Tag Archives: prozac

MJ’s story

Hi my name is MJ and i spoke to a member of your team on facebook messenger the other night , and due to my functional neurological disorder – fnd for short, i have severe speech problems , so i am emailing over a brief summary of whats been going on for me with the NHS and having concerns that my fnd may of been caused by medication, especially after watching your video for your awareness day that was in December 2018

Where do i start , always from a child (i am 44 now) i always had sadness and not quite fitting in and was severely bullied at home and at school , so by the age of 16 i found myself in a abusive relationship and had my first child at 17 by the time i was 20 after the birth of my second child i was on antidepressants not sure which ones they were like red smarties  and over the years following i was on various antidepressants Prozac or Citalopram were the drs favourite ones and to be honest they never did nothing apart from cause massive weight gain and lethargy.

Then in a bout 2003/4 after trying to turn my life around to be healthier and already losing about 7 stone in weight but then coming to a standstill weight wise i heard about these tablets that drs were prescribing called Sibutramine or Reductil , so i asked the dr about these and she put me on the highest dose and i agreed to visit dr regulary as they can cause heart problems , but i was so desperate to lose the weight and fit in (be normal , these days i realise it doesn’t matter your size and everyone has their own level of normal) so i started taking these tablets and wow at last something that worked.

It was like my brain had been rewired in the space of an hour of taking the first one , i could think clearly i had so much energy , it was like “yey something at last that kinda makes me feel normal and fitting in”, needless to say i continued with these tablets for several years, then come 2005/6 when i was coming off the tablets as i found out 12 months should’ve been the maximum time i should’ve been taking them there was stress going on surrounding my daughter and i started getting these attacks which the drs at the time just said it was anxiety attacks that mimicked a stroke which i now know to be fnd and i had many visits to A&E in the early days of the attacks and being doped up on Diazepam and anti depressants , eventually i seen another gp at the surgery and he said it wasnt right and referred me to neurology at Lydney outpatients this was in 2006.

The day i met the neurologist i wasn’t having attacks so i had to rely on explaining to him and he agreed to send me for a MRI of my brain, and a test where they wire your head up and flash lights in your eyes i think its called an EEG, then i went back to Lydney outpatients sometime later for results, i walked into the neurologists room when i was called and the neurologist looking down messing with something not really paying attention muttered actually there is something wrong then looked up and said sorry wrong person.

He had no notes or computers files open in front of him, really at the time i should’ve questioned him but i didn’t as i just thought it must be me again my body over reacting and doing strange things , so I went on my way continuing of going back and forth to gps and mental health services for various anti depressants and therapies , like cbt and counselling, art therapy etc … and tablets over the years ranged from Citalopram to Prozac to Veneflaxine to Mirtazipine , some in liquid form some tablets these spanned over many years.

I soon learnt what mostly the triggers were for these attacks it seemed anything that would raise my heart rate , so things like stress , exercise , etc… so I just tried to avoid these these things as much as I could but sometimes the attacks would happen for no reason at all , also over the years I sought private therapy through NLP, EFT, plus I socialised through spiritual groups and learning techniques like meditation and other forms of healing the therapies all helped me one way or another but never made a difference to attacks.

In 2008 I saw my gp again about my weight as it was creeping back on, and she referred me for a gastric band which I had placed in 2010 , which was helping manage weight etc… then in 2013 I became very unwell with the band I won’t go into the gory details but after not being able to eat or drink for 3 months the drs decided to refer me back to the ones who fitted the band , and the drs gave me Lanseroprazole which helped to keep down very small amounts of soft food like runny mash or watery ready break , and the people at south mead who originally fitted it did a swallow X-ray and it turned out my stomach had pushed through the band , so I was given the option of having it corrected or removed , so I agreed to have it corrected as at the time I really didn’t want to be without it.

Apparently when it was corrected there was several hernias and loads of ulcers in or around my stomach , I was told it would never be able to be tightened again but that was ok as at the time as it was like a security blanket for me what with my ongoing issues with weight, so life moved on and in about 2014/15 I saw a neurologist again as I had been back to gp so fed up of attacks and really beginning to question the anxiety thing especially as I had worked hard with loads of therapies and adopting a spiritual attitude to life and having a good social life with some really good friends who accepted me for me.

