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Dr. Bob is Robert Hsiung, MD,
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Posted by phidippus on September 17, 2012, at 16:14:37
In reply to Re: Need out of the box suggestions, posted by gilmourr on September 17, 2012, at 15:42:02
If the dosage of clomipramine is modest, he should be fine.
I don't mind Nortryptaline, only the blood monitoring. Something as effective as Nortryptaline (Ki 3.4 NET) without the TCA side effects would be Straterra (Ki 5.0 NET) or Reboxetine(Ki 1.1 NET)-the lower the Ki the stronger the effect on norepenephrine. (Reboxetine is a potent, selective, and specific noradrenergic reuptake inhibitor. It has a superior pharmacological selectivity to existing tricyclic antidepressants and selective serotonin reuptake inhibitors when tested in a large number of in vitro and in vivo systems).
I have no arguments against the Vyvanse.
Eric
Posted by SLS on September 17, 2012, at 16:55:02
In reply to Re: Need out of the box suggestions » gilmourr, posted by phidippus on September 17, 2012, at 16:14:37
Did I not understand you?
Nardil and clomipramine together?
> If the dosage of clomipramine is modest, he should be fine.
No way, man.
No way.
- Scott
Posted by SLS on September 17, 2012, at 17:00:42
In reply to Re: Need out of the box suggestions » SLS, posted by phidippus on September 17, 2012, at 15:45:23
> I experienced very few side effects while on the Clomipramine-those I did suffer went away within weeks.
>
> EricI took clomipramine, too. My experience with it was quite different than yours. However, I did not remain on it beyond 8 weeks. It is a very dirty drug. This might make it more efficacious, but also makes it less tolerable. I hated it. It was worse than imipramine. Plus, you get sexual side effects with clomipramine that you don't get with any other TCA (although amoxapine can reduce libido).
- Scott
Posted by phidippus on September 17, 2012, at 17:53:19
In reply to Re: Need out of the box suggestions » phidippus, posted by SLS on September 17, 2012, at 17:00:42
I should have mentioned I did suffer anorgasmia, one of the most frustrating sexual side effects ever.
Eric
Posted by phidippus on September 17, 2012, at 17:56:05
In reply to Re: Need out of the box suggestions » phidippus, posted by SLS on September 17, 2012, at 16:55:02
Why?
Eric
Posted by SLS on September 17, 2012, at 23:21:38
In reply to Re: Need out of the box suggestions » SLS, posted by phidippus on September 17, 2012, at 17:56:05
> Why?
When one is taking a MAOI, just sniffing a SRI will produce serotonin toxicity (syndrome). This is the opinion of the overwhelming majority of people in the field. Clomipramine is as potent a serotonin reuptake inhibitor as the SSRIs are; having a Ki of less than 1.0 nM. There is no safe dosage.
My experiment with Parnate and Effexor has me convinced of the danger of combining these drugs. Adding a tiny piece of a 75mg IR tablet to Parnate was enough to pin me to my bed with muscle rigidity and being altered to the point of incoherence. This episode lasted for about an hour. I had chosen Effexor because of its short half-life. Unfortunately, my parents had to witness this. When I gained sufficient coherence, I asked them to take my body temperature. Fortunately, it was only about a degree higher than it usually is. I don't recall sweating.
I was desperate.
- Scott
Posted by phidippus on September 18, 2012, at 17:45:36
In reply to Re: Need out of the box suggestions » phidippus, posted by SLS on September 17, 2012, at 23:21:38
I need to learn more about MAOIs and what drugs can be taken with them.
Eric
Posted by ChicagoKat on September 19, 2012, at 12:32:15
In reply to Re: Need out of the box suggestions » SLS, posted by phidippus on September 18, 2012, at 17:45:36
> I need to learn more about MAOIs and what drugs can be taken with them.
>
> EricIf you find out which drugs can be safely taken with MAOIs, please let me know. Saw the pdoc yesterday, and since the Tramadol was a disaster, we are not going through a washout and then restarting Nardil. I told him that you guys had talked about takiing TCAs while on an MAOI, and he was aware that it was done but had never done so himself. He was curious if you were on the TCA first, or it you started it once you were stable on yourr MAOI.
