Whats your effective "antidepressant" dose?

Does buprenorphine treat depression? Is my depression from Suboxone? Will Suboxone treat bipolar? Will naltrexone or Vivitrol make me depressed?
Steffen36
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Whats your effective "antidepressant" dose?

Post by Steffen36 » Mon Aug 21, 2017 2:14 pm

So, I was good at 2mg total daily (1mg 2xday) but was dealing with some anxiety, a drop in mood in the middle of the day and temptations to dabble in alcohol and other drugs so I added 1mg more (1mg 3xday) for a total of 3mg a day and in less then a week, like a light switch, the antidepressant effect turned off for me.

So now I am dropping back to 0.5mg 3 x day for a total of 1.5mg in hopes it comes back.

I thought I read some study saying the benefit drops after 1.8mg so maybe I went too high? I guess that would make sense....

What dose does everyone else find is best for the antidepressant effect?

Thank you.
-Steffen

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Re: Whats your effective "antidepressant" dose?

Post by OpenMind » Mon Aug 21, 2017 7:08 pm

I would be curious to see what others may have to say. But I think most of the people come here because of the effects of addiction on their lives. Buprenorphine isn't actively prescribed for depression that I know of. If it is, I would assume it's by some forward-thinking therapists living on the fringe of their science since there isn't a lot of data showing the effectiveness of opioids as effective treatment for depression. Especially in this witch hunt-style environment where doctors are feeling immense professional and social pressure to withhold addictive pain killers, even to those who may need them the most.

There are those on this forum whose lives are being turned upside down due to a sudden decrease or sudden stop of any and all narcotic pain medicine as a reaction to the opioid epidemic. It would really surprise me to hear of a doctor who would write a script of sub specifically for depression. Not saying it doesn't happen and I'm sure there are those who use the drug in off-label applications, but I suspect it's the patients that are seeking out bupe for emotional or psychological reasons. If it works, that's great. Maybe one day our medication won't suffer from such close-minded stigma.

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Re: Whats your effective "antidepressant" dose?

Post by Tragicom » Mon Aug 21, 2017 8:38 pm

Hi Steffen,
Hope you are doing well today. I wanted to get a better idea of what you mean when you say "the antidepressant effect turned off? What antidepressant effects did you feel you were receiving at the lower dose that dissipated at the slightly higher dose?

You said initially that at 2mg you would get low mood in the afternoon and have drug cravings. How did the higher dose affect the cravings? And how did the low mood you felt in the afternoons on 2mgs compare to the low mood you felt at 3 mg?

Sorry for so many questions but I'm really curious. I think research in the area of antidepressant effect is still ongoing but I've read that up to 2mg is what is commonly used for depression.

Speaking for myself I noticed my mood improve right away at 2mg, but it continued to improve and stabilize as I increased my dose. I'm on 8mg now, and while I wouldn't say I have more of an antidepressant effect at 8mg I also don't feel like my mood is lower.

My mood feels very good and stable. I have a long history of depression, bipolar 2, anxiety, etc, and I'm experiencing the best mental health of my life right now. It is also the first time in many years that I've been off all other opiates, alcohol, weed, etc. So, who knows?
Love to hear from others.
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Re: Whats your effective "antidepressant" dose?

Post by Steffen36 » Tue Aug 22, 2017 12:51 pm

Hopefully more people will post their dose and maybe years on the medicine too, that would be interesting.

Openmind-I should note I am prescribed suboxone not for depression but for addiction to vicodin/norcos and poppy pods. It just happens to work as an antidepressant for me. Just like you I am very concerned for the future availability of this medicine due to the current opiate epidemic and resulting hysteria. Too many people are diverting their suboxone too, screwing it up for the rest of us which really pisses me off. So far suboxone has flown under the radar it seems but its only a matter of time before something happens to bring it more attention.

