Harvard Women's Health Watch Going off antidepressants, updated 2018

[Altostrata]

ADMIN NOTE This thread contains several revisions of this article. See below for its evolution through revisions.

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2010

 

Going off antidepressants

If not handled carefully, coming off your medication can cause disturbing symptoms and set you up for a relapse of depression.

About 10% of women ages 18 and over take antidepressants....But as you begin to feel better and want to move on, how long should you keep taking the pills?

If you're doing well on antidepressants and not complaining of too many side effects, many physicians will renew the prescription indefinitely — figuring that it offers a hedge against a relapse of depression. But side effects that you may have been willing to put up with initially — sexual side effects (decreased desire and difficulty having an orgasm), headache, insomnia, drowsiness, vivid dreaming, or just not feeling like yourself — can become less acceptable over time, especially if you think you no longer need the pills.

The decision to go off antidepressants should be considered thoughtfully and made with the support of your physician or therapist to make sure you're not stopping prematurely, risking a recurrence of depression. Once you decide to quit, you and your physician should take steps to minimize or avoid the discontinuation symptoms that can occur if such medications are withdrawn too quickly.

....
Why discontinuation symptoms?

Antidepressants work by altering the levels of neurotransmitters — chemical messengers that attach to receptors on neurons (nerve cells) throughout the body and influence their activity. Neurons eventually adapt to the current level of neurotransmitters, and symptoms that range from mild to distressing may arise if the level changes too much too fast — for example, because you've suddenly stopped taking your antidepressant. They're generally not medically dangerous but may be uncomfortable.

Among the newer antidepressants, those that influence the serotonin system — selective serotonin reuptake inhibitors (SSRIs, now commonly known as SRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) — are associated with a number of withdrawal symptoms, often called antidepressant or SRI discontinuation syndrome. Stopping antidepressants such as bupropion (Wellbutrin) that do not affect serotonin systems — dopamine and norepinephrine reuptake inhibitors — seems less troublesome over all, although some patients develop extreme irritability.

Having discontinuation symptoms doesn't mean you're addicted to your antidepressant. A person who is addicted craves the drug and often needs increasingly higher doses. Few people who take antidepressants develop a craving or feel a need to increase the dose. (Sometimes an SRI will stop working — a phenomenon called "Prozac poop-out" — which may necessitate increasing the dose or adding another drug.)

A range of symptoms

Neurotransmitters act throughout the body, and you may experience physical as well as mental effects when you stop taking antidepressants or lower the dose too fast. Common complaints include the following:

Digestive. You may have nausea, vomiting, cramps, diarrhea, or loss of appetite.

Blood vessel control. You may sweat excessively, flush, or find hot weather difficult to tolerate.

Sleep changes. You may have trouble sleeping and unusual dreams or nightmares.

Balance. You may become dizzy or lightheaded or feel like you don't quite have your "sea legs" when walking.

Control of movements. You may experience tremors, restless legs, uneven gait, and difficulty coordinating speech and chewing movements.

Unwanted feelings. You may have mood swings or feel agitated, anxious, manic, depressed, irritable, or confused — even paranoid or suicidal.

Strange sensations. You may have pain or numbness; you may become hypersensitive to sound or sense a ringing in your ears; you may experience "brain-zaps" — a feeling that resembles an electric shock to your head — or a sensation that some people describe as "brain shivers."

As dire as some of these symptoms may sound, you shouldn't let them discourage you if you want to go off your antidepressant. According to a 2004 consensus statement by a panel of physicians, many of the symptoms of SRI discontinuation syndrome can be minimized or prevented by gradually lowering, or tapering, the dose over weeks to months, sometimes substituting longer-acting drugs such as fluoxetine (Prozac) for shorter-acting medications. The antidepressants most likely to cause troublesome symptoms are those that have a short half-life — that is, they break down and leave the body quickly....Examples include venlafaxine (Effexor), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). Extended-release versions of these drugs enter the body more slowly but leave it just as fast. Antidepressants with a longer half-life, chiefly fluoxetine, cause fewer problems on discontinuation.

....
Slow and steady

If you're thinking about stopping antidepressants, you should go step-by-step....

Take your time....Don't try to quit while you're under stress or undergoing a significant change in your life, such as a new job or an illness.

