardenergirl on March 21, 2005, at 9:49:49

In reply to Re: Medications and sleep, specifically REM sleep gardenergirl, posted by Sarah T. on March 21, 2005, at 2:14:03

Actually, Nardil is the only MAOI I've tried. It did cause me some pretty significant early awakening at higher doses. I have been using a light therapy unit since September, and that has really helped me regulate my sleeping habits. You might consider using one, or perhaps a dawn simulator with your Parnate (assuming you are still on it?) to see if it helps your sleep cycle.

Take care,
gg

 

Re: Medications and sleep, specifically REM sleep

Posted by Phillipa on March 21, 2005, at 16:51:52

In reply to Re: Medications and sleep, specifically REM sleep Sarah T., posted by gardenergirl on March 21, 2005, at 9:49:49

I found an older pdoc who will Rx valium. For me, the newer benzos just don't work as well. Unfortunately I need the Brandname as the generics don't work as well so it's expensive. Fondly, Phillipa

 

Re: Medications and sleep, specifically REM sleep gardenergirl

Posted by Sarah T. on March 21, 2005, at 19:25:37

In reply to Re: Medications and sleep, specifically REM sleep Sarah T., posted by gardenergirl on March 21, 2005, at 9:49:49

Hi gg. I actually do have a light box that I use pretty consistently. It does help to some extent, but I'm still a slug in the morning. I'm coming to the conclusion that that's just what I'm like. I'm not a morning person. On several occasions in the past, I had to work an early shift. Even when I did that for several years in a row, I NEVER felt well in the morning. I've done just about everything I can do to try to force myself to be a morning person. I have a lightbox that I use. I exercise in the morning. I'm just very slow to reach consciousness and I don't have a sense of well-being until late in the day. My doctor has suggested the dawn simulator. I might try that. It seems like a gentler way to wake up. I would like to throw my alarm clock out the window.

 

Re: Medications and sleep, specifically REM sleep Phillipa

Posted by Sarah T. on March 21, 2005, at 19:27:45

In reply to Re: Medications and sleep, specifically REM sleep, posted by Phillipa on March 21, 2005, at 16:51:52

Hi Phillippa. I have also found that I do better on brand name medicines than generics. In several instances, I have noticed a huge difference between the two.

 

Re: Medications and sleep, specifically REM sleep Sarah T.

Posted by ed_uk on March 21, 2005, at 19:43:53

In reply to Re: Medications and sleep, specifically REM sleep gardenergirl, posted by Sarah T. on March 21, 2005, at 19:25:37

Hi,

>I would like to throw my alarm clock out the window.

Me too :-S My mobile phone currently plays me a rather pretty little tune in the morning, it is considerably less irritating than an alarm clock!

Ed.

 

Re: Medications and sleep, specifically REM sleep Sarah T.

Posted by gardenergirl on March 21, 2005, at 23:11:13

In reply to Re: Medications and sleep, specifically REM sleep gardenergirl, posted by Sarah T. on March 21, 2005, at 19:25:37

Hmmm, how long have you had the light box? At some point you need to change the bulb. It doesn't look burned out, but it loses intensity and you may not realize it.

And I once suggested, oh so morning voice sweetly, that my hubby rip the alarm clock out of the wall. I think I meant unplug it, but I can be a real grouch in the a.m. :)

Take care,
gg

 

Re: Medications and sleep, specifically REM sleep Sarah T.

Posted by Minnie-Haha on March 23, 2005, at 12:24:46

In reply to Re: Medications and sleep, specifically REM sleep Minnie-Haha, posted by Sarah T. on March 21, 2005, at 2:20:33

> Hello Minnie-haha. What an unusual screen name...

It was a nickname my dad called me when I was a girl.

> May I ask what antidepressants you were on when you were in college? You said that were on AD's and mood stabiizers...

I started college in fall 2000 on Depakote (500mg/pm) and Effexor (150mg/am, 150mg/pm -- FWIW, I was 42 years old.)