Fortunately, my pdoc gave me lots of goodies, benzos, gabapentin, and ambien to help me through the washout. And he said I could keep taking Ritalin until a few days before I start Nardil since it has such a short half life. Wish me luck,and let me know if you have any answers to my questions.
Kat
P.S. the he is a she ;)
Posted by brynb on September 19, 2012, at 13:21:43
In reply to Re: Need out of the box suggestions, posted by ChicagoKat on September 19, 2012, at 12:32:15
Hi Kat,
Being that you do well with Ritalin, have you tried the MAOI selegline? Apparently, it's a stimulant derivative (as I learned here). It comes in a patch form, Emsam. I think a few people here have done well with it, and I believe it has less side effects than other MAOIs. It was too stimulating for me, and I don't know much about MAOI's, but, just a thought...
-b
Posted by ChicagoKat on September 19, 2012, at 15:48:56
In reply to Re: Need out of the box suggestions, posted by brynb on September 19, 2012, at 13:21:43
> Hi Kat,
>
> Being that you do well with Ritalin, have you tried the MAOI selegline? Apparently, it's a stimulant derivative (as I learned here). It comes in a patch form, Emsam. I think a few people here have done well with it, and I believe it has less side effects than other MAOIs. It was too stimulating for me, and I don't know much about MAOI's, but, just a thought...
>
> -b
>
>Hi Bryn...I really appreciate your suggestion, but I've tried Ensam and it made me really agitated...I just couldn't tolerate it. Too bad there aren't any MAO-A reversible inhibitors in the US, as there are in Europe. Seems like something like that would really help. Oh well, someday, maybe. For the meantime, I'll give Nardil another try, albeit at a lower dose (prob 45mg a day) so that it doesn't cause the ataxia I got the first time I tried it. At that dose my anxiety was completely blown away, and it may eventually help my depression somewhat.
Sorry to babble so much, I'm on my Ritalin :D
Hope you are well,
Kat
Posted by SLS on September 19, 2012, at 18:57:57
In reply to Re: Need out of the box suggestions » brynb, posted by ChicagoKat on September 19, 2012, at 15:48:56
> Too bad there aren't any MAO-A reversible inhibitors in the US, as there are in Europe.
Just a quick FYI:
The RIMAs don't seem to work nearly as well as the irreversibles. They tend to poop-out quickly. Moclobemide underwent clinical trials in the US for social anxiety 20 years ago, but was abandoned for lack of efficacy. Having a few irreversible inhibitors of MAO-A would be nice. Clorgyline worked very well, but was not developed because the patent had expired. Perhaps a new indication would bring it back. It seems to be therapeutically active in fungal infections and heart failure.
Brofaromine was available for a short period of time in a few countries in Europe. It probably worked better than moclobemide, but perhaps not good enough. Maybe there was a safety issue. Maybe a business decision. I don't know. If I remember correctly, brofaromine was a serotonin reuptake inhibitor in addition to being a RIMA. This is not a good combination.
- Scott
Posted by ChicagoKat on September 19, 2012, at 19:20:18
In reply to Re: Need out of the box suggestions » ChicagoKat, posted by SLS on September 19, 2012, at 18:57:57
> > Too bad there aren't any MAO-A reversible inhibitors in the US, as there are in Europe.
>
> Just a quick FYI:
>
> The RIMAs don't seem to work nearly as well as the irreversibles. They tend to poop-out quickly. Moclobemide underwent clinical trials in the US for social anxiety 20 years ago, but was abandoned for lack of efficacy. Having a few irreversible inhibitors of MAO-A would be nice. Clorgyline worked very well, but was not developed because the patent had expired. Perhaps a new indication would bring it back. It seems to be therapeutically active in fungal infections and heart failure.
>
> Brofaromine was available for a short period of time in a few countries in Europe. It probably worked better than moclobemide, but perhaps not good enough. Maybe there was a safety issue. Maybe a business decision. I don't know. If I remember correctly, brofaromine was a serotonin reuptake inhibitor in addition to being a RIMA. This is not a good combination.
>
>
> - ScottThanks for the info Scott!