Make a plan. Going off an antidepressant usually involves reducing your dose in increments, allowing two to six weeks between dose reductions. Your clinician can instruct you in tapering your dose and prescribe the appropriate dosage pills for making the change. The schedule will depend on which antidepressant you're taking, how long you've been on it, your current dose, and any symptoms you had during previous medication changes. (Sample tapering plans are available in the books listed in "Selected resources"....) It's also a good idea to keep a "mood calendar" on which you record your mood (on a scale of one to 10) on a daily basis.

Complete the taper. By the time you stop taking the medication, your dose will be tiny. (You may already have been cutting your pills in half or using a liquid formula to achieve progressively smaller doses.) Some psychiatrists prescribe a single 20-milligram tablet of fluoxetine the day after the last dose of a shorter-acting antidepressant in order to ease its final washout from the body, although this approach hasn't been tested in a clinical trial.

Check in with your clinician one month after you've stopped the medication altogether. At this follow-up appointment, she or he will check to make sure discontinuation symptoms have eased and there are no signs of returning depression. Ongoing monthly check-ins may be advised.

How to taper off your antidepressant

Discontinuing an antidepressant usually involves reducing your dose in increments, allowing two to six weeks or longer between dose reductions. Your clinician can instruct you in tapering your dose and prescribe the appropriate dosage pills. In some cases, you can use a pill cutter to create smaller-dose pills, though be sure to check with your clinician or pharmacist to find out if your antidepressant can be cut. You may also be able to use a liquid formulation for smaller dose adjustments.

Your tapering schedule will depend on which antidepressant you’re taking, how long you’ve been taking it, your current dose, and any symptoms you had during previous medication changes....However, depending on how you respond to each dose reduction, you may want to taper more gradually using smaller dose reductions, longer intervals between dose reductions, or both. If you experience discontinuation symptoms after a particular dose reduction, you may want to add back half the dose — or all of it — and continue from there with smaller dose reductions. There are no hard and fast rules for getting off antidepressants, other than that the approach should be individualized! Some people can taper off an antidepressant in a matter of weeks, while others may take months.

....
Selected resources

Taking Antidepressants: Your Comprehensive Guide to Starting, Staying On, and Safely Quitting, by Michael D. Banov, M.D. (Sunrise River Press, 2010).

The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and "Addiction," by Joseph Glenmullen, M.D. (Free Press, 2006).

http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2010/November/going-off-antidepressants

Edited January 15, 2019 by Altostrata
Added admin note

[Claudius]

This compilation surely contains a lot of good information but unfortunately also echoes the infamous mantra that antidepressants are not addicting.

Having discontinuation symptoms doesn't mean you're addicted to your antidepressant.

 

And that confirms the criminal word-playing that has mislead me and so many other sufferers... because any normal individual will interpret the word non-addicting in the sense of "no need to cease the intake in a very gradual way". And therefore I and many others got in WD so many times, were baffled by the miserable symptoms and put back on the stuff, because "it could not cause our illness because it is non addicting"... THis is even told by doctors so they re in fact mislead too.

 

This pitfall should be brought to light more clearly IMHO. And of course be included in the leaflets but that it probably wishful thinking...

[alexjuice]

Going off an antidepressant usually involves reducing your dose in increments, allowing two to six weeks between dose reductions. Your clinician can instruct you in tapering your dose and prescribe the appropriate dosage pills for making the change. The schedule will depend on which antidepressant you're taking, how long you've been on it, your current dose, and any symptoms you had during previous medication changes. (Sample tapering plans are available in the books listed in "Selected resources"....) It's also a good idea to keep a "mood calendar" on which you record your mood (on a scale of one to 10) on a daily basis.

 

emphasis mine...

 

Boy, does this article mean well. While a nice step in the right direction, still too deferential to establishment. First of all, I get around... And I still have not personally encountered a physician/psychiatrist who even entertains the possibility that any symptoms remaining after, say, 100 days from last dose of a psychiatric medication could be related to the medication. My suggestions of the existence of a protracted w/d syndrome have been met with amused dismissal, flat denial or 'i've never heard of that'.

