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Cymbalta Withdrawal Symptoms

Cymbalta withdrawal symptoms range from mild to severe and occur with more frequency if Cymbalta withdrawal is abrupt. 6, 24,25,28-30,32-35,37
Cymbalta withdrawal symptoms can include:
  • Seizure
  • Suicidal thoughts
  • Akathisia
  • Dizziness, nausea, vomiting, headache
  • Paresthesia, electric-shock sensations, prickling skin sensations
  • Irritability
  • Nightmares
  • Anxiety
  • Panic attacks
  • Parkinsonism and other movement disorders
  • Withdrawal-induced mania
  • Withdrawal-emergent delirium
  • Sexual dysfunction
  • Brain fog, cognitive impairment, inability to concentrate
  • Muscle aches, tremors

Cymbalta Withdrawal Symptoms


Cymbalta withdrawal symptoms occur in the majority of users who try to quit and about half of those report their withdrawals as severe. Since these numbers are generally underestimated, a person may think their situation is unique when in fact it is more common than they’ve been led to believe.6

Antidepressants like Cymbalta, despite overwhelming evidence and patient testimonials, still get overlooked as being a source of many patient-reported problems. In many cases, this can lead to misdiagnoses and missed opportunities for effective and meaningful treatment.37

Do Your Symptoms Require Cymbalta?


getting off cymbalta
Cymbalta use can cause serious side effects and debilitating Cymbalta withdrawal syndrome for certain persons. Unfortunately, these are the exact patients that tend to get abandoned in their very real suffering.

Alternative to Meds Center helping patients with antidepressant withdrawal for over 17 years. We have published evidence regarding our success. Our founding staff and many of those who have been drawn to this work have had similar struggles. We are peers in this process. Feel free to reach out to us and get the kind of support you need to get through this.

Watch this video of a woman who gained her life back after coming off of antidepressants and benzodiazepines that she had been taking as prescribed. When she started the program, she thought her life was over. Unable to work, depressed, and barely able to walk. Little did she know, her life was coming to a new beginning. She left medication-free, hiking up to 1½ hours per day, and re-entered her professional counseling career. She is successful and happy to this day.

15 Years Experience by Professionals Who Understand Your Journey.
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Can Holistic Treatment Help With Cymbalta Withdrawal?

At Alternative to Meds Center, we have found certain methods that can make the Cymbalta withdrawal process substantially more tolerable. We use a combination of inpatient medically monitored tapering techniques, orthomolecular-based dietary modifications such as organic diet and targeted supplementation, as well as counseling, and other daily support and peer support programs for encouragement. Over 40 trained professionals including dedicated care managers and medical doctors provide services to our clients, including lab testing, to assess vitamin and mineral deficiencies, genetic factors, and evidence of toxicity in the body, factors that all need correction. Additional tools include neurotransmitter rehabilitation protocols, IV therapies, and holistic detoxification techniques to help alleviate a toxic body burden that may be contributing to neurochemical and psychological stress and impairments.

The client typically begins to feel better very early in the process, and the client can relax and complete the withdrawal process without unnecessarily harsh Cymbalta withdrawal symptoms, worry, or strain. Our Cymbalta withdrawal program is uniquely tailored to the specific points that need to be addressed and allows us to focus on regaining mental health naturally.

Fascinating research has shown that the adverse reactions to drugs may be the body’s protective responses to substances that are biologically harmful, supporting the preferred use of drug-free alternatives during Cymbalta withdrawal, and also for mental wellness broadly.39

We encourage you to view our articles that cover Cymbalta tapering methods, and drug-free alternatives to Cymbalta that truly assist the withdrawal process and the beneficial shift to natural alternatives.

