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LostWaves: Few questions about Risperidone

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LostWaves

Hi. Was taking 4 mg of risperidone for two months. Suddenly stopped taking it for a week (didn't notice any withdrawal). Then took 2 mg for two weeks (approved by psychiatrist). Then took 1 mg for two weeks (approved by psychiatrist). Have not noticed any withdrawal symptoms. Asked psychiatrist if it was okay for me to suddenly go from 4 mg to 2 mg, and then 2 mg to 1 mg. She said it was okay since I hadn't been showing any symptoms. I have read that withdrawal symptoms can surface after months or even a year after you stop taking it. I am not sure what that person's credibility was. I have also read, from a .org website that the withdrawal symptoms are mild and rare.

I have stopped taking the 1 mg for almost a week, and I am wondering if I will be alright. I have not noticed any withdrawal symptoms, and I feel like I will still be seeing my psychiatrist for a little while at least. I am also wondering if it is true that withdrawal symptoms can surface months or even a year after you stop taking the medication. That just seems far-fetched to me.

 

Any help is appreciated!

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Shep

Hi, LostWaves.

 

Welcome to Surviving Antidepressants.

 

Yes, it is possible to have a delayed withdrawal with these drugs. It only takes a month to develop a dependency on an antipsychotic. So it's possible you are dependent after 2 months, but with dependency, there's no way of knowing who is or isn't dependent. 

 

Here is some information that may be helpful. 

 

Tips for tapering off Risperdal (risperidone)

 

Why taper by 10% of my dosage?

 

How psychiatric drugs remodel your brain - NOTE: this is on antidepressants, but antipsychotics also remodel the brain in relation to dopamine. 

 

Did you go on this drug for what is termed a "psychotic" symptom (i.e. hearing voices, seeing visions, being in an altered state)? If so, it's important to taper so you don't have any rebound symptoms. The reason you went on the drug is important in us helping you make the decision to reinstate or not and to provide more specific non-drug coping information. 

 

It's possible you could reinstate a small amount and do a more rapid taper than 10% due to only being on the drug for 2 months. If you do consider reinstatement, here is some information:

 

About reinstating and stabilizing to reduce withdrawal symptoms 

 

If you decide not to reinstate, it's important to develop some non-drug coping skills in case symptoms arise. There could be a delay, so it's important to learn how to handle these symptoms so you don't get caught back up in the system. 

 

Non-drug techniques to cope with emotional symptoms

 

Please keep in mind that there is a windows and waves recovery from these drugs:

 

The Windows and Waves Pattern of Stabilization

 

What is withdrawal syndrome? 
 

Coming off an antipsychotic can get difficult if insomnia becomes a problem because that can make rebound symptoms more likely. Also, have you been off and on antipsychotics or other psych drugs before? That can also play a role in how you'll do. Are you on any other drugs or supplements? 

 

Please add a signature.  Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

  • Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 
  • Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
  • Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
  • Please leave out symptoms and diagnoses. 
  • A list is easier to understand than one or multiple paragraphs. 
  • This is a direct link to your signature:  Account Settings – Create or Edit a signature.

 

Please use this thread to ask questions and let us know how you're feeling. 

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LostWaves
Posted (edited)

Hi Shep. Thanks for the reply. I updated my signature. I went on this drug because I told people that I heard a voice in my head. I read in a book that there was scientific evidence for telepathy, and I thought I could talk to my friends in my head (or verbally), like it was a Skype call. At some point, I realized I wasn't communicating with my friends telepathically. And since then, I haven't had trouble with 'voices.'

If I were to reinstate, how would you recommend I do it? I was already on 1 mg for two weeks. Would you want me to take it down to .5 or .25 mg? And for how long? Is it safe to cut risperidone pills?

 

Currently, I plan on staying off risperidone. I believe I am going to keep seeing my psychiatrist for the next five months, and will have ready access to 1 mg of risperidone, throughout that time, if anything comes up. I am wondering what the odds are, that I will experience delayed withdrawal symptoms, even after the five months have passed.

 

Edited by ChessieCat
removed quote

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Shep
16 hours ago, LostWaves said:

If I were to reinstate, how would you recommend I do it? I was already on 1 mg for two weeks. Would you want me to take it down to .5 or .25 mg? And for how long? Is it safe to cut risperidone pills?

 

Hi, LostWaves. Thanks for the additional information.

 

Yes, you can cut the pills. Please see:

 

Tips for tapering off Risperdal (risperidone)

 

The farther out you are from when you took your last dose, the less medication you should reinstate. It's only been 11 days, so you could return to your 1 mg dose or maybe a lower dose at .75 mg since you're not having any symptoms so far. 

