These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk with antidepressant use in patients aged 65 or Sep 15, 2023 · blurred vision. Jul 7, 2022 · nausea, loss of appetite, diarrhea, and indigestion. Although not all of these side effects may occur, if they do occur they may need medical attention. The overall pooled increase of dementia in patients with SSRI use was RR 1. I. Talk to your provider if you experience unpleasant side effects. . decreased libido. However, in some people, a particular antidepressant may simply stop working over time. For many people, these improve within weeks of starting an antidepressant. However, it may also cause side effects with long-term use. reduced sexual desire. A critical discussion of potential adverse effects of long-term use is important to consider but beyond the scope of the present article. , 2013). Watch The Antidepressant Story on Feb 1, 2016 · Given all available data to date it appears far more likely that SSRI use decreases suicide rates rather than increases them. Oct 25, 2022 · Each of the five experts I spoke with for this piece told me that long-term use of antidepressants is fairly safe. Often, SSRI side effects will go away over time as your body adjusts Yes, SSRIs can have a number of long-term side effects, such as PSSD. SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). This difference can be explained on basis of the difference of acute- and long-term treatment of SSRIs on the brain (Sugrue, 1983). muscle tension or tightness. 1,2 Among SSRIs, fluoxetine, escitalopram, citalopram, paroxetine, and sertraline are the most prescribed drugs. 5% experienced emotional blunting. nausea and vomiting. sexual problems, including decreased sex drive and Jun 11, 2015 · Some research indicates taking antidepressants could worsen depression in patients down the road. Mar 1, 2015 · The secondary aim is to explore differences of side effects profile between patients with major depression (MD) and anxiety disorders (AD). confusion. heavier menstrual periods. Subjects, aged 19 to 67 years, in the May 8, 2013 · Conducting long-term trials on the general public is unethical; I believe that most people taking drugs don’t know that their medicine (in most cases) has not been tested for long-term side effects of SSRI. May 6, 2017 · We would like to show you a description here but the site won’t allow us. Meet with a therapist. Jan 26, 2024 · Summary. increase in the frequency of urination or amount of urine produced. This study used mixed methods to examine patients' views and experiences of long-term antidepressant treatment, including benefits and concerns. 12,17,18 A general framework for typical duration of antidepressant treatment in this age group is provided by treatment guidelines with a recommendation of 6 to 12 months of treatment following Jul 26, 2019 · We therefore decided to do a systematic review of long-term, or persistent, harms of treatment with SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs) after at least six months follow-up after end of a drug treatment in humans. 8%), not feeling like themselves (54. Possible adverse effects of selective serotonin reuptake inhibitors (SSRIs) include: Cardiac — palpitations (common); tachycardia (uncommon); QT interval prolongation, torsade de pointes (citalopram or escitalopram). When depression symptoms improve after starting an antidepressant, many people need to continue taking medication long term to prevent symptoms from returning. increased sweating. Some patients taking SSRIs develop insomnia, skin rashes, headaches, joint and muscle pain, stomach upset, nausea, or diarrhea. Jun 18, 2020 · The question of side effects can also be key when choosing which drug to take: Some people might be more keen to avoid digestion problems. Olson, M. Although tolerability might be considered different from side effects, the two could also be closely related because side effects from antidepressants are some of the most common factors responsible for the treatment discontinuation. Most side effects associated with selective serotonin reuptake inhibitors (SSRIs) occur early and are short lived. Another study by Cartwright et al. This leaves a higher level of serotonin in the brain. Many people take antidepressants for much longer, and as they can cause unpleasant side effects, long-term use puts people at risk of harm that may outweigh the benefits. Apr 4, 2024 · loss of bladder control. dizziness. The current literature suggests that the general health risks of long-term SSRI use are low; however, further research, particularly in special populations including youth and the elderly, is needed. Selective serotonin reuptake inhibitors are associated with a variety of side effects, many of which are resolved during the first couple of weeks of treatment. Signs and symptoms such as nausea, weight gain or sleep problems can be common initially. 