Posted by phidippus on September 19, 2012, at 22:34:38
In reply to Re: Need out of the box suggestions, posted by ChicagoKat on September 19, 2012, at 12:32:15
SSRIs are contraindicated with concomitant use of MAOIs (monoamine oxidase inhibitors). This can lead to increased serotonin levels which could cause a serotonin syndrome.
Overall, it appears from the literature that the combination of MAOIs and TCAs can be relatively safe and effective in the treatment of patients whose depression is treatment-resistant. On the other hand, the risks associated with MAOI and TCA treatment have made this strategy relatively unpopular.
What you want to avoid is serotonin syndrome-combining serotogenic antidepressants with MAOI presents a risk.
For me the one time I was on an MAOI it was started at the same time I started a TCA-both were raised slowly.
I think you can take Ritalin and Nardil together.
Eric
Posted by SLS on September 20, 2012, at 0:43:07
In reply to Re: Need out of the box suggestions » SLS, posted by ChicagoKat on September 19, 2012, at 19:20:18
I would just add to Eric's list of drugs to avoid while taking a MAOI anything that is a serotonin reuptake inhibitor. This includes the SNRIs. It also includes the TCAs imipramine and clomipramine. The other TCAs are probably okay, although I have my doubts about protriptyline. It might be too noradrenergic and anticholinergic. I would worry about cardiovascular side effects. I know someone who did well on Nardil + doxepin. Trimipramine should not be a problem theoretically, but I don't know anyone who has taken this drug in combination with a MAOI. I would recommend desipramine and nortriptyline as first choices. They are secondary amines that are milder in anticholinergic effects and have little or no serotonin reuptake inhibition.
When taking TCA + MAOI, the two drugs can be started together. If one is already taking TCA, the MAOI can be added gradually. If one is already taking MAOI, adding a TCA is discouraged. I don't know why. I have done this on a few occasions and had no problem with it. I think the main concerns are cardiovascular and would include a hypertensive reaction or tachycardia. One's heart rate will almost always be increased by TCA. However, a resting rate above 120 beats per minute should raise concern. Perhaps one can use propranalol to control this, but I have never seen it done. TCAs are contraindicated if there is heart-block conductance pathology. If you are worried about this, you can get a ECG before treatment and then after you begin treatment. Desipramine is a bit harsher than nortriptyline. However, there are people who respond to one drug but not the other.
Other drugs to avoid because of serotonin reuptake inhibition during MAOI treatment are meperidine (Demerol) and dextromethorphan. Personally, I would stay away from ziprasidone (Geodon) and tramadol. Direct-acting noradrenergic agonists must be avoided, too. This would include decongestants (phenylpropanolamine and pseudoephedrine). So, too, are epinephrine and norepinephrine. I'm sure you can find a more comprehensive list on the Internet.
With MAOI, one can take Wellbutrin, amphetamine, and methylphenidate, even though these drugs are contraindicated. Since hypertensive reactions are possible, this should be done cautiously. I recommend taking your first dose of a stimulant in the doctor's office so that your blood pressure can be monitored. Dopamine agonists are also okay. I once took together Parnate, desipramine, Dexedrine, and bromocriptine. I have also added Wellbutrin to Parnate.
I think you should use my statements here as a guideline for you to do further research on your own rather than to assume their accuracy.
- Scott
Posted by phidippus on September 20, 2012, at 8:41:15
In reply to Re: Need out of the box suggestions » ChicagoKat, posted by SLS on September 20, 2012, at 0:43:07
Preliminary trials of low-dose amphetamine and MAOIs being administered together are in progress. However, this is to be done only under strict supervision of the prescribing parties.
Indirectly acting sympathomimetic amines, such as amphetamines, ephedrine and MAOI with amphetamine-like properties, can be potentiated, because they may release increased amounts of nor-adrenaline from sympathetic nerve endings after MAO inhibition.
Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication
by
Feinberg SS.
From the Department of Psychiatry,
Albert Einstein College of Medicine, Bronx, N.Y.
