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mikl_pls

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  1. I had no idea where to put this. It possibly could be psychosis, but it seems to be more sleep-related. Mods please move this wherever you see appropriate. I have for years struggled with this and it only now occurred to me to ask about this here. If I sleep all night, all day, and wake up late in the evening to early the next morning, I have a distinct feeling that there is a sinister, malevolent, "evil" presence or several presences in the room with me. Very seldom (once in a blue moon) I hear a whispering voice or several whispering voices that get(s) louder and louder as time passes until I do something like open my door. But if I go somewhere else in the house, I have to turn on all the lights as I go or else I feel like I'm being watched. It's extremely disturbing and very scary and I don't know what to do. It's usually when everyone else in the house is asleep, and happens at a time when I wouldn't be able to reach my friends. I can even try to reach some of my friends but it's useless, they're asleep too and can't be woken (one of my best friends in particular is an extremely heavy sleeper). I think maybe it's anxiety, so I take a benzo and a Stelazine in hopes that it goes away, but no, it's still there. I have actually been feeling this "presence" following me as of lately since my depression and suicidality got to be probably at an all time worst. It's strongest if I sleep all day and wake up late in the day/early next morning. I feel a darkness about it, an undertow of flowing dark energy from it like it's trying to pull me under the water so to speak, and like it's trying to claim me for its collection or something. Is this a sleep thing, or a psychosis thing, or what? If so, has anyone had this before, and how did you deal with it? Benzos and antipsychotics aren't really helping that much except maybe to just knock me back out. I try listening to cheerful, upbeat music, read about things to distract me, draw or color, etc., but that same presence is there with me, and I feel often like I'm being watched. My current sleep meds, trazodone and Seroquel, are too potent for me and make me sleep upwards of 15 hours, sometimes up to 24+ hours. They didn't used to do that. Taking less than I was prescribed doesn't touch my sleep.
  2. I find that staying in bed is literally toxic for me. The more I stay in bed, the worse I get and the more I decline in condition. Staying cooped up in the house and socially isolating myself is just as toxic. I have found that no matter how bad I feel, taking a shower always helps me feel at least a little better, especially if I haven't showered in days (which is usually the case). It's just a matter of motivating myself to get laundry done to have clean clothes to change into, and then getting myself in the shower (for some reason I hate getting and being wet now... but after I'm clean, it isn't an issue at all...). Finding something to do with friends helps me too, whether I want to get out of the house or not. Maybe they come visit me, maybe the pry me out the door, it depends on my needs. Maybe all we do is just go out and window shop at electronics stores... Maybe we just drive around and not really do anything in particular. Just getting out sometimes is just what I need whether I realize it or not. Another thing that is toxic is letting my room clutter up, which I am the worst about doing. My room right now is deplorable, but it's not as it was at its very worst. One of my best friends usually has to help me tackle cleaning it because I can't do it on my own—I lack the willpower and strength. I have been told to try meditating. I've never been able to meditate successfully before, but I have a CD my tdoc gave me with some guided meditations, and a book my ex-boyfriend recommended for me on the basics of meditation. I haven't delved into it yet, but I can let you know what its name and author is if you're interested.