8 Thus Abstract. Some of the rare but severe ones include bleeding, seizures, serotonin syndrome, and suicidal thoughts. Jul 20, 2023 · The most frequently reported SSRI long term effects, the most commonly prescribed antidepressants, were dry mouth, profuse sweating, sexual dysfunction, and weight gain (Bet et al. This is troubling, as there have been some severe risks associated with the long-term use of antidepressants. muscle spasm, especially of the neck and back. This is especially concerning in the elderly, who are at increased risk for psychomotor impairment, car accidents, and cognitive impairment such as anterograde amnesia-diminished short-term recall, and increased For most people, sertraline is safe to take for a long time. Nov 1, 2013 · Side effects of antidepressants are usually underreported in clinical trials and large scale naturalistic studies are restricted to six months of use. Sexual side effects, sleep changes, and weight changes can also happen. Subjects, aged 19 to 67 years, in the Netherlands Study of Depression and Anxiety were recruited from primary care and specialized mental health care covered 927 cases of single May 17, 2018 · Answer From Eric J. puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue. difficulty achieving orgasm. lack of emotion. Side effects of antidepressants are usually mild and improve with time. Headache. Others might prefer to avoid dizziness, decreased sex drive or erection problems. This webpage provides detailed information on the side effects of fluoxetine, as well as how to manage We examined the prevalence and nature of patient-perceived side effects and their determinants during long-term antidepressant use in a naturalistic setting. Jul 28, 2016 · Long-term antidepressant treatment has increased and there is evidence of adverse effects; however, little is known about patients' experiences and views of this form of treatment. Some other antidepressant types include: serotonin-norepinephrine reuptake inhibitors (SNRIs) Sep 16, 2021 · The major benefit of long-term SSRI use is relapse prevention. One important thing to know about this antidepressant is that taking high doses has been associated with a rare heart rhythm problem. erectile dysfunction/decreased vaginal lubrication. May 1, 2023 · Selective serotonin reuptake inhibitors (SSRIs) are a class of medications most commonly prescribed to treat depression. Alongside ejaculation troubles, some men also experience a lower general level of interest in sex after using SSRIs such as sertraline, which may present as erectile dysfunction. Nowadays, emerging data suggest that long-term use of SSRIs may could cause some side effects previously neglected or under-recognized, such as emotional blunting, cognitive impairment, bone fractures or thrombotic/hemorrhagic risks. sweating. The informed management of these side effects by primary care practitioners supports successful treatment of depression. Aug 23, 2023 · Common side effects of Zoloft may include: indigestion, nausea, diarrhea, loss of appetite; nose bleeds; increased sweating; tiredness, sleep problems, insomnia; anxiety; loss of bladder control; tremors or agitation; or. (2016) investigated patients’ views and experiences of long-term antidepressant use over the period of taking the Mar 19, 2021 · In particular, antidepressants were found to show a spectrum of effects from decrease to increase in each of these side effects. Nov 8, 2021 · Despite the availability of these studies, critical evaluation of the impact of long-term use of antidepressants on the developing brain is lacking. For example, increased levels of cortisol from stress are known to cause all kinds of issues including high blood pressure, sleep disorders, sexual dysfunction, suppressed immune system, etc. Anecdotal reports have suggested that the long-term use of selective serotonin reuptake inhibitors (SSRIs) may be associated with significant weight gain, sexual dysfunction, drug interactions, and discontinuation symptoms. severe headache. At the individual patient level however, SSRI use can be associated with emotional/behavioral side effects that require appropriate clinical management. Along with its needed effects, bupropion may cause some unwanted effects. nightmares or unusually vivid dreams. Sexual dysfunction. low sex drive. headache. sexual problems. Check with your doctor immediately if any of the following side effects occur while taking bupropion: More common. paired with ibuprofen, for example Feb 16, 2023 · Signs and symptoms. Jul 7, 