About Cymbalta / duloxetine Addiction

Addiction is not a term often used concerning SNRI medications, yet there has been considerable research concerning patients developing tolerance and dependence on SNRIs, and suffering withdrawals when the drug is discontinued. In 2018, Fava et al authored an extensive review of 22 double-blind randomized controlled trials, numerous open trials, and 23 case reports on various types of second-generation antidepressants like Cymbalta. After reviewing these trials and numerous other research papers, the authors found that withdrawal symptoms occurred after any SNRI drug was discontinued.36 In contrast, the FDA label for Cymbalta offers one lean sentence on the subject, that recommends gradual discontinuation when possible, rather than abrupt cessation. No other guidelines are given for how to stop taking Cymbalta safely.18

Wilson et al in the research published in Therapeutic Advances in Pharmacology Journal take a much stronger stance on the subject and in particular point to the extreme withdrawals of newer antidepressants such as Cymbalta, described as comparable to benzodiazepine withdrawals.30 In this review, the authors comment on various methods that have been proposed over time, such as reducing by some percentage per week or per month, converting to a liquid form for more precise tapering, switching to a drug with a longer half-life, and the NIH (who appear to have never seen the phenomena in any patients) that continues to discount the need to address withdrawals at all “because antidepressants are not habit-forming.” 30

For nearly 2 decades, the staff at Alternative to Meds Center have dedicated themselves to assisting others to free themselves from the unwanted burden of duloxetine addiction/dependence on pharmaceutical drugs. With careful preparation, the use of lab testing, nutritional, psychosocial, and other support, our center has enjoyed a remarkable success rate for our clients eliminating original symptoms while also recovering from SNRI adverse effects and withdrawal phenomena.

Planning Your Cymbalta Withdrawal

Please use the data here freely in coordination with your primary caregivers, to assist in your information-gathering phase, which is essential to successfully plan your Cymbalta withdrawal treatment. When given a residential level of support with experienced staffing, for most people it is possible to stop taking Cymbalta with a minimum of discomfort. For all of those who have come through our program, the overwhelming and consistent consensus has been that their recovery was worth the investment.

Concerns About Cymbalta Withdrawal

The concerns about Cymbalta withdrawal, and the drug in general, cover a wide range of topics, which we will aim to address below. We will discuss the symptoms and side effects of trying to get off Cymbalta, plus the drug’s mechanism of action upon the brain and body, and interactions with other substances that one should be aware of. Also, the information below covers Cymbalta’s side effects, pregnancy-specific data, and more.

Any SNRI type of antidepressant can produce unexpected adverse effects. Sometimes, as in the case of Cymbalta, many of these AEs only came to light after the drug was placed on the market for consumers.2,7,8 Anyone considering taking such a drug is well advised to research the matter thoroughly so that the best-informed decisions can be made. Many feel as if the discontinuation syndrome associated with Cymbalta withdrawal has been understated by drug regulators and promoters. However, we find the challenges of this particular drug to be quite steep. Withdrawing from an SNRI like Cymbalta is thought to impact both serotonin and norepinephrine neurochemistry, as the drug classification itself suggests. There is more that is unknown than known about the neurochemical effects of SNRIs. Additionally, tapering generally involves opening the capsules and dividing up the beads, which can be frustrating at a minimum.

If you are currently taking Cymbalta or a similar SNRI medication, are suffering from Cymbalta addiction, dependence, or considering Cymbalta withdrawal, please remember the FDA warning against abruptly stopping Cymbalta.18 Stopping Cymbalta all at once is definitely a health risk — with one exception, in the case of Serotonin Syndrome, which is described in more detail in the Cymbalta Side Effects section of this article.

Testimonial
Cymbalta Withdrawal
Success

At ATMC I was always supported. The staff was great at providing opportunities for me to work towards stability. What helped me here was always keeping a positive outlook and the constant encouragement and reminders to keep faith in myself.

-Jackie

What is Cymbalta (duloxetine) Used For?

The SNRI antidepressant Cymbalta (duloxetine) is most widely used to treat depression, anxiety disorders, and certain types of pain. Following is a timeline showing when the FDA approval for these uses came into effect:  Some of the uses of Cymbalta are “off-label” which are not all listed here. SNRIs in general have developed a very long list of these.

Please note that even in off-label use, Cymbalta withdrawal should never be abrupt.