  3. Absolutely, I'll do my best, but I can't assure you it will be an accurate picture as I lack insight into my obsessions. I do know that one thing I do is obsess over my meds, how they aren't working, and I will either schedule an appointment with my pdoc to change them (and she doesn't because she catches onto what's going on), or I change them myself (I keep all my past meds just in case of an unforeseen emergency). That's just one example. Another example is when I was in school, while studying for a test, I would fixate on all the things I am not remembering and in my eyes it outweighs the things I have a good grasp on, and I allow that to throw me off and I just don't show up for the test, for example. Or I do very poorly on the test because I tried to study for too much the night before. Evidently, my suicidality plays into my OCD and vice versa. How, though, I'm not sure. My pdoc brought this up but wouldn't go into depth about it, probably because she didn't want me to obsess over it. She has to withhold information about my diagnoses and whatnot because she knows I'll obsess over it. I can tell her all day that I won't, and that I would appreciate not being left in the dark, but she still doesn't tell me anything. Whether she's right or not I don't know. I obsess over the negative things in my life so much that I don't see the positive. I obsess over my current situation with myself (32, no job, living with parents), and at home (family is basically disintegrating...), to the point where I become suicidal. I don't see all the positive things I have going for me (a wonderful, expansive network of close friends who are willing to do whatever it takes to help me, in addition to an extended network of friends I have yet to even come to for help, but who I know would do something for me, for example). I turn everything into a catastrophe. Small scale issues in plans turn into giant meltdowns. Not sure if this is OCD or depression symptom, but it's a big one for me. I hope that explains my symptoms at least a little. I know for a fact that it's not a wholesome picture though. It's way more complicated than I can possibly explain. You're right, I haven't tried risperidone. I have asked my pdoc about it, knowing it can cause hyperprolactinemia, and she is vehemently opposed to prescribing both it and Invega for me. I'd be willing to try a low, low dose of it, though, if it meant having my life back together (as much as it can be at this point now). Yes, I have been diagnosed with OCD since I was about 9 or 10 years old. My mom took me to a pediatric neuropsychiatrist when I was about that age. He diagnosed me with Tourette's disorder, OCD, and ADHD, which was basically just a confirmation diagnosis of what all my pediatrician had diagnosed me with. He didn't offer anything much in the way of treatments as the meds for Tourette's often have very harsh side effects (typical antipsychotics were probably the only meds available at the time, possibly even Zyprexa as it was brand new back then). I was medicated for OCD with Prozac, which made my behavior worse. I was tried on Adderall when it was all the rage to prescribe to kids, but it made my stomach hurt and kept me from eating, so my mom took me off of it after a week and didn't bother to pursue other ADHD treatment options. I think at this time, pemoline was still on the market or had just been taken off the market. Ritalin had a huge stigma to it at the time, which is why I guess my mom didn't bother letting me try that. So I just stayed on 10 mg Prozac for a few years until summer before 6th grade, when I took myself off of it after having a massive panic attack in Walmart because there were people nearby me talking loudly to each other (misophonia?). I believe it is being treated directly alongside my depression. In fact, I think my OCD is responsible for a majority of my depressive and self-destructive symptoms. I have never had exposure therapy before. I have thought about trying it though. I just wouldn't know what to work on because, like I've said, I lack insight into my obsessions so much. I have gone psychotic as a result of obsessive psychotic preoccupations before—it's that bad. I'll ask my tdoc about it next time I see him.
  4. I apparently have very treatment-resistant OCD. My pdoc hasn't said it, but I have gathered this from my profound lack of insight into my obsessions, psychotic preoccupations, and the fact that OCD is not only interfering with life, but treatment as well. I have tried novel strategies like memantine (30 mg), lamotrigine (400 mg), zonisamide (400 mg), topiramate (400 mg), etc. I've tried somewhat high doses of SSRIs (my pdoc hates prescribing anything at max dose) (fluoxetine 80 mg, fluvoxamine 100 mg (nightmare), escitalopram 10 mg (nightmare), sertraline 200 mg), SNRIs (venlafaxine XR 825 mg!!, duloxetine 120 mg, desvenlafaxine 150 mg, Fetzima (joke...)), Viibryd 40 mg, Trintellix 20 mg, etc., clomipramine 225 mg. I've tried various antipsychotics (typical and atypical) alongside SSRIs: fluphenazine 1 mg tid, perphenazine 4 mg tid, trifluoperazine 5 mg bid, haloperidol 1 mg tid to 5 mg x1, pimozide 2 mg bid, etc. Nothing seems to really help. Basically, if there's a way to treat it, I've probably tried and failed it or tried it partially due to conservative prescribing habits of my pdoc. I have not tried low-dose clomipramine + SSRI, supratherapeutic doses of SSRIs (pdoc won't hear of it...), higher doses of typical antipsychotics (for acute psychotic preoccupations), certain antipsychotics (thioridazine, clozapine, etc.). I'm thinking about seeking a second opinion from another pdoc soon because my current pdoc is no longer helping me. She just keeps me on the same useless regimen and never wants to change anything, pats me on the back saying "you're better than you think you are," and sends me on my way. The office staff are severely understaffed, and one of them in particular always bitches me out after my sessions because it's so late, but it doesn't matter if I take 5 minutes or 55 minutes... she's going to bitch me out no matter what about it. She never says anything to the people who go back there and take two hours though. Just me, because I'm at the end of the day. It royally pisses me off and I'm about to snap at her, and I really don't want to (the office staff person). I'm also about to snap at my pdoc and ask if she'd rather the meds kill me or me kill me due to inadequate medication. I know meds aren't all there is in treatment, but she seriously has to budge for something to change. I am seeing a therapist, but he's new and still getting to know me, so nothing has been done yet. He's taking notes and asking thorough questions though. I like him so far. He actually has a white dry-erase board in his office that he uses to illustrate things he's trying to convey to patients, and he's the only therapist with one in that whole office. I wish I could see my original therapist though. She's known me since I was 9 years old... She knows me like no other mental health practitioner knows me, and has the most extensive history on me. Last I saw her, she was in "partial retirement," which meant she blocked off half her office to this new guy (ex-pastor gone family counselor), disposed of all her notes on all her patients, sent half of her patients to this new guy, and kept the other half of her patients (mostly younger patients she said). I saw her twice or 3 times during that time, and she dismissed me after that. I wasn't really seeing her for my own purpose, but because of a problem I had I didn't know how to deal with. I tried calling her semi-recently when I was looking for a counselor several times, texting her, everything, and never got an answer, so I assumed she fully retired. Anyway, I didn't mean to digress so much in this post.