Tragicom-We seem to share the exact same diagnosis and previous addictions. Congrats on feeling so well and staying off the opiates and other drugs! The antidepressant effects I get are hard to describe, obviously you get the slightest "opiate" feeling. But I will never call it "euphoria" as I recall vividly how great norcos and pods felt and this med is so far from that. Its really a strange feeling but exactly what I have been searching for these past 2 decades of suffering through mental illness. It pulls me right out of my dark hole. How does it feel to you? The higher doses are no doubt better at keeping away the cravings. My highest was 2mg 3 x day and that was perfect. However over the past year I guess my brain healed from not abusing opiates because the higher doses started to feel "too good." I didnt want that. So gradually over the year I have been on it I went down as far as 0.5mg 2 x day but I realize now I must take it 3 x day as to me the effect, for mental illness that is, lasts 5-6 hours. I'll try to include a link to a study I found where they too used a 3 x day dosing. Thats how long the analgesic effect lasts. Hope the link works.
http://www.de-poort.be/cgi-bin/Document.pl?id=385
Last week the 1mg on the 2nd and 3rd dose of the day would only cause dysphoria and tiredness and I have no explanation for that so far. Hopefully someone can answer as to why that would happen. I was scared to death it had quit working for me but in the past two days I am back down to 0.5mg 3 x day and its working again! Strange drug.

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Re: Whats your effective "antidepressant" dose?

Post by OpenMind » Wed Aug 23, 2017 6:19 pm

Steffen36 - Thanks for the clarification and the link to that document about a depression research study that involved the use of buprenorphine. Some of what I wrote was for the benefit of those who happen to stumble onto this forum and read a little bit. It wasn't all aimed at you. I understand you're being prescribed subs for addiction but are finding them to also be helpful with your mental health. Tragicom and I also share a history with bipolar and depression and anxiety. When I first started taking my subs I could have sworn I was getting some relief with my moods, too.

Since then a lot has happened and now I care for a very sick parent without any help from family or friends. Whatever benefit I was getting at the beginning, it's hard to feel it now under my current circumstances. I wish I would have had a little more time to see if the subs were indeed helping to stabilize my moods without the influence of a personal tragedy in the mix. But that's life. Maybe in a sense, it's a better test now while I'm under all the pressure I'm feeling.

When I look back now I think it was natural for me to feel like it was having a positive effect on my mood. After all, I had just turned my life around by giving up pain killers, getting out of the house and into a social atmosphere by attending intensive outpatient therapy three days a week, and SMART Recovery meetings after that ended. I was doing everything the right way that I knew of.

That little honeymoon phase is over and the intensive work has begun. Changing habits and behaviors that took years for me to develop has proved to be one of the hardest decisions of my life. Don't ever believe it completely when someone says all you have to do is take your bupe everyday. No, it's much more complex and involved for me. I want these changes to be permanent so that I will never go back to the life I once led. My priorities have changed and because of buprenorphine and my new outlook on life, I still have quite a few tough decisions to make and life lessons to learn. But I'm willing to put in the effort.

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Re: Whats your effective "antidepressant" dose?

Post by Steffen36 » Thu Aug 24, 2017 8:19 pm

OpenMind- I knew that what you wrote initially was not directed specifically to me but instead was noting what is currently going on in the country and this community and its beneficial to put that information out there for others that don't post but instead read the forums for their own information gathering, so no worries at all. These are troubling times for us in this current position using this medication.

In regards to the use of buprenorphine for its antidepressant effects I certainly do not want people to rush to it without first exhausting all the other options for their mental illness. As we all know too well opiates of any kind are not something that you can just pick up, use and then walk away from easily. Its a decision that should not be taken lightly by any means. Though in the end I do think there is promise in buprenorphine for those that have gone decades like myself with subpar results with the standard treatments. Especially those with concurrent addiction issues.

I am so sorry to hear about your current situation. Dealing with mental illness, addiction recovery AND caring for a sick parent must be incredibly taxing and testing of how far you have come in your process. Outside stressors have always been my trigger, and an excuse to fall back on old habits. However you sound like you are in a good place mentally through the use of buprenorphine, outpatient therapy, recovery meetings and a significant change in lifestyle. I do wish you the best in these difficult times your facing. I realize I am very new here but I am around if you need someone to lean on or just vent to.