  • In August of 2004, Cymbalta was approved for treating depression, and a month later the FDA added approval for treating diabetes-related peripheral neuropathy.9,41
  • In 2006, the drug gained approval to be prescribed for the treatment of GAD, or general anxiety disorder.17
  • In 2008, the FDA granted approval for prescribing Cymbalta in managing symptoms relating to Fibromyalgia, a medical condition that causes widespread pain throughout the entire body, rather than pain localized to a specific area or body part.31
  • In 2010, the FDA expanded its approval for Cymbalta to be prescribed in the treatment of CMP, or chronic musculoskeletal pain, for example, chronic back pain.38

An SNRI is sometimes prescribed for conditions that lay outside the above list, generally called “off-label” prescribing. Often, where a certain condition has not yet been successfully treated or managed with a particular medication, trials are done to explore other medications that may be of some help. When enough positive results have been documented, such off-label use can eventually become FDA-approved. Switching antidepressants should be done with care because of the Cymbalta withdrawal syndrome being activated. If you feel your prescribing physician is becoming desperate or starts referring to your case as “treatment resistive”, this is a good opportunity to begin to research alternative holistic solutions that carry no such liabilities as pharmaceutical products are associated with.

Off-label uses for Cymbalta (duloxetine) in the USA include:
  • Urinary incontinence in females, i.e., after pelvic surgery.3
  • Chemotherapy-induced neuropathy, i.e., after breast cancer or other chemo treatment.10
  • Chronic pain.40

Cymbalta Alternative Names and Slang

Duloxetine is the generic name for the brand or trade name Cymbalta. Other trade names include Yentreve, and the drug is sold in the EU as Xeristar and Ariclaim.

Care should be taken not to confuse Cymbalta or its generic name, duloxetine with “SALA” drugs, meaning drug names that sound alike or look alike. To avoid mistaking one drug for another, drug manufacturers often use specific colors, add markings, or use other distinctive features to help minimize this risk.

For example, the Institute for Safe Medication Practices 4 lists Symbyax as a drug that is often confused with Cymbalta (duloxetine). Symbyax is an SSRI drug that compounds two drugs:

  • An SSRI called fluoxetine, and
  • An antipsychotic drug called olanzapine

These similarities make Symbyax a drug that might be confused with Cymbalta, but are, in fact, much different from each other in how and when they would be prescribed, despite their similar-sounding names.

Cymbalta Side Effects

SynapsesIn addition to Cymbalta withdrawal symptoms, the drug does come with a number of side effects. Cymbalta (duloxetine) primarily targets the serotonin and norepinephrine neurotransmitters, and to a lesser extent, dopamine.11 Cymbalta has a blocking effect so that these naturally occurring neurotransmitters are restrained from following their normal pathway. Instead of being reabsorbed, they become suspended. The resulting build-up can result in a wide variety of effects such as mood-brightening or feelings of euphoria that speak to its popularity in the treatment of depression and pain relief.

These effects are temporary because after the neurotransmitters have been suspended it is likely that the brain and nervous system adapt in ways that, as a domino effect, diminish the effect of the drug. This phenomenon is called antidepressant tachyphylaxis.12 Tachyphylaxis presents as a weakened response to repeated doses of medication. Certain humanized rat and mice studies indicate that antidepressants like Cymbalta can actually diminish brain serotonin.13 The drug itself does not create new stores of these naturally produced chemicals, but only manipulates the ones that are there, causing a lasting change in the chemical states in the brain, known as neuroplasticity.15

The result of drug-induced neuroplasticity is not completely understood but might explain why some people have to wait weeks to get an effect from Cymbalta.16 Initially perceived benefit can often be overshadowed by other troubling side effects that begin to appear after weeks or months.