 

As to tapering... Your clinician is most likely the LAST person who should instruct your taper. Last year I phone screened many, many docs looking for help related to tapering and NONE advocated a reduction schedule that would be considered remotely appropriate by anyone on this board. And I was calling about benzos which are much more widely understood in this regard than the newer psych meds such as the SSRIs/SNRIs and atypicals. Also, just a quick note. I've spoken with a handful of experienced psychiatrists and psychologists who specialize in anxiety. Thus far none of them had ever heard the name Dr. Heather Ashton. Not that she's Jesus Christ but if you look at, say, a wikipage on benzos she's more cited by far than any other clinician or researcher. Still none had ever even heard the name.

 

Anyway, maybe this will change in the future, but right now docs are vastly more in the problem column than they are in the solution column.

 

Also I love that SSRIs are now SRIs. I hadn't heard that. I like that change though. Calling them selective gives a false impression of precision. Personally, I'd rename them SDs, Serotonin Disruptors. But I'm a stickler for accuracy.

 

Alex

[compsports]

Hi Alex,

 

""Boy, does this article mean well. While a nice step in the right direction, still too deferential to establishment. First of all, I get around... And I still have not personally encountered a physician/psychiatrist who even entertains the possibility that any symptoms remaining after, say, 100 days from last dose of a psychiatric medication could be related to the medication. My suggestions of the existence of a protracted w/d syndrome have been met with amused dismissal, flat denial or 'i've never heard of that'. ""

 

I suspect I would have a similar experience in my area. When I was working with some mental health consumers on involuntary commitment legislation, a few of them flat out told me I was lucky that my psychiatrist cooperated with my tapering program even though it was clear he felt I should be on meds. They felt my psychiatrists would not have done that.

 

I am sure if I consulted anyone about my insomnia issue, they would blame it on depression in a heartbeat. And I am sure if I mentioned that the cherry juice I posted about in my intro post helped, I would be blown off as a nutcase.

 

This situation makes me realize why so many people get misdiagnosed generally. If doctors have the attitude that they have never heard of something and aren't curious, how can you move towards the path of the right diagnosis?

 

How do we change this situation? I am so sorry you have experienced this.

 

""As to tapering... Your clinician is most likely the LAST person who should instruct your taper. Last year I phone screened many, many docs looking for help related to tapering and NONE advocated a reduction schedule that would be considered remotely appropriate by anyone on this board. And I was calling about benzos which are much more widely understood in this regard than the newer psych meds such as the SSRIs/SNRIs and atypicals. Also, just a quick note. I've spoken with a handful of experienced psychiatrists and psychologists who specialize in anxiety. Thus far none of them had ever heard the name Dr. Heather Ashton. Not that she's Jesus Christ but if you look at, say, a wikipage on benzos she's more cited by far than any other clinician or researcher. Still none had ever even heard the name. ""

 

Exactly! But yet, when I try to explain this on various boards, I am met with huge skepticism even though I am very diplomatic. If I had listened to my psychiatrist about tapering, there is no doubt in my mind that I would still be on the meds.

 

It is pretty bad that folks had never heard of Heather Ashton. Wow.

 

""Anyway, maybe this will change in the future, but right now docs are vastly more in the problem column than they are in the solution column. ""

 

Definitely.

 

""Also I love that SSRIs are now SRIs. I hadn't heard that. I like that change though. Calling them selective gives a false impression of precision. Personally, I'd rename them SDs, Serotonin Disruptors. But I'm a stickler for accuracy.""

 

I love you quest for accuracy:)

 

CS

[Altostrata]

All very true, Claudius and Alex.

 

Let me point out that Harvard is a hotbed of the kind of research that finds efficacy, touts using antidepressants for everything, and downplays adverse effects -- one of those paper mills that the pharmaceutical industry love$$$$.

 

At least the article says a tolerable taper may last months -- it cites a paper (Baldessarini) that says a long taper is two weeks. (I didn't include this info because it's stupid.)

[Altostrata]

cs -- moved your post to Taking Action.

[Rhiannon]

Well I personally am thrilled about this article--it's such an improvement over the usual stuff you find published on this subject. Sure, it could be better, but it actually says that you should wait weeks between cuts and a taper can take months! I mean, compared to the usual crap you read on this subject, it's so much better. Not just the usual Big Pharma propaganda. Definitely a step in the right direction.