I saw a different neurologist and he wanted to try and witness an attack so he called a nurse into the room and asked me to undress to my underwear and tested my reflexes etc by this time I was pretty nervous so I began to shake a bit , so he thought that was an attack and said it was a functional movement disorder and gave me a web address to look at he ordered some bloods to be done , several months later I still hadn’t heard nothing so I rang up about bloods and the secretary said they were clear , so I continued plodding on life the best I could finding part time work etc… more tablets from the drs etc…

In 2016 I had the band removed as problems were beginning to occur again and I had just come to the conclusion I would rather be fat and happy than put my body through anymore torture plus the stress on my family In 2017 things started going downhill fast , the attacks were getting more frequent and more random.

Then in March the Friday before mother’s day so I wasn’t stressed and I was looking forward to being pampered and a day off from cooking and housework etc… as I have now got 5 children , I had an attack in the evening that basically hadn’t stopped yet 2 years on , so when it started I kept telling myself it would pass and made visits to out of hour gps who gave me beta blockers which done no good so I stopped them and my regular gp gave me Lorazepam and Zopliclone which really altered my thoughts and mood and by April I took a massive overdose of them which I am ashamed of but my mind was so scrambled and I was so off my face on them but not making no difference to the ongoing attack.

A group of mental health people visited my home on the following Monday which I now know was a assessment but wasn’t told at the time or received any copies of assessments but I will go more into that later as a lot has came to light about that more recently.

By May I had an appointment with the neurologist called Dr M__ S______ and before me and my partner had chance to sit down she blurted out your in a violent relationship aren’t you which is not true yes over 20 years ago I was but the man I am with now is such a good man , I tried to explain to her with my speech problems that this was not true , she just looked at my partner and said well you better not be , she did some standard neurological tests like reflexes although very difficult due to my movement and all over tremors and agreed to have me in as a inpatient ASAP for assessments and tests etc …and she prescribed pregabalin but after a week or so of taking it I recognised the feelings I had previously from meds that I stopped them and in a couple of days although still feeling awful the real horrible feelings went away.

In June I was called on a Friday night and asked if I could come in straight away as a bed had come free , so I did as the attack was still ongoing and really getting me down , it wasn’t a good experience at all , especially due to my speech problems , I even had a nurse taking the mickey out of my speech , the beds were set up weird and I wasn’t allowed to pull the curtains around me for privacy , I saw a physio once or twice and a health phsycologist once , Dr S______ saw me once or twice and one day she brought a colleague around with her with some student drs , he got me to do some things that I found really difficult like raise arms , then he said fnd we get a video done for dr S____ to go through with you to show you it’s fnd , then one of the students said to him how do you know it’s fnd and he grabbed my head and I started to feel electric shocks all through my body and making this weird humming buzzing noise then all of the drs went off to chat and go onto next patient , so great he started a new symptom of vile electric shocks in my body which I get daily now along with everything else.

So I was discharged and invited back the following week for the video to be made , the following week my partner booked yet another day off work and took me up for the video , we was left waiting for hours as somebody had cancelled it but eventually they got the video people to come over , they got me to sign a folded over peice of paper supposedly to say it was not for public use but I do question that now , the video was done which I found very stressful due to not being able to communicate and feeling unheard at one stage he rubbed his hand on my spine and I flinched with pain and he said in a loud voice for the camera oh I’m sorry that tickled I was so glad when it was over it was so humiliating, a few weeks later I had a appointment with Dr S___ , so again another day off for my partner but we thought we was going to go through video , but it wasn’t , it was more or less a discharge appointment.

My partner asked about the video and she was very awkward about it and said oh yes definitely fnd and quickly changed the subject  , so god know what happened to that video , so great discharged or so I thought I felt so alone so I turned to the internet and researched fnd and found someone talking about the Rosa Burden centre in Bristol and how they specialised in fnd , so I emailed Dr S____ through pals to ask wether she could refer me and she did ,so in the August I met Dr E__ M___ a neurologist from the Rosa burden centre and by the beginning of September I was a inpatient there on a four week rehab programme ,

I had some speech therapy there and physio and to input it was good there and great improvement was made there , towards the end you are set a task to walk to local Lidl ( about a 10 minute walk for average person ) but when I did it , it took me nearly 3hours as all symptoms returned but I managed to get back and just sit in a vegetive state for some hours after and pull myself out of it , so upon leaving they advised me to get a self referral for CBT, so I did even though it didn’t help things before , within weeks all of my symptoms were back worse and by the November I had to purchase a wheelchair for outings and by the February 2018 I was fully mute.