J Clin Psychiatry. 2004 Nov;65(11):1520-4ABSTRACT
BACKGROUND: Among antidepressant augmentation strategies, the addition of a stimulant to a monoamine oxidase inhibitor (MAOI) has received little attention in the literature in recent years because of the diminished clinical use of the latter and concerns of precipitating a hypertensive crisis or other serious complication. Despite that fact, experienced clinicians continue to use this combination for a variety of indications after other options have failed. This article reviews these reported uses and presents a case suggesting another possible indication. METHOD: A MEDLINE search was conducted for articles published from 1962 to December 2003 using relevant search terms (psychostimulant, stimulant, amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion, monoamine oxidase inhibitor, and selegiline). A manual search was conducted of cross-references and other relevant recent psychiatric sources (2000-2003). RESULTS: The described uses of the MAOI-stimulant combination have included treatment of refractory depression and the MAOI-related side effects of orthostatic hypotension and daytime sedation. No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI. Also presented here is another possible indication for this therapeutic regimen: treatment of attention-deficit/hyperactivity disorder in an adult patient whose major depression had uniquely responded to the MAOI tranylcypromine. CONCLUSION: As in other fields of medicine, potentially hazardous medication combinations are utilized in psychiatry after cautiously weighing the danger of the treatment against the morbidity and risk of not adequately addressing the illness. Particularly, as the potential arrival of the apparently safer transdermal selegiline may increase the use of MAOIs, we feel this combination deserves additional controlled study.
Eric
Posted by ChicagoKat on September 20, 2012, at 9:10:57
In reply to Re: Need out of the box suggestions » SLS, posted by phidippus on September 20, 2012, at 8:41:15
> Preliminary trials of low-dose amphetamine and MAOIs being administered together are in progress. However, this is to be done only under strict supervision of the prescribing parties.
>
> Indirectly acting sympathomimetic amines, such as amphetamines, ephedrine and MAOI with amphetamine-like properties, can be potentiated, because they may release increased amounts of nor-adrenaline from sympathetic nerve endings after MAO inhibition.
> Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication
> by
> Feinberg SS.
> From the Department of Psychiatry,
> Albert Einstein College of Medicine, Bronx, N.Y.
> J Clin Psychiatry. 2004 Nov;65(11):1520-4
>
> ABSTRACT
>
> BACKGROUND: Among antidepressant augmentation strategies, the addition of a stimulant to a monoamine oxidase inhibitor (MAOI) has received little attention in the literature in recent years because of the diminished clinical use of the latter and concerns of precipitating a hypertensive crisis or other serious complication. Despite that fact, experienced clinicians continue to use this combination for a variety of indications after other options have failed. This article reviews these reported uses and presents a case suggesting another possible indication. METHOD: A MEDLINE search was conducted for articles published from 1962 to December 2003 using relevant search terms (psychostimulant, stimulant, amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion, monoamine oxidase inhibitor, and selegiline). A manual search was conducted of cross-references and other relevant recent psychiatric sources (2000-2003). RESULTS: The described uses of the MAOI-stimulant combination have included treatment of refractory depression and the MAOI-related side effects of orthostatic hypotension and daytime sedation. No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI. Also presented here is another possible indication for this therapeutic regimen: treatment of attention-deficit/hyperactivity disorder in an adult patient whose major depression had uniquely responded to the MAOI tranylcypromine. CONCLUSION: As in other fields of medicine, potentially hazardous medication combinations are utilized in psychiatry after cautiously weighing the danger of the treatment against the morbidity and risk of not adequately addressing the illness. Particularly, as the potential arrival of the apparently safer transdermal selegiline may increase the use of MAOIs, we feel this combination deserves additional controlled study.
>
> Eric
>
>
>
Thanks much for the abstract Eric. I shall print it and take it to my next pdoc appt, after my washout is finished.Kat
Posted by SLS on September 20, 2012, at 9:17:55
In reply to Re: Need out of the box suggestions » SLS, posted by phidippus on September 20, 2012, at 8:41:15
Good find.
- Scott
> Preliminary trials of low-dose amphetamine and MAOIs being administered together are in progress. However, this is to be done only under strict supervision of the prescribing parties.
>
> Indirectly acting sympathomimetic amines, such as amphetamines, ephedrine and MAOI with amphetamine-like properties, can be potentiated, because they may release increased amounts of nor-adrenaline from sympathetic nerve endings after MAO inhibition.
> Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication
> by
> Feinberg SS.
> From the Department of Psychiatry,
> Albert Einstein College of Medicine, Bronx, N.Y.