In studies on pregnant women, antidepressants were found to have decreased efficacy due to the increased rate of drug metabolism during pregnancy, which has also left questions about safety for the child that need more definite answers.14 Cymbalta withdrawal symptoms may overlap some drug side effects. There are hundreds of reported Cymbalta side effects but here we will focus on the most common ones (1%-10% or higher) and a number of less common reactions that would signal a high health risk and potentially require swift medical intervention, should they occur. The list of Cymbalta side effects below is taken from the FDA label, and other sources as noted.18

Cymbalta Side Effects Include:
    • Suicidal behavior, suicidal ideation, especially in those under the age of 25 2
    • Seizures
    • Dysphoria 23
    • Gastrointestinal hemorrhage, or other areas of internal bleeding 19
    • Pain in the upper right abdomen area
    • Blurred vision, dilated pupils
    • Back or neck pain, muscle spasms (dystonia) 20
    • Anorgasmia, premature ejaculation, decreased libido, erectile dysfunction
    • Skin reactions including Stevens-Johnson Syndrome (extremely serious reaction of the eyes, skin, and mucous membranes caused by certain medications, signaled by fever and flu-like symptoms, followed by discoloration and rash/eruptions/skin ulcers which can become septic, the skin then blisters and falls off, requires medical intervention done best in a burn unit or ICU, and is fatal in approximately 5 to 10% of cases.) 5
    • Pruritis (severe and unrelenting itchiness)
    • Hyperhidrosis (excessive sweating)
    • Spiking blood pressure 21
    • Heart palpitations
    • Fatigue
    • Vertigo
    • Decreased appetite
    • Weight loss
    • Weight gain (less common) 22
    • Worsened depression
    • Anxiety
    • Hyponatremia (abnormally low sodium level, can result in seizure, coma, spasms, mental confusion, muscle weakness, inability to speak clearly, vomiting, swelling of the body, etc.)11
    • Insomnia, abnormal dreams, sleep disorders
    • Emotional blunting (reduction or total absence of normal emotional responses)
    • Mental confusion, inability to focus or think clearly 11
    • Panic attacks 26
    • Irritability, hostility, aggressive, impulsive behaviors 26
    • Akathisia (a relentless internal sensation of discomfort involving a compulsion to rock, pace, march, shift the feet, or otherwise stay in constant motion) 27
    • Mania or the lesser hypomania (an abnormally intense episode of racing thoughts, hyperactivity, euphoria, decreased need for sleep, disorganized behavior, elevated self-esteem, grandiosity, etc.)
    • Dizziness
    • Tremors
    • Vomiting
    • Darkened urine (may be a sign of liver or other organ dysfunction and should be medically assessed without delay.)
    • Abdominal pain
    • Dry mouth 11
    • Unusual bruising or tenderness in the upper abdominal area may be a sign of internal bleeding and requires medical attention.11
    • Serotonin Syndrome–a potentially life-threatening condition that occurs when too much serotonin is in the body which can result in seizure, coma, heart palpitations, and other symptoms and requires immediate medical intervention.5
    • Hepatotoxicity
    • Cymbalta Discontinuation Syndrome
    • Controlled Narrow-Angle Glaucoma

This is an astonishing list of possible Cymbalta side effects. Some doubt has been expressed concerning the quality of drug safety trials before duloxetine was approved for commercial sale.2 Considering our success rates at transitioning people off of Cymbalta and managing symptoms effectively without debilitating side effects, we feel that safer lifestyle interventions, as opposed to invasive medications, should be one of the first lines of treatment for the majority of patients, certainly not the last.

Inpatient Clinic for Cymbalta Withdrawal

There can be potentially overwhelming difficulties after long-term use and coming off Cymbalta.24,25 Choose treatment of a mild nature, with medical oversight, to ensure a safe and comfortable withdrawal experience. Cymbalta addiction or dependency can be overcome. Residential treatment is often the best choice to significantly reduce any discomforts that otherwise may make Cymbalta withdrawal near impossible to accomplish without step-by-step help.

inpatient care for cymbalta withdrawalInitial lab tests can be utilized in order to get a snapshot of existing neurochemical anomalies and deficits, as well as possible nutritional deficiencies and levels of toxic body burden. Then, each of these areas can be addressed using a combination of protocols that work to safely and gently restore nutritive values, remove toxins, and stabilize a person’s neurochemistry.