I went to gp who sent me to A&E but I ended up leaving because the one Dr was so rude and shouting at me , my partner had to step in and tell him to pack it up , but by this time I was so distressed I just got my partner to get my wheelchair to take me home , and the Dr on the way out said quite sarcastically yes go to Bristol they will sort you they are much better , why he said that I don’t know there was no need of his attitude , anyway I went to se Dr M___ a few weeks later for a outpatient review ,and she did her best to get me speech therapy locally and she reassured me not to worry or blame myself relapse is common in fnd , so by April/May 18 someone from mental health visited and realised I was mute so they then had to think as talking therapy wasn’t going to obviously work , so when they went I emailed them and asked if a psychiatrist could see me as I just had gotten to the point where I think I had gone nuts , so off to a psychiatrist I was referred I met him 3 or 4 times each time he was very rude and very impatient with my speech difficulties and just kept on wanting to give me tablets the first lot was Sertraline well I didn’t even collect prescription and the next time it was a very high dose of Prozac

I collected the prescription but never took them as he said to me in the appointment if I didn’t have tablets there was nothing he could do even though I was explains that meds were having a negative effect on me even paracetamol or anti histamines have a negative impact these days , so the next appointment that was like 6 minutes long he wasn’t happy because I wasn’t taking tablets and he referred me to psycologist L__ M___, I met her several times and she seemed to get it until I received a report in the post where she had written that my man had committed suicide , which when I emailed her to ask her where this had come from as it was distressing to read and not true she wrote back to me saying she got it wrong it was my grandad which again was not true , she wished me all the best for the future in the letter and that was the last I heard from her.

In that time as well I seen the speech therapist who was stumped after 5 sessions what to do, and Dr S___ had sent a random appointment so I went even though I thought I was discharged from her even though i was a lot worse and fully mute she didn’t seem bothered or even examine me and I ended up in tears by the end of the appointment and all she said to my son who had accompanied me was it does them good to let it out and patted me on the back.

When the report came through the lies that was wrote in there I just broke down blaming myself again , so a few more waste of time gp appointments etc … after but I won’t go into all of it as I can appreciate I’ve gone on loads already.

February 2019 I had another appointment with Dr M___ who has now discharged me , and I’m stuck at home housebound , more or less mute and tons of other symptoms , feeling very lost and alone and not knowing where to turn.

It’s surprising how much we take things like talking for granted but when it goes you soon realise what an important function it is , I just don’t understand why I’ve been lied about ? Diagnosis have been made on my past traumas in life are things being covered up especially as my symptoms now match MS or Parkinson’s or other neurological conditions but no recent scans have been done to rule them out ?

How can they waste NHS money on prescriptions and so called therapies when a true diagnosis has not been made ? Because the way I see it how can you begin to fix something if you don’t know what is wrong as fnd is just a umbrella diagnosis and the leading specialists in fnd say it is unusual for fnd to be the soul problem.

Did the years of antidepressants and those diet pills mess my brain signals up ? Especially as Reductil was designed to surpress the appetite through messing with the brain signals , I tried to help the health professionals the best I could by typing up everything prior to an appointment as I can appreciate it was hard for them with my speech problems and the last thing I ever wanted to be was a nuisance or a burden.

Thank you for taking the time to read this there’s probably loads more I could’ve added but I can appreciate this is loads already and I would really appreciate any support or advice you could offer many thanks MJ. 

J.J.’s story

4 years is nothing. 4 years is a black spot on a clean canvas that you can only really see if you step over those red rope barriers in museums that stop you from getting too close. But 4 years of depression and anxiety left my life paralyzed from the early teens onwards. It came in waves, waves of not being able to leave my bed, wishing I was dead, crying until my eyes were burning and my brain felt like it was under a hydraulic press.

Being 15 – noting that I’m 16 now – my mother was desperate. She was frustrated, blaming herself, my father, mostly just me, though. I couldn’t face going to school, so I missed most of the high school experience, I couldn’t even leave my room most days.

We tried aromatherapy. I had candles and drank herbal mixtures and dropped two drops of flower water onto my tongue a day. I had mouth sprays and scent sticks and special herbal chewing gum. That didn’t work so well.