 

If you decide to ride it out a bit longer and wait to reinstate, you would start at an even lower dose. The first post in the reinstatement thread explains why. 

 

16 hours ago, LostWaves said:

Currently, I plan on staying off risperidone. I believe I am going to keep seeing my psychiatrist for the next five months, and will have ready access to 1 mg of risperidone, throughout that time, if anything comes up. I am wondering what the odds are, that I will experience delayed withdrawal symptoms, even after the five months have passed.

 

 

You really need to weigh the effects of delayed withdrawal with your ability to self manage and cope. If you experience hearing voices again, do you know how to cope? You may want to read over information on some alternatives and see if you can find a therapist who does Open Dialogue or other similar treatments in lieu of medication. That kind of treatment is by far more effective. 

 

Open Dialogue: Alternative Care for Psychosis

 

Alternatives for psychotic outbreaks

 

You may also find the website Mad in America helpful, as it has articles and blogs about non-drug treatments, as well as information on the dangers of these drugs.

 

Mad in America

 

And they have great podcasts:

 

Mad in America podcasts

 

And a great list of non-drug coping skills in case you do get withdrawal symptoms, which could include other symptoms besides the reason you started taking the drug in the first place. Some people find they experience insomnia and anxiety when they come off an antipsychotic, so there are some great resources for mindfulness, CBT, yoga, etc which may help: 

 

Non-drug techniques to cope with emotional symptoms

 

How are you feeling as far as motivation goes? How is your sleep? 

 

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LostWaves

Shep, thank you again for the response. I am confident that I will not hear 'voices' again. My hearing of the voices, was contingent upon me believing that I had telepathic capabilities. Since I no longer have this belief, I strongly believe that I don't have anything to worry about. If for some reason I do hear voices again, I will meditate.

I am more concerned about developing withdrawal symptoms, that I did not have before. I had a mild headache last night, but I think it is gone now. My sleep is fine. I have felt unmotivated recently, but I believe that is more due to my life circumstances (having trouble deciding on a career path). I also felt this lack of motivation was present, even while I was on 1 mg of risperidone. Also, I have been able to go to the gym, as well as work, even while dealing with motivation issues.

 

I also have a therapist (different from my psychiatrist) who has known me before any of this started, and who I see every two weeks. I am going to see him soon. I can talk to him about any unpleasant emotions I have, but lately, I haven't felt the need to.

Right now my plan is, to taper from .75 mg for two weeks, then .5 mg for two weeks, then .25 mg for two weeks; if I reinstate between the 14 to 21 day period (of discontinuation). Or, I would taper from .5 mg for two weeks, then .25 mg for two weeks, if I reinstate between the 21 to 28 day period (of discontinuation).

Does this seem reasonable to you?

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Shep

This is a hard call, LW. The fact that you've solved your problem with the voices is great, as rebound psychosis is the main concern when people come off an antipsychotic. 

 

So reinstating at this point, especially when you don't have any withdrawal symptoms, may not be warranted with only 2 months' use. While it is possible to become dependent in that time, the fact that you're sleeping 11 days off is also a good sign. 

 

Also, you have a nice support system set up with people you can reach out to should you start to feel unwell. 

 

I'm going to ask the other mods for feedback. 

 

Two other questions that will help us help you sort this out: 

 

1. In your signature, you wrote that you took a very short round of Seroquel in April of 2016 - was that for the same issue as you had in December 2017? 

2. Did you have any withdrawal symptoms from going cold turkey from 4 mg on February 6 that led to you reinstating 2 mg on February 14? 

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LostWaves

Shep, thanks again for the continued feedback.

 

1. The seroquel was for depression. I stopped taking it, only because the doctor asked me how it made me feel. I said that I did not like it, and he said that I did not have to take any medication after that.

 

2. No. I simply reinstated because I wanted to taper. I did not want to develop withdrawal symptoms.

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Shep

Thanks for your response, LW. I'm not comfortable with any psychiatrist who prescribes an antipsychotic for depression so I'm glad you came off that one so quickly. I'm glad you have a separate therapist to talk to, as there are so many options for handling depression without medication (and certainly not an antipsychotic!). 

 

Let's see what other mods have to say because at this point, I'm wondering if reinstating is really wise with such short term use and no withdrawal symptoms after a rapid taper. With a month or so of use, you can get away with a much more rapid taper, so you're in a bit of a gray area, but not by much. 

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Shep

Hi, LW. How are you doing? 

 

I talked to another mod about your case and we think it best for you to not reinstate at this time. If you continue to sleep well, are able to work on non-drug techniques for any withdrawal symptoms that might pop up AND for your pre-existing depression (if you are still having problems with that), you may do very well without reinstating. 