-Steffen

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Re: Whats your effective "antidepressant" dose?

Post by TeeJay » Sat Sep 02, 2017 1:34 am

I still get quite depressed while on Suboxone 8mg, so I don't believe it's a particularly effective antidepressant, at least not for me. I've yet to find an antidepressant that holds its effect long term. Every medication I've been on either (a) doesn't work at all or (b) works for a period, then stops working. The only thing that seemed to hold its effectiveness long-term was being on near toxic levels of lithium (over 1.0mmol/l), but I can't stay on those kinds of levels because of kidney damage and side-effects. I have bipolar disorder type 1, but the symptom that affects my functioning the most is the episodic depression. Over the years it's gotten worse too, with more severe symptoms during episodes, and less periods of remission. It's almost getting to the point of qualifying as a disability, which is depressing to think about. I'm concerned I might be getting a bit depressed again lately, as the moment I get home from work or school I just go straight to bed and have stopped reaching out to friends. I'm getting behind with everything from study to housework and bills. But at least I'm not using heroin.

I've come along way to no longer need to use heroin when I get depressed.

I personally don't hold opioids as particularly effective antidepressants long term.

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Re: Whats your effective "antidepressant" dose?

Post by Steffen36 » Sun Sep 03, 2017 12:00 am

TeeJay-Your name seems so familar, where you ever on another forum poppies.org? Regardless....
In all your med trials have you used lamictal? For me it has been a surprisingly good antidepressant. I too was still suffering from "down" periods while on suboxone and I do mean "I am ready to give up" down periods which is why I always try to preface my posts on here with saying suboxone is certainly not a cure all by any means. More like another tool in the toolbox to fight the mental illness. My shrink was the one who recommended lamictal. I can only take 25mg which is a super low dose but it works for me. Any higher causes my anxiety to go up. I suffer from bad anxiety. 50mg was very helpful but I just couldnt tolerate it. Since I can only take that low amount of lamictal I have also been experimenting with lithium in low doses to augment it. As always its a constant work in progress.

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Re: Whats your effective "antidepressant" dose?

Post by Tragicom » Sun Sep 03, 2017 10:51 am

Hi, I just wanted to chime in. Steffen, it's so funny, I found Lamictal to be one of my wonder drugs too. Also, not a cure all, but a real stabilizing effect on my mood along with a subtle mood lift. Just an FYI, in case you don't know, in higher doses (above 100mg) it is much less activating, and almost sedating. I found the same thing at 75 mg I felt too fast and more anxious. But as I increased I found it addressing both my mood and anxiety. So now, on 150 mg it doesn't have that anxious, activating feeling but still keeps my mood up. If you are doing well on your 25 mg and you like it, no need to change, but if you ever feel like you need more but are afraid of that anxiety, just know that after 75 mg it starts to get better.

Tee jay, I was just wondering if you said you have done ECT and if so if it was helpful. I have a friend who says it was much more effective than any other antidepressant, but it can cause headaches and memory loss. I'd be a little nervous about it, but if I get to the point where nothing else is working I can't say I'd rule it out. Just wondering, that could be a whole other discussion.

I know for you Tee Jay Buprenorphine has not proven to be a good long term antidepressant. And I've read that from a lot of other people. I've also read from a lot of people and feel my personal experience is that buprenorphine is acting like an antidepressant. It's both cliche and true to say "medication effects everyone differently." I really think as research into depression continues that they will discover that there are many different types of depression, with many different chemical causes. While some people may respond to opiate therapy, others to Ketamine, others to traditional antidepressants, others to medications not yet developed or even imagined. Gene therapy is another possible treatment in the future. I guess my point is that in the future I don't think it will be much of a debate. I think all of these treatments will be viable options.