We tried tapping, sort of like massage therapy. I’d tap areas of my body and tell it I will go to school tomorrow. I didn’t.

We tried therapy. My mother took me to a counsellor named Mindy who made me cinnamon tea. Later, I saw an Anne who let me play with the fidget toys she had in a box in the corner. Then I got to the top of the CAMHS waiting list and I saw a Sandra who brought in aromatic play-dough to make me feel more relaxed. Then I got to an Adrienne, who had a fun accent. After her came Linda, who said ‘breasts’ too much.

Then I got Dr Tom.
I’d done CBT – it hadn’t helped. I was missing my GCSEs due to anxiety – I was thrown deeper into depression. My relationship with my mother was angry yells and her being disappointed in me every time she saw me (or, that’s what it felt like to a 15-year-old).

I couldn’t live like this anymore.
Dr Tom explained, in much detail, that medication – Fluoxetine, 20mg – was a last-ditch effort to try to keep my 4 years of misery from becoming 5.

I’d had friends who’d benefitted from taking medication, so when I wasn’t opposed to the idea, my mother agreed. Desperate times and all that.

Dr Tom had explained the side effects to me, and how if they surpassed the two-week mark, I was to call his office immediately. Dizziness, nausea, suicidal thoughts. I was willing.

The first few days, I was dizzy. My head felt heavy and I felt like I was floating. No nausea, no suicidal thoughts.

A week later, I did get a dark cloud over my head. It didn’t last long, but it was there.

A week later, I’d tidied my room. The first time in months.

A month later, I looked up courses in local colleges. I didn’t cry about missing my GCSEs.

6 months later, I set up a board of aspirations and was slowly ticking them off.

A year later, I bought a pet budgie, whom I look after. That’s a lot of responsibility for someone who couldn’t look after themselves last year.

When the time came to come off of my meds, I had no side effects. I was living. I was alive. I had plans, I didn’t look around and hate where I was in life. I was something. Not nothing. 4 years of dark at the end of the tunnel, and suddenly there was light. And it wasn’t a train coming right at me this time, I’d actually found the end of the tunnel!
I’ve been off Prozac for a few months by now. I dyed my hair the other day and laughed when it didn’t come out the way I wanted it to.

When I was 13, if my hair wasn’t right, my anxiety would have me missing days of school to cry on my bedroom floor. My bird, Archie, is my best bud, and likes to sit on my shoulder. I volunteer at an animal rescue and walk the dogs. I used to cross the street when one was coming towards me. I want to learn sign language. I’m going to a concert next year. I go to a drama club. I take the train. I read books. I spend time with my friends. I smile at strangers. I’m not angry anymore.

Prescription drugs can be awful. It can turn something bad into something worse and make someone scared into someone scary.
But I’d been scared for so long.
And I’m not anymore. I’m unsure that I ever will be again.
Whatever prescription drugs are to you, I wish you luck, and remind you there is hope.
cool. peace.

BBC File on Four program on Antidepressants in Children

A recent BBC File on Four program on Antidepressants in Children, presented by Paul Connolly, has drawn disparaging comments on posts here. Here is some background detail. I was interviewed for the program. My messages were as follows:

  1. That the trials of Prozac in children were identical to the trials of other SSRIs and other antidepressant drugs in this age group – negative. There are more negative Prozac trials for depression in this age group than for any other antidepressant.
  2. Part of our problem s that MHRA and NICE don’t want to be seen to go back on judgements they made 14 years ago when they licensed Prozac. Better children die than regulators lose face.
  3. That all of the literature in this area is ghost or company written.
  4. That there is no access to data from clinical trials – MHRA don’t have access, NICE don’t have access – no-one does.

It was clear to me that Paul Connolly, although expressing shock just like Chris van Tulleken some months before at what I laid out, was not going to include this material. Chris was somewhat the braver of the two. He rather subtly skewered NICE – but probably too subtle for most people. A week before the programme ran, there was an email from File on Four saying that owing to space constraints I was one of several people being omitted.