 

There is a risk to both reinstating and not reinstating. The risk in not reinstating is you may have some withdrawal symptoms later on, as we've discussed. However, there's a risk in reinstating because if you aren't already dependent (and there's no way of knowing ahead of time), you may develop dependency or a greater dependency by staying on the drug longer. 

 

What do you think about not reinstating and giving yourself a lot of self care, working with meditation, gentle yoga, a healthy diet, etc. over the coming weeks and see how you do? 

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LostWaves

Hi Shep. I'm doing decent, how are you?

Thank you again for the feedback. I greatly appreciate it. I am fine with not reinstating. I do not know how to do yoga, and I believe I am relatively healthy with my diet choices as it is (but you are welcome to offer suggestions). I will continue to meditate. Considering the fact that I was only on the drug for two months (three months, if you count the tapering), is there any way of knowing when I would be most likely to experience any withdrawal symptoms?

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Shep

Hi, LostWaves. Sorry, we cannot predict withdrawal, but the best advice I can give you is to live life fully but gently. Explore new things but don't stress out your nervous system. 

 

Meditation is awesome and highly recommended, so you have a great non-drug coping skill already. 

 

As far as diets go, you may want to limit sugar and caffeine for the next few weeks. These can be very stimulating. Try to have clean, organic (when possible) meats and veggies and fruits. Make sure you're eating regularly throughout the day, as some people in withdrawal experience drops in blood sugar. Low blood sugar drops can mimic withdrawal with anxiety, dizziness, weakness, depression, etc. So it's important to fuel the body. 

 

And try to keep a regular routine as far as bedtime goes. Basically, the more stability and routine you can have, the less bumps to the nervous system. 

 

Please post from time to time and let us know how you're doing. The main reason we have so little advice for short time users is we've had very few short time users who show up on this website. Very well done for researching your drugs and getting this information early on. :)

 

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LostWaves

Hi. Have been clean since March 14. I don't meditate anymore, but I haven't noticed anything unusual. I don't imagine myself having conversations with my friends, telepathically, anymore. I heard that risperidone still stays in your body for a while, even after you've stopped taking it. I heard that it was 2-3 months. Could I get a more specific answer from anyone here?

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Shep
Posted (edited)

Hi, LW, thanks for the update.

 

I'm not familiar with Risperidone staying in your body for 2 - 3 months after you stop. Some of the long-lasting injectable forms of antipsychotics will last from a couple of weeks to several months, but you were taking the pill form of Risperidone. The half-life of the pills is 20 hours, so at nearly two months off, the drug is out of your system by now. 

 

But it's not so much about the drug "being in your system" but rather, what the drugs did to "change your system". 

 

This is about antidepressants and serotonin, but it really is transferable to the antipsychotic and dopamine:

 

How psychiatric drugs remodel your brain

 

How are you feeling overall? How is your sleep? 

Edited by Shep

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LostWaves

Shep,

 

Could I get some input from the other mods? I remember being told by my psychiatrist that risperidone was still in my system, even four days after not taking it. I also remember being told by my psychologist that risperidone stays in your system for about two months after not taking it. I also strongly believe I read something similar, either on this site, or another one. I'm pretty sure I found the site through Quora, which is also how I found this site.

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brassmonkey

The half life of risperidone tablets is 3 hours. So if you take a tablet at 8am on Monday you would have 1/64th of the original dose in your blood at 8am of Tuesday.  By 8am Wednesday it would essentially be gone from your body. According to studies the effects of the tablets can be felt for up to seven weeks after stopping. But the presence of the drug and it's effects are two different things.  If you're getting the injections it's a different story.  The half life for the injections is 3 to 6 days because they are designed to stay in the body for a long time so you only have to get injections once a month.

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Shep

LW, this from the FDA:

 

"The apparent half-life of risperidone was 3 hours (CV=30%) in extensive metabolizers and 20 hours (CV=40%) in poor metabolizers."

 

 FDA - Risperidone

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LostWaves

Thank you both for your responses. They were very helpful.

 

I now have another query. When I first started seeing my psychiatrist, I told her that I had spent nine days in the hospital, because I had taken between 11 and 15 melatonin pills within 2 days, and then called the hospital. I also stated that my rationale at the time of the event, was that a voice in my head told me that I was dying, and that I should call the hospital. I also told her that in previous years, I used to make threatening statements (not directed toward anyone) as a form of coping, and that I had thoughts of hitting someone (which I never actually did). I told her that I had been seeing a psychologist, and that one of my previous providers wrote a letter stating that I had calmed down. She stated that I exhibited psychosis. She reduced my dosage from 4 mg to 2 mg. This was in February. She also told me to bring my father with me to the next appointment. She also said that she would have to see me for six months to be able to say that I don't have a serious mental disorder (schizophrenia) and that I would have to stop doing 'weird things,' (I think she was referring to talking to myself, and hearing voices in my head).