> J Clin Psychiatry. 2004 Nov;65(11):1520-4
>
> ABSTRACT
>
> BACKGROUND: Among antidepressant augmentation strategies, the addition of a stimulant to a monoamine oxidase inhibitor (MAOI) has received little attention in the literature in recent years because of the diminished clinical use of the latter and concerns of precipitating a hypertensive crisis or other serious complication. Despite that fact, experienced clinicians continue to use this combination for a variety of indications after other options have failed. This article reviews these reported uses and presents a case suggesting another possible indication. METHOD: A MEDLINE search was conducted for articles published from 1962 to December 2003 using relevant search terms (psychostimulant, stimulant, amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion, monoamine oxidase inhibitor, and selegiline). A manual search was conducted of cross-references and other relevant recent psychiatric sources (2000-2003). RESULTS: The described uses of the MAOI-stimulant combination have included treatment of refractory depression and the MAOI-related side effects of orthostatic hypotension and daytime sedation. No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI. Also presented here is another possible indication for this therapeutic regimen: treatment of attention-deficit/hyperactivity disorder in an adult patient whose major depression had uniquely responded to the MAOI tranylcypromine. CONCLUSION: As in other fields of medicine, potentially hazardous medication combinations are utilized in psychiatry after cautiously weighing the danger of the treatment against the morbidity and risk of not adequately addressing the illness. Particularly, as the potential arrival of the apparently safer transdermal selegiline may increase the use of MAOIs, we feel this combination deserves additional controlled study.
>
> Eric
>
>
>
Posted by ChicagoKat on September 20, 2012, at 9:19:47
In reply to Re: Need out of the box suggestions » ChicagoKat, posted by SLS on September 20, 2012, at 0:43:07
> I would just add to Eric's list of drugs to avoid while taking a MAOI anything that is a serotonin reuptake inhibitor. This includes the SNRIs. It also includes the TCAs imipramine and clomipramine. The other TCAs are probably okay, although I have my doubts about protriptyline. It might be too noradrenergic and anticholinergic. I would worry about cardiovascular side effects. I know someone who did well on Nardil + doxepin. Trimipramine should not be a problem theoretically, but I don't know anyone who has taken this drug in combination with a MAOI. I would recommend desipramine and nortriptyline as first choices. They are secondary amines that are milder in anticholinergic effects and have little or no serotonin reuptake inhibition.
>
> When taking TCA + MAOI, the two drugs can be started together. If one is already taking TCA, the MAOI can be added gradually. If one is already taking MAOI, adding a TCA is discouraged. I don't know why. I have done this on a few occasions and had no problem with it. I think the main concerns are cardiovascular and would include a hypertensive reaction or tachycardia. One's heart rate will almost always be increased by TCA. However, a resting rate above 120 beats per minute should raise concern. Perhaps one can use propranalol to control this, but I have never seen it done. TCAs are contraindicated if there is heart-block conductance pathology. If you are worried about this, you can get a ECG before treatment and then after you begin treatment. Desipramine is a bit harsher than nortriptyline. However, there are people who respond to one drug but not the other.
>
> Other drugs to avoid because of serotonin reuptake inhibition during MAOI treatment are meperidine (Demerol) and dextromethorphan. Personally, I would stay away from ziprasidone (Geodon) and tramadol. Direct-acting noradrenergic agonists must be avoided, too. This would include decongestants (phenylpropanolamine and pseudoephedrine). So, too, are epinephrine and norepinephrine. I'm sure you can find a more comprehensive list on the Internet.
>
> With MAOI, one can take Wellbutrin, amphetamine, and methylphenidate, even though these drugs are contraindicated. Since hypertensive reactions are possible, this should be done cautiously. I recommend taking your first dose of a stimulant in the doctor's office so that your blood pressure can be monitored. Dopamine agonists are also okay. I once took together Parnate, desipramine, Dexedrine, and bromocriptine. I have also added Wellbutrin to Parnate.
>
> I think you should use my statements here as a guideline for you to do further research on your own rather than to assume their accuracy.