  5. This. Also, if you accidentally double your dose, don't get too analytical about it. Just go back to your normal dosing. If you try to overanalyze things like this it will interfere with your treatment and you will not do well. I know this because I do this myself, and have to be called out by my pdoc when I'm doing it because I lack insight about it so much. It almost becomes a psychotic preoccupation for me unless I have an intervention with my pdoc about it.
  6. I don't think it's permanent. I believe dextroamphetamine and Vyvanse are available in EU if I'm not mistaken. Dexedrine (dextroamphetamine) is superior to Adderall IMO anyway. Vyvanse just metabolizes into Dexedrine. Certainly less dulling than citalopram, but maybe not Prozac. Prozac is also a 5-HT2C antagonist which releases norepinephrine and dopamine. Zoloft is also a dopamine reuptake inhibitor in addition to being a serotonin reuptake inhibitor (about the same potency as Ritalin I believe, but the selectivity for the SERT over the DAT is such that this would probably only felt at high doses), and IIRC is one of the best meds for PMDD. There are two ways to take it for this indication: daily dosing (50 mg/day, may increase by 50 mg/day with each menstrual cycle) and luteal phase dosing (50-100 mg daily on cycle days 15-28). Viibryd is an SSRI + 5-HT1A partial agonist, and Trintellix is an SSRI + 5-HT1A full agonist, 5-HT3 antagonist, 5-HT7 antagonist, 5-HT1B partial agonist, and 5-HT1D antagonist. Both modulate release of dopamine, Trintellix also modulates release of additional serotonin, norepinephrine and acetylcholine among other neurotransmitters. Perhaps a trial of an MAOI might be what you need? Emsam, the patch, is probably the safest MAOI to take. Parnate is my favorite, but makes me gain weight like crazy paradoxically. You wouldn't have to give up your Ritalin if your pdoc is experienced in administering stims + MAOIs. Otherwise, MAOIs have stimulant-like properties in and of themselves, especially Parnate and Emsam (Parnate is a derived amphetamine, and Emsam metabolizes into L-amphetamine and L-methamphetamine). I totally hear you on that... I too suffer from this side effect, and I wouldn't wish it upon my worst enemy. I totally feel your frustration. I've recently asked my pdoc if I can just go off all my meds because none of them are doing anything... She seemed surprised that I would say that, but took me seriously and said "eventually, but not now." MAOIs work quite well for this side effect IME. Parnate especially combined with a stimulant was my favorite. I felt the most "alive" I had ever remember feeling on just 20 mg Parnate + 30 mg Adderall (I'm sure Ritalin or Dexedrine/Vyvanse would work too).
  7. Sick (physically), hopeless, depressed, rapidly declining...
  8. I'm getting the same problem too, and it's debilitating on top of my already debilitating treatment resistant depression and OCD, especially if I have trouble sleeping and take my Seroquel and traozodone to help me sleep. That's almot always a guaranteed way to sleep 15+ hours and skip all my meds in the morning and feel like complete shit the rest of the day. The more I read your posts, the more I feel I can identify with you. I've always thought our issues were similar, but here lately I've really begun to analyze my issues more closely instead of passively living through them just go get through the day. I don't know if that is worth anything, but maybe if one of us finds something that works, maybe we can pass it on to the other and see if it works for the other too. I agree with using melatonin to help shift your bedtime backwards (sleep phasing I believe it's called?) It can be very beneficial in this manner and you only really need tiny doses (like 1 mg at the most).