By supporting the natural rebalancing of neurochemistry, not only is it possible for the client to feel better very early in the process, but a wide array of adjunctive therapies allow the person to relax and complete the withdrawal process without unnecessarily harsh adverse effects, worry, or strain. When a client is ready for exercise, Equine-assisted therapy, or personal counseling, these and other opportunities on our services overview page can provide an enriched therapeutic experience.

We invite you to call us At Alternative to Meds Center for any information you would like for yourself or your loved one’s recovery. We are specialists in providing safer, gentler ways to overcome dependency and achieve successful and comfortable Cymbalta withdrawal and regaining natural mental health.


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2. Spielmans G, Spence-Sing T, Parry P, Duty to Warn: Antidepressant Black Box Suicidality Warning Is Empirically Justified. Front. Psychiatry, 13 February 2020 [internet] [cited 2022 May 24]

3. Schlenker B, Gratzke C, Reich O, Schorsch I, Seitz M, Stief CG “Preliminary Results on the Off-Label Use of Duloxetine for the Treatment of Stress Incontinence After Radical Prostatectomy or Cystectomy” PubMed [INTERNET] 2006 Jun [cited 2022 May 24]

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5. Wang RZ, Vashistha V, Kaur S, Houchens NW. Serotonin syndrome: Preventing, recognizing, and treating it. Cleve Clin J Med. 2016 Nov;83(11):810-817. doi: 10.3949/ccjm.83a.15129. PMID: 27824534. [cited 2022 May 24]

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13. Siesser WB, Sachs BD, Ramsey AJ, et al. Chronic SSRI treatment exacerbates serotonin deficiency in humanized Tph2 mutant mice.ACS Chem Neurosci. 2013;4(1):84-88. doi:10.1021/cn300127h. [cited 2022 May 24]

14. Ornoy A, Koren G. SSRIs and SNRIs (SRI) in Pregnancy: Effects on the Course of Pregnancy and the Offspring: How Far Are We from Having All the Answers? Int J Mol Sci. 2019 May 14;20(10):2370. doi: 10.3390/ijms20102370. PMID: 31091646; PMCID: PMC6567187. [cited 2022 May 24]

15. Andrade C, Rao NS. How antidepressant drugs act: A primer on neuroplasticity as the eventual mediator of antidepressant efficacy. Indian J Psychiatry. 2010;52(4):378-386. doi:10.4103/0019-5545.74318. [cited 2022 May 24]

16. Health Grades How long does it take for Cymbalta to work? Sarah Lewis, PharmD Last Updated: February 12, 2020. [cited 2022 May 24]

17. Carter NJ, McCormack PL. Duloxetine: a review of its use in the treatment of generalized anxiety disorder. CNS Drugs. 2009;23(6):523-41. doi: 10.2165/00023210-200923060-00006. PMID: 19480470. [cited 2022 May 24]

18. FDA Access Data CYMBALTA® (duloxetine hydrochloride) Delayed-release Capsules.  [cited 2022 May 24]

19. Perahia DG, Bangs ME, Zhang Q, et al. The risk of bleeding with duloxetine treatment in patients who use nonsteroidal anti-inflammatory drugs (NSAIDs): analysis of placebo-controlled trials and post-marketing adverse event reports. Drug Healthc Patient Saf. 2013;5:211-219. Published 2013 Nov 25. doi:10.2147/DHPS.S45445. [cited 2022 May 24]

20. Karakaş Uğurlu G, Onen S, Bayındırlı D, Cayköylü A. Acute dystonia after using single dose duloxetine: case report.Psychiatry Investig. 2013;10(1):95-97. doi:10.4306/pi.2013.10.1.95. [cited 2022 May 24]

21. Mermi O, Atmaca M. Duloksetin Kullanımına Bağlı Hipertansiyon: Bir Olgu Sunumu [Duloxetine-Induced Hypertension: A Case Report]. Turk Psikiyatri Derg. 2016 Spring;27(1):67-9. Turkish. PMID: 27369688.  [cited 2022 Mar 9]