Tee Jay, I also know that you have expressed concern over getting someone who is opiate naive dependent on (and possibly open floodgates to opiate addiction) by putting them on Buprenorphine for depression. That is a very valid concern that I don't have an answer to. People on SSRIS and especially Effexor definitely become physically dependent on the medication and can face pretty unpleasant withdrawal symptoms when stopping them, although not nearly on the same scale as Buprenorphine. I know that even if I wasn't an opiate addict my depression gets so bad I would have tried BUpe despite the risk of dependence. I would hope to, maybe that an opiate with less potential for dependence or addiction may be created sometime too. Easier said than done. Best
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Re: Whats your effective "antidepressant" dose?

Post by TeeJay » Mon Sep 04, 2017 11:32 pm

I have been on Lamictal a couple of times. I remember it had less side-effects than some of the other mood stabilisers. It didn't stop me from getting depressed though, and I had doubts as to whether it did much for me. Perhaps I expected too much from medications. I thought that eventually I would find a medication that would stop me from falling into bipolar depression, which none of them did. That being said it was impossible for me to know if any of the meds I was on actually reduced my incidences of depression. Maybe they did? Hard to tell.

There was one medication that did provide relief for depression and held its effect long term. That was high doses of lithium - 1300mg+. I noticed when my lithium levels were over 1.1 (high end of therapeutic), I could actually function through depression quite well. It really took the edge off. Only thing is, over the years lithium gave me really bad psoriasis. Eventually rather than just getting it on my scalp, I got it all over my body and it was quite painful in some areas, so I had to stop taking lithium. My doctor said he was surprised I took it as long as I did given how bad my skin was in the end, but it was the only thing that worked.

Never did ECT. Have heard mixed reports. Am wary about the memory loss, given my mother's side of the family have shocking memories as it is, and I experience memory based side-effects from medications quite easily. A family friend had ECT for the first time in his 60's a couple of years ago. His family said it was the best thing he ever did for his bipolar. I haven't actually asked his opinion personally. I'd probably be open to it if I got really sick again.

I've actually noticed lately that buprenorphine has a mild mood-enhancing effect. I'm experiencing moderate depression at the moment, and the time of the day I feel the depression least is usually in the hour or two after I take my Suboxone. For an hour or so, I almost feel in the normal mood range, especially if combined with a decent cup of coffee.

I'm in a weird place at the moment where I clearly have a chronic condition, but I seem to have lost faith that psychiatry has the answers, and I definitely KNOW that drugs, particularly opioids, are not even a short-term solution. So the only thing I have to manage my condition is the knowledge that eventually my mood episodes will pass. It's just a strange place to be, given in the past when I'd start to get sick I'd frantically make appointments with doctors, and when that didn't work I'd run to the dealers. Now I'm just .... sitting with it.

I'm on 40mg Latuda and 8mg Suboxone. At the height of my placing faith in psychiatry & western medicine, I was on 6 or 7 medications at a time (lithium, lamictal, depakote, zyprexa, pristiq, agomelatine, Suboxone etc).

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Re: Whats your effective "antidepressant" dose?

Post by Tragicom » Tue Sep 05, 2017 12:08 pm

Tee Jay, I know what you mean. The depression always lifts at some point, even if only for a little while. As much as it sucks sometimes sitting with it is probably the best thing you can do. Just accepting it and waiting for it to pass. Probably still a good idea to have support and talk to people during that time, but, there really is only so much medication can do. Therapy has its limitations too. Just knowing it will pass can be comforting.
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Re: Whats your effective "antidepressant" dose?

Post by raudy1975 » Tue Sep 05, 2017 4:09 pm

Hello,
I am on 40mg of Viibryd 4mg of Zubsolv (bup) and 20mg x3 a day of Propranalol (anxiety)

The mix of the Zubsolv and the Viibryd really seem to do the trick for my Depression.

I have posted before that i have been on an antidepressant and No Zubsolv and I was still depressed, I have taken Zubsolv or Bup by itself and been depressed.

Only the comb of both an SSRI and the Bup works well for me. Maybe because I am treating my Addiction with the Subs and my depression with the SSRI. Ha!