>
>
> - ScottThanks for the info Scott. I'll continue researching, but you've given me lots to consider when I do so. I am most curious about adding Nortriptyline b/c it has more NE effect than the others. My main concern is that you say that most clinicians don't like to add a TCA after an MAOI is started. I kinda wanted to see how the MAOI did on its own in case I didn't need to add anything else. Hmmmm. And can Ritalin really for sure be used with an MAOI??? Do you have any references to articles that prove this? If that is really true, we may have found the answer for me, b/c I know low-dose Nardil helps my anxiety, but I'm worried about how much it will help my depression. Thanks in advance for any info you can provide. :)
All my best,
Kat
Posted by jono_in_adelaide on September 22, 2012, at 19:53:14
In reply to Re: Need out of the box suggestions » SLS, posted by ChicagoKat on September 20, 2012, at 9:19:47
Kat, I wouldseriously consider taking nardil + nortriptyline, this combo acts through multiple mechanisms to help anxiety and depression, it might be the answer to your prayers
Posted by ChicagoKat on September 22, 2012, at 21:32:32
In reply to Re: Need out of the box suggestions, posted by jono_in_adelaide on September 22, 2012, at 19:53:14
> Kat, I wouldseriously consider taking nardil + nortriptyline, this combo acts through multiple mechanisms to help anxiety and depression, it might be the answer to your prayers
Thanks Juno. Tell me, do you know if the nortryptiline has to be started at the same time as the Nardil, or can it be added later? My pdoc wasn't sure about this. Thanks again, it's nice to know all of you care b/c right now I've been crying my eyes out and my husband has been ignoriing me surfing the net. Tonight is the closest I've ever felt to committing suicide.
Thanks again,
Kat
Posted by phidippus on September 22, 2012, at 23:14:37
In reply to Re: Need out of the box suggestions, posted by ChicagoKat on September 22, 2012, at 21:32:32
>do you know if the nortryptiline has to be started >at the same time as the Nardil, or can it be added >later?
Its better to start a TCA with an MAOI, raising both doses concurrently.
>Tonight is the closest I've ever felt to committing suicide
Are you safe? Babblemail me anytime you have these feelings.
Eric
Posted by phillipa on September 22, 2012, at 23:53:25
In reply to Re: Need out of the box suggestions, posted by ChicagoKat on September 22, 2012, at 21:32:32
Same here if not safe let us know. Phillipa
Posted by SLS on September 23, 2012, at 2:05:40
In reply to Re: Need out of the box suggestions, posted by ChicagoKat on September 22, 2012, at 21:32:32
Despite the recommendations, I have never had a problem adding desipramine or nortriptyline to an ongoing treatment with Nardil or Parnate. I just start the TCA at a very low dose and titrate gradually. Maybe I just got lucky. I will say this, though. Parnate + TCA is more friendly than Nardil + TCA with respect to low blood pressure and urinary retention.
To the best of my knowledge, there are no scientific studies comparing the safety of combining MAOI + TCA in different orders. The recommendations are based upon very sparse anecdotes and perhaps some unsubstantiated theory. Ivan Goldberg and Jay Amsterdam will add TCA to ongoing MAOI if necessary. The most relevant writings on this matter were done 10 or more years ago.
- Scott
Posted by ChicagoKat on September 23, 2012, at 7:34:38
In reply to Re: Need out of the box suggestions » ChicagoKat, posted by phidippus on September 22, 2012, at 23:14:37
> >do you know if the nortryptiline has to be started >at the same time as the Nardil, or can it be added >later?
>
> Its better to start a TCA with an MAOI, raising both doses concurrently.
>
> >Tonight is the closest I've ever felt to committing suicide
>
> Are you safe? Babblemail me anytime you have these feelings.
>
> EricI'm OK, thanks Eric. I was pretty bad last night but I turned to my trusty friends, cigarettes and chocolate ice cream. They are always there when no one I know is able or willing to talk. I have no idea how to use Babblemail...but I really appreciate your concern. :)
Kat
Posted by ChicagoKat on September 23, 2012, at 7:35:51
In reply to Re: Need out of the box suggestions » ChicagoKat, posted by phillipa on September 22, 2012, at 23:53:25
> Same here if not safe let us know. Phillipa
I'm OK now Phillipa..chocolate ice cream and cigarettes got me through my crisis. THanks so much for your concern.
Kat
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