What File on Four ended up was a combination of the irritatingly anodyne and bizarre. What is the definitive answer about whether antidepressants work, Paul Connolly asked – no one knows he said. There are definitive answers the public deserve to be told about but FoF bottled it. Doctors are all at the mercy of clinical trials, he said, before turning to Ian Goodyer, someone who has pushed antidepressants for children for years who said on the basis of the biggest trials with 475 children he could tell us that fluoxetine (Prozac) worked in 67% of cases rising to 80+ %. I’d fail a medical student who offered me this answer if presented with the results of the TADS trial – the one Goodyer was talking about. There is no good evidence fluoxetine worked in this trial. Goodyer omitted to tell us that there were 34 suicidal events on fluoxetine compared to 3 on placebo. Goodyer made something of the fact this was the biggest trial of Prozac which sounds good but isn’t the biggest – not by a longshot. Even if it were the biggest, Goodyer fails to appreciate that the bigger the trial the greater the chance you can show snake oil works. If drugs are worth it, small trials are all that is needed. Prozac, fluoxetine, is in fact the drug with more negative trials than any other. These points are irritating. The bizarre one was that FoF made Andrea Cipriani out to be the radical outlying voice. AC’s work is totally controlled by industry – he knows he has no access to the data and his work is based on ghostwritten or company written reports . He’s a very nice man but the idea that he is a voice for caution as regards the use of antidepressants is bizarre.

Read the full article

Starlings on Prozac? Fish on contraceptives!

As drugs – both legal and illegal – pass through us, they enter the UK’s waterways. But can this really lead to a change in the feeding habits, and even the sex, of wildlife?

Most people go to a music festival for the music, the mud and the social scene. But at this year’s Latitude festival Dr John Ramsey and Dr Bram Mizeres have come for the urine.

Bottling up the goods from festival urinals might not sound like cutting edge science, but it can provide a glimpse into our pharmaceutical lives.

The drugs that end up in our urine also make their way out into our waterways, with some startling effects.

Last year over a billion prescriptions were dispensed in the UK, along with a huge number of over-the-counter remedies. More medication is being taken than ever before and with an ageing population this trend is not likely to slow down any time soon.

But what is the fate of these drugs as they travel beyond our toilets?

Intersex fish

At Brunel University, Prof Sumpter has been studying the effects of pharmaceuticals in our waterways ever since intersex fish – male fish exhibiting female traits such as egg production – were first spotted in UK rivers in the 1990s.

He and his colleagues wondered what was in the water that could be causing such radical change.

“At a biochemical, molecular level, a fish is extraordinarily similar to you and I,” he explains.

“So almost every drug target in a human – receptors, enzymes, ion channels – is present in fish. And they do the same thing.”

As drugs – both legal and illegal – pass through us, they enter the UK’s waterways. But can this really lead to a change in the feeding habits, and even the sex, of wildlife?

Most people go to a music festival for the music, the mud and the social scene. But at this year’s Latitude festival Dr John Ramsey and Dr Bram Mizeres have come for the urine.

Bottling up the goods from festival urinals might not sound like cutting edge science, but it can provide a glimpse into our pharmaceutical lives.

The drugs that end up in our urine also make their way out into our waterways, with some startling effects.

Last year over a billion prescriptions were dispensed in the UK, along with a huge number of over-the-counter remedies. More medication is being taken than ever before and with an ageing population this trend is not likely to slow down any time soon.

But what is the fate of these drugs as they travel beyond our toilets?

Intersex fish

At Brunel University, Prof Sumpter has been studying the effects of pharmaceuticals in our waterways ever since intersex fish – male fish exhibiting female traits such as egg production – were first spotted in UK rivers in the 1990s.

He and his colleagues wondered what was in the water that could be causing such radical change.

“At a biochemical, molecular level, a fish is extraordinarily similar to you and I,” he explains.

“So almost every drug target in a human – receptors, enzymes, ion channels – is present in fish. And they do the same thing.”

As studies into intersex fish developed, researchers soon amassed evidence that hormones from the contraceptive pill in the effluent from sewage treatment works were responsible.

Two decades on, our wastewater treatment has improved and most scientists suggest the majority of intersex fish can still breed without difficulty. But the contraceptive pill is not the only pharmaceutical making its way to our waterways.

Starlings on Prozac

Prof Sumpter now focuses on the effects of anti-depressants on fish.

Like synthetic sex hormones, anti-depressants dissolve in fat rather than water. As a result, they enter the bloodstream of organisms exposed to contaminated water.