  9. I know you didn't ask me, but I too had the sugar pill effect with modafinil even at 400 mg/day. I tried Nuvigil when it was still brand-name and it was a day and night difference. At the highest dose of 250 mg, it helped me stay awake all day, helped me with depression/anhedonia, ADHD, even dissociation, lose weight, etc., but it was too expensive and I didn't know about copay coupons at the time, and I abandoned it. Years later, it went generic, and a few years after that (now) I asked to try Nuvigil, knowing it has gone generic. I got prescribed 200 mg/day, and I feel nothing. If anything, actually, I felt more sleepy at first than before I started it, I almost quit it, but I stuck with it. I ran out of it recently, and I honestly can't tell if I feel a difference without it. (In short, Brand-name is superior at least IME, but generic is useless...) Maybe trying different generic brands might be worth trying, if insurance will pay for other brands and pharmacy is willing to do it. I would only try Abilify if other options have been exhausted. I just posted about it a little while ago. Most people don't consider it a heavy hitter, but since taking Abilify 5 years ago, I have no imagination, no positive affect, have been completely dysphoric, anhedonic, etc., can't think properly/cognitive side effects/etc., feel like an empty shell of a person. It was great the first month, and then after a while, for about a year and a half, but I felt empty and without personality or creativity. Lamictal can actually stabilize you "too much." The "antidepressant" effect isn't necessarily dose dependent IME, and I've heard that higher doses can actually flatten most people. I went up to 400 mg and the cognitive side effects were immense, the flattening tangible/palpable, and other side effects like tremor were horrible. I went down to 150 mg/day while coming on Zonegran, which I eventually replaced Lamictal with, and it worked well for several years for me until my neurologist replaced it with Topamax, which... ugh...But if you're not bipolar, you might actually consider ditching the lamotrigine if it's not helping you, or at least trying a lower dose (like 50 mg/day). It does reduce glutamatergic neurotransmission, which is excitatory in nature. The glutamate theory I believe (I could be wrong) holds that depression is due to hyperglutamatergic neurotransmission (excessive glutamate), and that lowering glutamate release can help with depression (I believe this is specifically bipolar depression, but I could be wrong). There are other anti-glutamatergic drugs, and you may even try something to increase glutamate (what I don't know) with your pdoc's permission of course, because the opposite may be true in MDD depression. Ritalin and other stimulants can downregulate your dopamine receptors (I believe), hence causing a need for increased dose for the same effect, and you will start "chasing the high," even at therapeutic doses/levels, and the "high" you're chasing is a "therapeutic high," not a recreational one. It's hard to avoid. With amphetamines, at least, there are ways to potentiate its effects which would allow you to stay at the same dose longer ideally, like alkalizing your stomach/body chemistry/urine with calcium carbonate or something else alkalizing, like through diet, etc.; taking either memantine (Namenda) or magnesium glycinate to prevent tolerance, both of which work as a NMDA receptor antagonists; and taking zinc (a good zinc supplement, not zinc gluconate for sure), which binds to the DAT at a special binding site, and potentiates the effects of amphetamine through inhibiting this binding site. May work with methylphenidate too (not sure), but it has been documented with dextroamphetamine. Effexor at low doses is essetially an SSRI, and it could be that you need more serotonin if your mood was stabilized by the addition of Effexor. There are ways of countering the apathy/serotonin "blahs," though I believe you've tried all or most of them that should've worked, one being raising the dose of Effexor to 150 mg or above, 225 mg being ideal to gain the benefit of both SRI and NRI. I seem to remember you reacted negatively to trying to increase the Effexor. Trying a low dose of escitalopram (5 mg) might help you enough without triggering the typical Lexapro Lethargy that so many people get. Zoloft and Prozac might be others to try, but I'm sure you've tried them already... OMG SAAAAME....