 

Rhi <-- Silver Lining lady...

[Altostrata]

I agree, Rhi. And if you read the topic I posted with the 2010 withdrawal guidelines from the American Psychiatric Association, you will see some evolution in the right direction, too.

[Wilson]

Yes and while on cymbalta I experienced constipation, profuse sweating in a cold room, hallucinations, intense abnormal dreams, paresthesia, and incomprehensible obsessions that have led to the destruction of great friendships. Thanks! I quit taking that crap and went back to fluoxetine.

[Altostrata]

Hi, Wilson! We'd like to hear more about you. Are you thinking of tapering off fluoxetine? How about starting a topic in the Introductions forum?

[Sam]

I am so glad to find this site, I didn't think I would make it at times. I experienced suicidal thoughts while trying to quit, one day while running because I was so despondent, I walked to the edge of the river, and wanted to jump in. Not sure why I didn't, but glad now I didn't do it. The withdrawal from the antidepressants has been hell on earth. Doctors have to stop readily prescribing these type of medications.

[Altostrata]

It's good to have you here, Sam. Even though this is a pretty horrible situation, we help each other by confirming each other's reality. No one here has to feel alone.

 

And you're right -- one of the purposes of this site is to bring this to the attention of medicine and get the drugs prescribed much less frequently.

[Altostrata]

Good news -- this was updated in 2015. The newer version indicates Harvard may have learned something about withdrawal.
 

Harvard Women's Health Watch

Going off antidepressants

If not handled carefully, coming off your antidepressant medication can cause disturbing symptoms and set you up for a relapse of depression.

Updated: October 27, 2015
Published: November, 2010

About 10% of women ages 18 and over take antidepressants. ....But as you begin to feel better and want to move on, how long should you keep taking the pills?

If you're doing well on antidepressants and not complaining of too many side effects, many physicians will renew the prescription indefinitely — figuring that it offers a hedge against a relapse of depression. But side effects that you may have been willing to put up with initially — sexual side effects (decreased desire and difficulty having an orgasm), headache, insomnia, drowsiness, vivid dreaming, or just not feeling like yourself — can become less acceptable over time, especially if you think you no longer need the pills.
 
The decision to go off antidepressants should be considered thoughtfully and made with the support of your physician or therapist to make sure you're not stopping prematurely, risking a recurrence of depression. Once you decide to quit, you and your physician should take steps to minimize or avoid the discontinuation symptoms that can occur if such medications are withdrawn too quickly.

Why discontinuation symptoms?
Antidepressants work by altering the levels of neurotransmitters — chemical messengers that attach to receptors on neurons (nerve cells) throughout the body and influence their activity. Neurons eventually adapt to the current level of neurotransmitters, and symptoms that range from mild to distressing may arise if the level changes too much too fast — for example, because you've suddenly stopped taking your antidepressant. They're generally not medically dangerous but may be uncomfortable.

Among the newer antidepressants, those that influence the serotonin system — selective serotonin reuptake inhibitors (SSRIs, now commonly known as SRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) — are associated with a number of withdrawal symptoms, often called antidepressant or SRI discontinuation syndrome. Stopping antidepressants such as bupropion (Wellbutrin) that do not affect serotonin systems — dopamine and norepinephrine reuptake inhibitors — seems less troublesome over all, although some patients develop extreme irritability.

Having discontinuation symptoms doesn't mean you're addicted to your antidepressant. A person who is addicted craves the drug and often needs increasingly higher doses. Few people who take antidepressants develop a craving or feel a need to increase the dose. (Sometimes an SRI will stop working — a phenomenon called "Prozac poop-out" — which may necessitate increasing the dose or adding another drug.)
....
A range of symptoms
Neurotransmitters act throughout the body, and you may experience physical as well as mental effects when you stop taking antidepressants or lower the dose too fast. Common complaints include the following:

Digestive. You may have nausea, vomiting, cramps, diarrhea, or loss of appetite.
 
Blood vessel control. You may sweat excessively, flush, or find hot weather difficult to tolerate.
 
Sleep changes. You may have trouble sleeping and unusual dreams or nightmares.
 