It is kinda a chicken and egg thing with depression for ME. I am not sure if i used because i was depressed or got depressed after i used and went thru withdraw/ but i suffered non the less.
I Do know is that the combo works great and I have been on these meds now for about 3 years or more without any problems.

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Re: Whats your effective "antidepressant" dose?

Post by OpenMind » Tue Sep 05, 2017 7:30 pm

Steffen36 wrote:I am so sorry to hear about your current situation. Dealing with mental illness, addiction recovery AND caring for a sick parent must be incredibly taxing and testing of how far you have come in your process. Outside stressors have always been my trigger, and an excuse to fall back on old habits. However you sound like you are in a good place mentally through the use of buprenorphine, outpatient therapy, recovery meetings and a significant change in lifestyle. I do wish you the best in these difficult times your facing. I realize I am very new here but I am around if you need someone to lean on or just vent to.
Steffen36 - Thank you so much. The fact that you don't even know me but are willing to put yourself out there says a lot about your character. I'm so used to being the strong one that everyone comes to for help and now the tables have turned and now I'm the one that needs help. It's a weird feeling and I'm doing my best to keep up. I just get so worn out physically and emotionally and I never get a break.

And yet I keep finding the strength to get through every day... strength I didn't know I had. I can tell you it really helps being able to come here to this forum because I know I can find people like you that honestly care about helping out other addicts and those struggling with depression or other mental illness. So thank you so much for the support.

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Re: Whats your effective "antidepressant" dose?

Post by Steffen36 » Wed Sep 06, 2017 2:49 pm

Tragicom-Thats fantastic information on the lamictal. I had no idea it was one of "those" drugs where the higher up in dose you go it flips and becomes more sedating. I kept trying to go up but couldnt force myself figuring the activating aspect would just get worse and worse. My doc wants me to go higher saying it will benefit my moods and anxiety more and maybe this is why. You also mention Gene therapy which I have been hearing more about lately. If I understand correctly they can find more specifically what medications can target the proper areas of the brain that are not functioning properly? I know thats over-simplified but is that the gist of it from what you know?

TeeJay-Have you given Abilify a shot? That brought me out of some heavy depressions. But again like a lot of drugs it also caused my anxiety to ramp up. I keep some around for prn use when I have to pull myself out of a spiraling depression. Also you mention a slight mood lift from the buprenorphine a couple of hours after dosing. Have you tried splitting your dose into 3 times a day? For instance I take my dose every 5 hours specifically for the mood elevating properties. I know in some of the depression studies where they have used buprenorphine they dose it 3 times a day so that could be an option for you? Many are adamant about once daily dosing for addiction issues but it seems to work best split up for me and I have not abused it or anything else while on it.

raudy1975-I know exactly what you mean about the chicken and the egg. The depression, mood swings and anxiety no doubt in my mind led me to opiates. There is something there, some connection yet to be discovered. I too use an SSRI, Paxil in conjunction with the suboxone and they seem to go well together. As long as I have a mood stabilizer on board to keep the mania in check. How do you like the zubsolv by the way? My doc would like me to try it but I am scared to rock the boat at this point.

OpenMind-You're welcome. I sent you a pm. Just keep pushing on and your going to make it through to the other side. (I know, easier said then done.) Message me anytime.

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Re: Whats your effective "antidepressant" dose?

Post by TeeJay » Wed Sep 06, 2017 8:12 pm

Steffen36 wrote: TeeJay-Have you given Abilify a shot? That brought me out of some heavy depressions. But again like a lot of drugs it also caused my anxiety to ramp up. I keep some around for prn use when I have to pull myself out of a spiraling depression. Also you mention a slight mood lift from the buprenorphine a couple of hours after dosing. Have you tried splitting your dose into 3 times a day? For instance I take my dose every 5 hours specifically for the mood elevating properties. I know in some of the depression studies where they have used buprenorphine they dose it 3 times a day so that could be an option for you? Many are adamant about once daily dosing for addiction issues but it seems to work best split up for me and I have not abused it or anything else while on it.
Yeah I have done twice a day dosing at one stage, and you're right. I did notice I'd get that post-dose feeling more often. But it's just impractical for me to have a mouth full of subliva 3 times a day. I gotta be on the phone a fair bit for work, and not taking calls for the half-hour I let sub dissolve every morning is enough as it is.