 

I saw her again after two weeks. She mentioned that I had problems emotionally, based on what I had told her in the last meeting. I mentioned that I would prefer a lower dosage, and then she brought up the possibility of reducing it to 1 mg (from 2 mg). She said that she recommended the 2 mg, but if I felt more comfortable at 1 mg, she could reduce it. My father was pushing for her to give me the 2 mg, but since I mentioned that I felt more comfortable at 1 mg, she gave me the 1 mg.

 

I then saw her 2-3 weeks later. My father said that I get angry at times, but that it was normal. Psychiatrist kept me at 1 mg. She said she would see me in 2 months, unless I wanted to see her sooner.

 

I then saw her 2 months later, which was today. My father mentioned that I don't spend enough time with my family, and that I don't talk to most of them. He also mentioned how I was much more interactive with them when I was on 4 mg for 6 weeks. I started talking to only my father, since late 2014, and he's convinced that the medicine will make me spend time with the family. I only spent more time with my family during that period, because I was extremely frightened, after my experience in the hospital; and I thought that being around them would prevent me from falling into a a long-lasting depression (I did not mention this). He also mentioned how I'll laugh to myself, and how I explain it by saying that I'm thinking about something. I told the psychiatrist that I would be laughing because of a joke that I read on the internet. Father also mentioned how I 'stay isolated in my room,' with my door locked. She said that my behavior wasn't dangerous, but she still attributed all of this to my 'condition.' At first she was saying that I have a lack of social interaction, but then I told her that I interact with my friends. She then told me that I need to interact with my family. My father was pushing for me to go back on 2 mg, and the psychiatrist was going to do it, but then I tried bargaining. I asked if I could stay on 1 mg for a month, given that I agree to interact with my family more, and leave my door open; and then we could re-assess the situation from there. She agreed, but instead of a month, I'm seeing her in 3 weeks.

Additional information: When I was trying to be friendly and make conversation with her, she said to my father that I constantly talk, which is another sign of schizophrenia (this was during the second meeting) [I felt like she was being unfair to me]. I spend all of my time with my psychologist (different person) talking face to face, whereas this psychiatrist asks some questions here and there, and spends a lot of time typing on her computer. In my first meeting with her, I challenged something she said to me, by saying that my Psychologist (who I had been seeing for over a year) did not feel that way, and then she responded by saying that she knew more than him, because she was a psychiatrist, and that he was a psychologist. I also told her that I had stopped seeing two of my old mental health providers, and she then mockingly asked if it was because they said that I had schizophrenia (which they didn't).

She has a 2.4 out of 5 rating on vitals.com, out of 30 votes; she has a 2.3 out of 5 rating on doctors.webmd.com, out of 3 votes; she has a 2 out of 5 rating of yelp.com; out of 6 reviews; and lastly, she has a 1.1 out of 5 rating on healthgrades.com, out of 13 reviews.

I'm trying to figure out if this psychiatrist will actually allow me to stop taking medication, at the end of the six month period (which would be mid-August). If that doesn't happen, I'm wondering if she'll ever allow me to stop taking the medication at all.

 

I'm only seeing her because my parents will not pay for my expenses (grad school tuition, gas) if I don't. I actually haven't been taking the medication for a while now (see signature), because my father trusts me enough to take it on my own. I just don't want to have to keep faking it, and I want to cut off the psychiatrist once and for all.

Also, for anyone who's actually concerned about my mental health, I've learned how to control my anger for quite a while now, and I was avoiding most of my family because they have negatively contributed to my mental health.

If anyone could any offer any input, I would seriously appreciate it. This has really been bothering me.

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Altostrata

Hello, LostWaves. I thought you went off riseperidone in March? Did you start something else?

 

Are you a minor or are you over 21? Is your father your legal guardian? If you are over 21 and not under a court order to take drugs, or if you are your own guardian, you have the right to refuse drugs.

 

1 hour ago, LostWaves said:

She stated that I exhibited psychosis.

 

It sounds to me like you have extensive difficulties with your family, including your father. I hope you understand now that threatening suicide in order to make a point can get you into a lot of trouble. Apparently you have a psychiatric diagnosis of psychosis because of behavior your father and others think is odd.