  10. Granted! The ability to sleep has now been removed from you, even just to take a nap, but you don't "need" to sleep to heal your brain—it does all that automatically while you work! But your brain pines to dream again, yet you are so much more productive now! Just look at everything you're getting done! Hmm... a wish... let me think... Oh! I wish my beard were fuller, straighter, and thicker—not as thin and scraggly as it its now, especially on the sides. (I'm really asking for it with this one I know... lol)
  11. They have longer half-lives and they also don't exhibit these crash-like side effects for be, so both. Just note that pdocs most often now are usually closed to the idea of prescribing TCAs. I personally wouldn't have any discomfort or concerns with hot-swapping a TCA with Fetzima. Fetzima has such a short half-life anyway it will clear out of the system in just a few days. However, if you're susceptible to side effects, you may wish to take 20 mg for a few days, then take 20 mg every other day for a week or so, then start a low dose of a TCA, like 10 mg or 25 mg at the very most, or if starting with protriptyline, 5 mg 2-3x/day. For me, they are better insofar as they actually produce therapeutic effects, and they for most people have less side effects, except protriptyline, which for me the anticholinergic side effects can get nasty after a while sometimes (like urinary hesitation, constipation, dry mouth/throat, blurry vision, unable to focus close up, etc.) Nortriptyline is sedating slightly in lower doses and at first because of its affinity to the histamine H1 receptor. But after a while and especially at higher doses, it becomes stimulating because it is a relatively selective NRI (more of a SNRI though with much more emphasis on NE). Nortriptyline just so happens to be the "cleanest" and "safest" TCA, I use quotes because no TCA is actually 100% "clean" or "safe." IOW, they all are slightly dirty in their mechanism of action (targeting many receptors and transporters) and can have dangerous side effects (like cardiovascular in particular, some are worse than others, but nortriptyline is the safest supposedly). Desipramine is actually cleaner mechanism of action wise because it is essentially just a selective NRI (most selective NRI and most potent NRI), with mininmum antihistaminergic, anticholinergic, antiadrenergic, etc., side effects. It's not necessarily safer than nortriptyline, but it's safe enough to be used in the geriatric and pediatric population somewhat commonly. It's used in the pediatric population for ADHD and geriatric population for depression not responsive to first-line agents. It's safe for use in geriatric population from the TCA agents because of its lack of anticholinergic and antiadrenergic side effects, causing less delirium, cognitive side effects, and orthostatic hypotension (leading to less falls) than other TCAs. It's also probably the least sedating, and for most, stimulating even in low doses. Protriptyline is an entirely different animal. Instead of being taken at night (except for desipramine which can be taken day or night), it is taken along 3-4 divided doses throughout the day. It comes only in 5 mg and 10 mg tablets, much like a stimulant (and it is rather stimulating from my experience, probably the most stimulating TCA... even more stimulating than desipramine for me). It also tends to respond to depression quicker than most antidepressants and the rest of the TCAs, sometimes taking just two weeks to respond to depresssion. So it has a good therapeutic mechanism of action. But this is offset by its rather dirty side effect profile. It's highly anticholinergic, almost as much as Elavil (amitriptyline). It has some affinity for the H1 receptor, so there is some potential for sedation despite the stimulant-like properties. It also is known for cardiotoxic side effects, like almost all TCAs... Might not be a good choice for a geriatric patient unless used in low doses, same for pediatric patients. But if you aren't taking too much meds already and can tolerate some potential side effects for a very good antidepressant with a good therapeutic profile, protriptyline is a good one. If I had to summarize them, I would say this (these are my personal assessments about their effects on me): nortriptyline: "safest," (least side effects across dose span), probably most sedating of the three but goes away after a while, moderately anticholinergic but not noticeable, only "feel" the medicines effects in high doses (100-150 mg), somewhat stimulating in high doses (usually at max dose of 150 mg) desipramine: probably second "safest," cleanest side effect profile, effective as an adjunct but not monotherapy personally (even up to 200 mg, max 300 mg for most), least side effects aside from those caused by therapeutic effects, somewhat stimulating rather than sedating even in low-ish doses (~50 mg), high doses probably not necessary (150+ mg, 50-100 mg probably all that is needed), low doses can help with sleep yet help with depression a little (10-25 mg) protriptyline: probably the most stimulating of the three (usually at 30 mg/day or 10 mg 3x/day), probably most cardiotoxic of the three but not as bad as clomipramine for example, anticholinergic