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Re: Whats your effective "antidepressant" dose?

Post by Cory » Mon May 28, 2018 2:44 pm

Hello everyone.
New to the site. I have been a long time sufferer of quite serious depression and also addictions to opioids and stimulants. After a few terrifying binges with IV methamphetamine I put the brakes on hard and sought to stop this before I found myself in a world that I had desperately escaped years ago. Within 2 days of starting the Sub my cravings for opioids and miraculously for meth had both vanished and mostly remain absent now after 6 weeks of treatment. The meth cravings are more appropriately described as PTSD flashbacks. Truly horrifying. That it should help with stimulants is far beyond what I had hoped for.
I had read in depression forums that Sub is being used for depression too. I can say that without a doubt I have felt better than I have in probably 10 years. Something completely outside of any euphoria or sense of wellbeing is at play. The Kappa receptors I assume. I have an excitement in the morning to go about my day and dare I say a feeling of joy which has been absent from my life for far too long.
I have no intention of stopping this medication. I have been noticing some changes in effect but I think it's just the shine is wearing off some. I think for me the antidepressant effect is the most important because I know that if I am suicidal I am unable to see any reason to stay away from drugs and that drugs would once again be my way out of the misery.
I am male, 56 yrs old, and am at 24mg Suboxone daily. Trintellix and bodybuilding as adjuvants.
Glad to have found this forum.

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Re: Whats your effective "antidepressant" dose?

Post by Ashlee » Wed May 30, 2018 1:49 pm

Hi Cory,

Welcome to the forum & glad to have you here. Everyone here at talkzone has had their fair share of issues... We're a support system for eachother, so feel free to ask us anything! You oughta check out the bupe for life section in the forum, you'll read some pretty great stories & research!
Hopefully you come back & become a regular member of the forum!


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Re: Whats your effective "antidepressant" dose?

Post by TeeJay » Sun Jun 10, 2018 8:28 pm

Most effective antidepressant dose of Suboxone for me is 0mg.

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Re: Whats your effective "antidepressant" dose?

Post by Ashlee » Mon Jun 11, 2018 2:51 pm

Teejay...

You have me curious now, why do you say that?
I may not have all what I want, but thank GOD I know how that I have all that I need.

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Re: Whats your effective "antidepressant" dose?

Post by Amy-Work In Progress » Mon Jun 11, 2018 6:45 pm

To understand that, Ashlee, you would need to look back through TeeJay's history here.

I don't know if TeeJay has been here longer than Rule, but I know he's been here longer than me. TeeJay has been very up front about his mental health and addiction history. He has been dealing with these problems for a long time now and he has tried many mental health drugs for his bipolar disorder and several forms of recovery from opioid addiction.

TeeJay has been on buprenorphine and off several times now. If I remember correctly, TJ has been appreciative of suboxone, dismissive and somewhat hostile to suboxone, and back to grateful. The last time he was grateful, buprenorphine seemed to be helping with his depression. Then it started not to work and he went on methadone. Now he has been tapering off methadone for a bit. TJ has also found help "in the rooms" of AA and NA before, but has also rejected their approach as too rigid. In addition, TJ has relapsed and relapsed badly a few times.

All of this back and forth may seem inconsistent or jumpy, but it would be very unfair to categorize TJ that way. TJ's mental illness has stricken him more than once with severe enough depression to make him borderline suicidal. He has had a difficult time maintaining a balanced mood and staying in recovery, while dealing with both manic and depressive episodes and intense cravings.

All this is to say that TeeJay has been through more than his fair share of trying different methods and combinations of treatment. He is, of course, welcome to share his own version or correct me if I misrepresented any part of his journey. I just wanted you to know, Ashlee, that he comes by his opinion through lots of experience and recovery work. :)

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