Balance. You may become dizzy or lightheaded or feel like you don't quite have your "sea legs" when walking.
 
Control of movements. You may experience tremors, restless legs, uneven gait, and difficulty coordinating speech and chewing movements.
 
Unwanted feelings. You may have mood swings or feel agitated, anxious, manic, depressed, irritable, or confused — even paranoid or suicidal.
 
Strange sensations. You may have pain or numbness; you may become hypersensitive to sound or sense a ringing in your ears; you may experience "brain-zaps" — a feeling that resembles an electric shock to your head — or a sensation that some people describe as "brain shivers."
 
As dire as some of these symptoms may sound, you shouldn't let them discourage you if you want to go off your antidepressant. Many of the symptoms of SRI discontinuation syndrome can be minimized or prevented by gradually lowering, or tapering, the dose over weeks to months, sometimes substituting longer-acting drugs such as fluoxetine (Prozac) for shorter-acting medications. The antidepressants most likely to cause troublesome symptoms are those that have a short half-life — that is, they break down and leave the body quickly. (See the chart "Antidepressant drugs and their half-lives.") Examples include venlafaxine (Effexor), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). Extended-release versions of these drugs enter the body more slowly but leave it just as fast. Antidepressants with a longer half-life, chiefly fluoxetine, cause fewer problems on discontinuation.

Besides easing the transition, tapering the dose decreases the risk that depression will recur. In a Harvard Medical School study, nearly 400 patients (two-thirds of them women) were followed for more than a year after they stopped taking antidepressants prescribed for mood and anxiety disorders. Participants who discontinued rapidly (over one to seven days) were more likely to relapse within a few months than those who reduced the dose gradually over two or more weeks.
....
Slow and steady
If you're thinking about stopping antidepressants, you should go step-by-step, and consider the following:

Take your time. ....
 
Talk to your clinician about the benefits and risks of antidepressants in your particular situation, and work with her or him in deciding whether (and when) to stop using them. Before discontinuing, you should feel confident that you're functioning well, that your life circumstances are stable, and that you can cope with any negative thoughts that might emerge. Don't try to quit while you're under stress or undergoing a significant change in your life, such as a new job or an illness.

Make a plan. Going off an antidepressant usually involves reducing your dose in increments, allowing two to six weeks between dose reductions. Your clinician can instruct you in tapering your dose and prescribe the appropriate dosage pills for making the change. The schedule will depend on which antidepressant you're taking, how long you've been on it, your current dose, and any symptoms you had during previous medication changes. It's also a good idea to keep a "mood calendar" on which you record your mood (on a scale of one to 10) on a daily basis.

Consider psychotherapy. Fewer than 20% of people on antidepressants undergo psychotherapy, although it's often important in recovering from depression and avoiding recurrence. In a meta-analysis of controlled studies, investigators at Harvard Medical School and other universities found that people who undergo psychotherapy while discontinuing an antidepressant are less likely to have a relapse.
 
Stay active. Bolster your internal resources with good nutrition, stress-reduction techniques, regular sleep — and especially physical activity. Exercise has a powerful antidepressant effect. It's been shown that people are far less likely to relapse after recovering from depression if they exercise three times a week or more. Exercise makes serotonin more available for binding to receptor sites on nerve cells, so it can compensate for changes in serotonin levels as you taper off SRIs and other medications that target the serotonin system.
 
Seek support. Stay in touch with your clinician as you go through the process. Let her or him know about any physical or emotional symptoms that could be related to discontinuation. If the symptoms are mild, you'll probably be reassured that they're just temporary, the result of the medication clearing your system. (A short course of a non-antidepressant medication such as an antihistamine, anti-anxiety medication, or sleeping aid can sometimes ease these symptoms.) If symptoms are severe, you might need to go back to a previous dose and reduce the levels more slowly. If you're taking an SRI with a short half-life, switching to a longer-acting drug like fluoxetine may help.
 
You may want to involve a relative or close friend in your planning. If people around you realize that you're discontinuing antidepressants and may occasionally be irritable or tearful, they'll be less likely to take it personally. A close friend or family member may also be able to recognize signs of recurring depression that you might not perceive.
 