side effects can be troublesome and are dose-related, hardly sedating at any dose, 30 mg is probably the best dose for balancing therapeutic effects and side effects, 40 mg is slightly more effective yet with much more side effects (mostly anticholinergic), max is 60 mg but I personally couldn't imagine taking that much It won't really do much good in the way for drive, but does have strange, random sexual side effects, that one happening in a minority of patients. I guess I was "lucky..." (???) I stopped because the combo pooped out. I too have meds that don't work if I try them again, but some my brain seems to just "like," and no matter how many times I swap out for other meds and come back to them, they always work at least a little and for a longer period of time than other meds. Zoloft + desipramine has been the most consistently-working combo for me ever. It has worked the most consistently, the longest, and has been the best-working, with least amount of side effects. Zoloft can cause sexual side effects in the higher dose range for me (150 mg and up), but I'm usually able to keep the Zoloft at 100 mg and the desipramine at 50 mg, only occasionally needing more of one or both agents. The temporary need of increased doses makes the side effects they cause more tolerable. If you need 200 mg Zoloft though, the side effects will eventually go away mostly, but will have some remaining side effects). I don't get it, my pdoc has a lot of qualifications similar to your pdoc, but her prescribing habits are so much more conservative and guarded... I dunno lol. I've not heard good things about reboxetine. I think I read that same article... Reboxetine is very similar to atomoxetine (Strattera) if I'm not mistaken. Strattera can help me but sometimes has this dysphoriant ettect on me, causing profound dysphoria and suicidality. I think one of its metabolites works a certain way on the opioid receptors that can be prone to cause dysphoria and suicidality. It's not working on the µ-opioid receptor, it's one of the other ones... Desipramine, being the most potent and selective NRI (at least in the US), strangely enough, while helping immensely at moderate doses (±50 mg, like 50-75 mg, but my pdoc won't prescribe over 50 mg anymore for some reason), at higher doses like 150-200 mg, it doesn't help any more than it did at lower doses, produces a little more side effects, and may sometimes make me feel a little flat (the one time she did let me take 200 mg a few years ago when I was severely depressed. I was taking desipramine alone without the Zoloft at this dose, so I think I need both serotonin and norepinephrine reuptake inhibition for it to be therapeutic at all). I don't know man... Abilify was great for me at first the first time I tried it, but then caused me to sink into what was theretofore the most dysphoric a depressive episode I had yet to experience. I am still in that depressive episode and haven't remitted from it, and that was about 5 years ago. I have not been able to shake this episode except for a few weeks or so at a time. Any subsequent time I tried Abilify, I would get very angry, irritable, and aggressive at low doses (2-5 mg). So I tried starting it at 10 mg with my pdoc's permission and I did fine, but needed to keep increasing it until I was up to 30 mg. That was awful because of the compuslivity reaction, which for me exhibited itself as compulsive spending/shopping. I still haven't recovered completely from that either. I tell ya, Abilify was great while it lasted (the first month the first time I took it, and for about a year and a half a few more times after that), but it has permanently altered the way my brain works. I have no imagination, no positive emotions (flattened affect), no creativity (haven't written a song in 5 years, not a single one... started on a handful only, and not finished any of them...), etc., am always depressed, suicidal, dysphoric, etc., can't shake obsessive thoughts especially when they're related to suicide... Ugh. I have a very profound love/hate relationship with Abilify. I was so glad to get off of it last spring, but now I'm hating Vraylar and wanting back on Abilify despite the side effects it causes... I'm going to look for an alternative, but unless I can find one, it'll be Abilify for me all over again, and I'll be an happy yet empty shell of a person again without any personality. It's a very strong, potent antipsychotic compared to the others... IMO... It works in a different way that is not nearly as well studied IMO. I think these dopamine partial agonists need more trials and studies to be done before more of them come out. The dopamine antagonists are far more well studied simply because they've been around longer. I'd recommend a trial of Abilify to anyone, but only after certain other trials have been done... That's how I feel about it. Most people don't consider it a "big gun" or a "sledgehammer," but personally because of my experience with it, I consider it a pretty heavy hitter. I wish you the best of results and the least negative side effects with it!
  12. Are you afraid someone is going to see what you've posted here and somehow know it's you or something?
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