22. Wise TN, Perahia DG, Pangallo BA, Losin WG, Wiltse CG. Effects of the antidepressant duloxetine on body weight: analyses of 10 clinical studies.Prim Care Companion J Clin Psychiatry. 2006;8(5):269-278. doi:10.4088/pcc.v08n0503. [cited 2022 May 24]

23. Sansone RA, Sansone LA. Duloxetine-related acute dysphoria.Psychiatry (Edgmont). 2007;4(11):65-68.  [cited 2022 May 24]

24. Perahia DG, Kajdasz DK, Desaiah D, Haddad PM. Symptoms following abrupt discontinuation of duloxetine treatment in patients with major depressive disorder. J Affect Disord. 2005 Dec;89(1-3):207-12. doi: 10.1016/j.jad.2005.09.003. Epub 2005 Nov 2. PMID: 16266753. [cited 2022 May 24]

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27. Akagi H, Kumar TM. Lesson of the week: Akathisia: overlooked at a cost. BMJ. 2002 Jun 22;324(7352):1506-7. doi: 10.1136/bmj.324.7352.1506. PMID: 12077042; PMCID: PMC1123446. [cited 2022 Aug 24]

28. Perahia DG, Kajdasz DK, Desaiah D, Haddad PM. Symptoms following abrupt discontinuation of duloxetine treatment in patients with major depressive disorder. J Affect Disord. 2005 Dec;89(1-3):207-12. doi: 10.1016/j.jad.2005.09.003. Epub 2005 Nov 2. PMID: 16266753. [cited 2022 May 24]

29. Qadir A, Haider N. Duloxetine withdrawal seizure.Psychiatry (Edgmont). 2006;3(9):10. [cited 2022 May 24]

30. Wilson E, Lader M. A review of the management of antidepressant discontinuation symptoms.Ther Adv Psychopharmacol. 2015;5(6):357-368. doi:10.1177/2045125315612334 [cited 2022 May 24]

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32. Warner C, et al., “Antidepressant Discontinuation Syndrome.” published in American Family Physician [online] Aug 1 2006 Issue [cited 2022 Mar 9]

33. Read J. How common and severe are six withdrawal effects from, and addiction to, antidepressants? The experiences of a large international sample of patients. Addict Behav. 2020 Mar;102:106157. doi: 10.1016/j.addbeh.2019.106157. Epub 2019 Nov 30. PMID: 31841871. [cited 2022 May 24]

34. Ali S, Milev R. Switch to mania upon discontinuation of antidepressants in patients with mood disorders: a review of the literature. Can J Psychiatry. 2003 May;48(4):258-64. doi: 10.1177/070674370304800410. PMID: 12776393. [cited 2022 May 24]

35. Hengartner MP, Schulthess L, Sorensen A, Framer A. Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum. Ther Adv Psychopharmacol. 2020 Dec 24;10:2045125320980573. doi: 10.1177/2045125320980573. PMID: 33489088; PMCID: PMC7768871. [cited 2022 Aug 24]

36. Fava GA, Benasi G, Lucente M, Offidani E, Cosci F, Guidi J. Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review. Psychother Psychosom. 2018;87(4):195-203. doi: 10.1159/000491524. Epub 2018 Jul 17. PMID: 30016772. [cited 2022 May 24]

37. White P, Faingold CL. Emergent Antidepressant Discontinuation Syndrome Misdiagnosed as Delirium in the ICU. Case Rep Crit Care. 2019;2019:3925438. Published 2019 Aug 4. doi:10.1155/2019/3925438 [cited 2022 May 24]

38. Skljarevski V, Desaiah D, Liu-Seifert H, Zhang Q, Chappell AS, Detke MJ, Iyengar S, Atkinson JH, Backonja M. Efficacy and safety of duloxetine in patients with chronic low back pain. Spine (Phila Pa 1976). 2010 Jun 1;35(13):E578-85. doi: 10.1097/BRS.0b013e3181d3cef6. PMID: 20461028.[cited 2022 May 24]

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Originally Published Feb 13, 2021 by Diane Ridaeus


This content has been reviewed and approved by a licensed physician.

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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