 

Please consider this seriously. Having once been in the hospital for psychiatric reasons, you can more easily be sent back against your will if you behave oddly in public or if your family reports you. If you don't want to go back to the hospital, I would learn to manage your behavior so you don't make it happen.

 

If I were you, I'd find a psychotherapist with whom you can discuss your family relationships and the ways you try to get attention from them -- without your father being present (unless you are a minor or he is your legal guardian).

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LostWaves

Altostrata,

 

Mainly, I want to get my psychiatrist's approval to stop taking risperidone. I got her to let me take 1 mg, when I used to be on 4 mg. She said that after 6 months, she would be able to make a determination that I no longer need the drug (as long as I dont do 'weird things'). It's been three months.

 

I never threatened suicide. You're misunderstanding. Just forget about that part.

 

My main question was the bolded part, in my last post, though, I guess I might've misled you.

 

Also, I see a psychologist, without my father. What would you want me to discuss? How much time I spend the family, and what I say to them? They're not as bad anymore, it's moreso what they've done in the past. Some of them are controlling, and insulting sometimes. I just dont feel like they deserve my attention, but I guess Ill keep a face if I have to. And sometimes I get recurring memories of a traumatic(?) experience.

 

And thank you for the advice. How do you know the part about a person being more easily hospitalized, against their will? Have you seen this happen?

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Altostrata

If you are an adult and not under a court order, you do not need your psychiatrist's permission to reduce risperidone. However, you will need to manage your behavior so nobody asks authorities to hospitalize you.

 

Yes, we often see people with diagnosis of psychosis who have been hospitalized multiple times, for many different reasons.

 

Your father, whose presence you dislike, does not need to be at your appointments with the psychiatrist. That turns you into a child. If I were you, I would stop that immediately. If you don't like the psychiatrist, see another one. Any doctor can prescribe risperidone, it doesn't have to be a psychiatrist.

 

If I were you, I would discuss with the therapist your psychiatrist's requiring your father's presence at your appointments and why you don't trust her -- or him.

 

As an adult, you don't need to let people you distrust make decisions for you. To unpatient yourself and get free of drugs, you may have to start thinking of yourself differently.

 

 

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LostWaves

Altostrata,

 

I greatly appreciate the input. Let me restate, though, that I am not currently on the drug. My father is ordaining that I see a psychiatrist, mainly because he believes that it will prevent me from calling the hospital again. At some point, he decided that he trusted me enough to take the drug on my own, without his supervision. Due to this, I believe that I have successfully been able to taper off, and have not noticed any withdrawal symptoms at all.

If I don't continue seeing the psychiatrist, and keep them both under the impression that I'm taking the drug, my father will not pay for my expenses (gas; grad school tuition, if I dont get enough aid) and he may not allow me to use the car that I drive to school. Additionally, he may even decide to evict me from the house.

I will consider finding a new psychiatrist, and going to the appointments myself, but with that being said, either of those things may arouse suspicion in my father, especially since both of them want to evaluate me during these coming three weeks, to decide about whether or not I should go back on 2 mg. If I arouse his suspicion too much (after he's already questioned me laughing to myself), he may start watching me to see if I'm taking the drug.

Mainly, I'm wondering if this psychiatrist will allow me to go off the drug after six months (mid August) like she said, or if she will ever allow me to go off the drug at all.

 

Edit: Also, talking to my therapist won't really do much. All I can really do is use him for venting or social interaction. My father will not listen to anything he says.

Edited by LostWaves

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Altostrata

We all do what we've go to do. Psychiatrists operate on subjective reports from their patients, if you tell the doctor you're doing okay, she is not likely to ask any other questions. It's very possible that at intervals, if you report you've reduced the drug a bit and still feel fine, she will simply nod, if you behave normally.

 

Please be aware the medical establishment is very, very concerned about preventing suicide. With your prior record, deserved or not, if they hear of any comments that might be interpreted as suicidality or any behavior that might be construed as "psychotic," they will insist on prescribing high doses of drugs This includes displays of anger or frustration or even a raised voice, weeping, or complaining.

 

Do not ever raise your voice or heatedly argue with a psychiatrist, even though he or she might deserve it, or cry at your appointments. They will suspect displays of emotion to be associated with your "psychosis". Psychiatrists prescribe drugs, most are not interested in helping you work out any personal problems, and this one does not seem sympathetic to you.

 

Still, I would request your father not attend the appointments. This is not a good psychological position for you. Keep reminding yourself: Some day this bad family situation will be in the rear-view mirror. You just need to get through it.

 

Always talk to psychiatrists in a calm, even voice. Make requests clearly and firmly with a straight, serious face. You may have to repeat yourself. Do this calmly. Do not raise your voice. Keep it simple.

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