Complete the taper. By the time you stop taking the medication, your dose will be tiny. (You may already have been cutting your pills in half or using a liquid formula to achieve progressively smaller doses.) Some psychiatrists prescribe a single 20-milligram tablet of fluoxetine the day after the last dose of a shorter-acting antidepressant in order to ease its final washout from the body, although this approach hasn't been tested in a clinical trial.
 
Check in with your clinician one month after you've stopped the medication altogether. At this follow-up appointment, she or he will check to make sure discontinuation symptoms have eased and there are no signs of returning depression. Ongoing monthly check-ins may be advised.

[nz11]

If you're doing well on antidepressants and not complaining of too many side effects, many physicians will renew the prescription indefinitely — figuring that it offers a hedge against a relapse of depression.

 

This is disturbing to read.

Pharma must love this advice.

 

Check in with your clinician one month after you've stopped the medication altogether. At this follow-up appointment, she or he will check to make sure discontinuation symptoms have eased and there are no signs of returning depression. Ongoing monthly check-ins may be advised.

This is a very dangerous thing to do as the doctor will incorrectly label the withdrawal as depression.

 

However its nice they have acknowledged this:

Unwanted feelings. You may have mood swings or feel agitated, anxious, manic, depressed, irritable, or confused — even paranoid or suicidal.
 

You may want to involve a relative or close friend in your planning. If people around you realize that you're discontinuing antidepressants and may occasionally be irritable or tearful, they'll be less likely to take it personally. A close friend or family member may also be able to recognize signs of recurring depression that you might not perceive.
 This is disappointing as pharma are using well meaning but uninformed people to herd patients back to the doctor.

 

Some psychiatrists prescribe a single 20-milligram tablet of fluoxetine the day after the last dose of a shorter-acting antidepressant in order to ease its final washout from the body, although this approach hasn't been tested in a clinical trial.

Never heard of this one before.

 

In a meta-analysis of controlled studies, investigators at Harvard Medical School and other universities found that people who undergo psychotherapy while discontinuing an antidepressant are less likely to have a relapse.

I dont believe this. Its about the taper not about psychotherapy.

Psychotherapy in and of itself does not and cannot stop withdrawal.

[Lilu]

Still feels like they're glossing over the issue.

 

http://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants

[Altostrata]

Updated: April 2, 2018

Published: November, 2010

 

The article has become considerably shorter. This is the entire article except for the table:
 

Quote

 

How to taper off your antidepressant

Response to dosage dictates best schedule to stop taking medication

 

Discontinuing an antidepressant usually involves reducing your dose in increments, allowing two to six weeks or longer between dose reductions. Your clinician can instruct you in tapering your dose and prescribe the appropriate dosage pills. In some cases, you can use a pill cutter to create smaller-dose pills, though be sure to check with your clinician or pharmacist to find out if your antidepressant can be cut. You may also be able to use a liquid formulation for smaller dose adjustments.

 

Your tapering schedule will depend on which antidepressant you're taking, how long you've been taking it, your current dose, and any symptoms you had during previous medication changes. Below is a chart with sample tapering schedules for some of the most popular antidepressants. However, depending on how you respond to each dose reduction, you may want to taper more gradually using smaller dose reductions, longer intervals between dose reductions, or both. If you experience discontinuation symptoms after a particular dose reduction, you may want to add back half the dose — or all of it — and continue from there with smaller dose reductions. There are no hard and fast rules for getting off antidepressants, other than that the approach should be individualized! Some people can taper off an antidepressant in a matter of weeks, while others may take months.

 

 

Table Suggested dose reductions for tapering off antidepressants shows steps utilizing capsule and tablet dosages as supplied by drug manufacturers, no intermediary dosages. No indication which drugs are available in liquid form.
 

Quote

 

Footnotes:

 

+Alternate 40 mg one day and 20 the next to get the equivalent of 30 mg per day. [fluoxetine (Prozac)]

++Take 20 mg every other day to get the equivalent of 10 mg per day. [fluoxetine (Prozac)]

*Pill should not be cut. [duloxetine (Cymbalta), bupropion (Wellbutrin)]

Sources: Adapted from material found in Banov, Taking Antidepressants: Your Comprehensive Guide... and Glenmullen, The Antidepressant Solution: a Step-by-Step Guide...