Early in '02, I switched to Trileptal (150mg/am, 300mg/pm) from Depakote, because I was bummed about gaining 30 pounds. (I think the weight gain had also caused menstrual problems that made me severaly anemic.)

Within a few months of switching from Depakote to Trileptal, I also switched from Effexor -- which seemed to be pooping out on me -- to Wellbutrin. The Wellbutrin didn't do a lot for me either, so early in '03, I went on a pdoc-sanctioned drug holiday. This was just before the second semester of my 3rd year. I got through that OK (but with increased anxiety) and then, wham!, in the following semester I got terribly sick.

I sought a medical reason for 15 months. Saw several specialists. But finally figured, because my cortisol levels were so high, I must have pseudo-Cushing's, which results from untreated depression. Got back on Trileptal and added Cymbalta as my AD, and I feel so much better, despite a few side effects.


> Also, I'm interested to know whether you are still on Cymbalta and, if so, how are you doing on it? How many milligrams do you take each day?


I started Cymbalta at 30mg. After 1 week, I went up to 60mg. I stayed there about two months, but lowered my dose to 40mg because my blood pressure was up. Oh! those last couple of weeks on Cymbalta at 60mg were some of the best I'd experienced in years. I just plain felt good.

Cymbalta at 40mg wasn't helping as much, so I'm augmenting with Wellbutrin XL 150mg. I take the Wellbutrin in the morning and the Cymbalta in the evening. So far, so good. And the WB seems to be curbing my appetite. (I'm one of the people who gained weight on Cymbalta: 5 pounds while I was on 60mg.)

Good luck finding something to help you through college. I know from experience my last 3 semesters how awful it can be when you're tired and depressed, and you feel like you're cognitive skills are lost. Can you lighten your load until you get your health squared away?

 

Re: Medications and sleep, specifically REM sleep Minnie-Haha

Posted by Sarah T. on March 23, 2005, at 23:16:28

In reply to Re: Medications and sleep, specifically REM sleep Sarah T., posted by Minnie-Haha on March 23, 2005, at 12:24:46

Hi Minnie-haha.
Thanks for your post. I'm glad to hear that Cymbalta has helped you. I've been reading posts about Cymbalta since it came out last fall, and I have to say that I was getting worried that there didn't seem to be too many enthusiastic "takers." I wonder whether they just didn't take a large enough dose. I was interested to hear that you had your cortisol levels taken. Have they improved? My elevated cortisol levels have not responded to any medication so far, so I'm looking into other treatments, possibly TMS or even acupuncture.

I am not in college now. I graduated quite a long time ago. What I meant in my earlier post was, I've had so much difficulty with antidepressants that, in looking back, I'm glad I wasn't on AD's in college. It is clear that you have benefited greatly from your medications. That is encouraging to hear. It sounds as if you and your doctor work well together.

 

Re: Medications and sleep, specifically REM sleep Sarah T.

Posted by Minnie-Haha on March 25, 2005, at 15:07:30

In reply to Re: Medications and sleep, specifically REM sleep Minnie-Haha, posted by Sarah T. on March 23, 2005, at 23:16:28

> ... I was interested to hear that you had your cortisol levels taken. Have they improved? My elevated cortisol levels have not responded to any medication so far, so I'm looking into other treatments, possibly TMS or even acupuncture.


Yes. My anxiety, depression and insomnia are 80-90% better and my cortisol is now normal.


> ... It is clear that you have benefited greatly from your medications. That is encouraging to hear. It sounds as if you and your doctor work well together.

I've had a few, and we haven't always worked well together. I try to be respectful (which is hard when you feel so sh***y), and I think they appreciate that. I think what's really helped is feeling like I'm starting to understand my illness better, despite how it's labeled, that I'm learning to accept it (well, sort of), and I've learned a lot (and have a lot yet to learn!) about the lingo and treatment.

Good luck on your wellness journey!


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