This can affect other wildlife too, including birds. Dr Kathryn Arnold from the University of York has been studying the effect of Prozac on starlings, a number of which feed on the worms, maggots and flies found at sewage treatment works.

These creepy crawlies, living happily on the abundance of food found at the treatment works, contain high levels of pharmaceuticals, especially Prozac.

To study the effects this might be having on starlings, Dr Arnold and her team confined wild birds to aviaries and fed them on Prozac-laced worms, with the research to be published in October. They found that these birds ate less overall, snacking throughout the day instead of having full meals.

“And it’s all these small, very subtle effects that build up and potentially compromise an animal in the wild,” Dr Arnold says.

As yet, the science is at an early stage. Although the evidence seems to be mounting that laboratory-controlled, environmentally-relevant levels of micro-pollutants can have behavioural effects on fish and birds, only a small number of studies have tried to look at these changes in animals in the wild.

Dr Arnold and her team intend to start measuring the levels of Prozac in wild starlings’ blood this winter.

“So we’ve done what many researchers in this area have done, we’ve kind of tried to do things in a controlled environment, in the lab,” Dr Arnold explains.

“I guess the question that a lot of us are asking is, well, what does it mean for a normal healthy bird or fish in the wild to be consuming anti-depressants, or anti-psychotic drugs?”

Monitoring disease outbreaks

Such emerging evidence makes it all the more important that we know what is actually in the water.

Dr Barbara Kasprzyk-Hordern, an analytical chemist at the University of Bath, uses urine samples to provide near real-time data into levels of drug use.

“In the case of MDMA,” explains Dr Kasprzyk-Hordern “there will be spikes during the weekend because it is a club drug. While, when we look at heroin, its use will be stable throughout the week because it’s a very addictive drug.”

Dr Kasprzyk-Hordern thinks this technique will also be able to monitor populations for outbreaks of disease.

“Usually when we test for certain diseases we use urine,” she explains. “Why do we have to collect urine from every individual, why not look at wastewater?”

Just as an individual’s urine can help assess their risk of developing certain forms of cancer, Dr Kasprzyk-Hordern hopes that by analysing a wastewater treatment plant it may be possible to identify areas with a greater incidence of cancer and target them with increased patient screening.

Full article

https://www.bbc.co.uk/news/health-29108330

further reading

https://www.health.harvard.edu/newsletter_article/drugs-in-the-water

The Dangers of Abruptly Stopping Antidepressants

Are you feeling better and think you’re ready to stop taking your antidepressant? It may seem like you no longer need the medication, but in most cases, it’s contributing to your improved feelings. That’s why it’s important you stick with the treatment prescribed by your doctor. If you think you’re ready to stop taking an antidepressant, ask your doctor to create a plan of action that will help your body slowly adjust to being without the medicine.

Antidepressants help balance brain chemicals called neurotransmitters. These brain chemicals affect your mood and emotions. An imbalance can cause major depression or anxiety disorders. Antidepressants correct this imfbalance, but it can take four weeks or more to get the maximum effect.

you feel like stopping your medicine because of bothersome side effects, remember that finding the right treatment may take trial and error and some tweaking. Don’t stop taking the medicine until you have spoken with your doctor. It might seem like you don’t need the medication anymore, but if you stop taking it, the medicine will leave your body and your symptoms might return. Quitting without consulting your doctor can be life-threatening. Suicide is a serious concern. It can also trigger withdrawal symptoms and relapse of your depression. If you relapse and start taking an antidepressant again, it can take weeks for the drug to rebalance your mood.

Side effects of quitting medication

Quitting “cold turkey” may cause withdrawal symptoms. Suddenly stopping your medicine may also worsen your depression. Here are some of the possible effects of quitting too quickly:

You get sick. Antidepressant discontinuation syndrome, also called antidepressant withdrawal, occurs when a person abruptly stops taking antidepressant medication. Many people who experience antidepressant withdrawal feel like they have the flu or a stomach bug. They may also experience disturbing thoughts or images.

You set back your treatment. Stopping medication can set back your treatment plan. It can increase the time it takes to feel better or it can actually cause your symptoms to worsen.

You contemplate suicide. Not being properly treated may increase your risk of suicidal thoughts. It also increases the risk that you’ll act on those thoughts. The most common health problem linked to suicide is ddepression……

full article