2023 · This medication has been found to counter SSRI-induced sexual dysfunction, boost sexual drive and arousal, and increase the intensity or duration of an orgasm. It can cause more depression or more anxiety if it Jun 19, 2023 · The scale of long-term use - and concerns about withdrawal symptoms - are revealed by BBC Panorama. need to keep moving. Although night sweats can be worrisome, they usually diminish with time as your body and brain adjust to the medication. Depression is the most common psychiatric disorder, and SSRIs are first-line drugs for its treatment. The good thing for me at least is that I can take medications to fix these problems. delayed ejaculation. g. Some recent studies suggest long-term antidepressant use may come with side effects previously unknown to scientists. changes in mood, such as depression, irritability, and Mar 29, 2022 · Although the research notes that longer term horizons are rare in depression research when the issue under investigation is long term antidepressant use, twelve months is a relatively short time to draw conclusions if reduction in side effects and reduced risk of relapse both improve over time. But as I weaned off my medication , my Jul 12, 2022 · These side effects can affect both men and women. These include: Nausea. Trouble sleeping. pale skin. lower back or side pain. Sep 21, 2023 · Warning. Although these adverse events are serious, they can be managed Nov 6, 2023 · A smaller study from New Zealand involving 180 people on long-term antidepressant therapy found that 64. This is not a complete list of side effects and others may occur. Gastrointestinal — reduced appetite, diarrhoea, nausea (dose-related), dry mouth, abdominal pain Jun 25, 2019 · Back in the early days of SSRIs, antidepressants were originally considered a short-term treatment for depressive episodes, to be taken six to nine months. increased sensitivity of the eyes to light. painful or difficult urination. Citalopram and other SSRIs may cause withdrawal symptoms such as: an electric shock-like sensation in the head. Are these effects inevitable or can they be managed effectively with the app … May 25, 2018 · TOLERABILITY AND DROPOUT RATE. fluoxetine, venlafaxine) may disrupt sleep, while others with sedative properties (e. Doctors don't fully understand what causes the so-called Feb 8, 2021 · These side effects were reported with long-term use of antidepressants and could worsen with age. fear or nervousness. Sep 15, 2023 · decreased interest in sexual intercourse. Nov 1, 2022 · If You Do Have to Take Antidepressants Forever, You Will Be OK. Anorgasmia. “These risks include an increased risk of gastrointestinal bleeding, especially for SSRI users,” Dr. 3. In some cases these can continue even after stopping the medicine. An S. Our search up until January 2020 found 33 studies, which included 4995 adult participants. inability to orgasm. Some people need to take trazodone long term to treat depression or anxiety that keeps coming back. Side Effects of These side effects should improve over time, although some – such as sexual problems – can persist. For sleep-promoting action, the Sep 29, 2021 · The decision to remain on long-term treatment is offset by any potential side-effects and many people prefer not to take medication for many years. Conclusions This work enhances the understanding of the side effects of antidepressants by identifying distinct linguistic markers in the longitudinal social media data of individuals showing the most and least Mar 30, 2022 · Tricyclic and tetracyclic antidepressants, also called cyclic antidepressants, are among the earliest antidepressants developed. Closely monitor for clinical worsening and emergence of suicidal thoughts and behaviors. 3 SSRIs act by inhibiting the 5-hydroxytryptamine (5-HT) transporter (5-HTT) on the axonal terminals of serotonergic neurons in the raphe nuclei, which terminates Similarly, no agreement exists on the detrimental effects of SSRIs on bone metabolism and coagulation. hearing loss. Less common side effects of SSRIs can include: bruising or bleeding easily, including vomiting blood or bleeding from your bottom; confusion; movement problems, such as stiffness or shaking Sep 23, 2019 · These immediate onset sexual effects ordinarily lift when treatment stops. Blurred vision. No relapse in 44% of participants In general, common side effects of antidepressants include: Upset stomach. Dec 8, 2000 · The author explores the reasons for the different profiles and discusses adverse effects, especially sexual dysfunction, weight gain, and sleep disturbance, the most troubling adverse events seen during long-term SSRI therapy. If you have diabetes, sertraline can affect your blood sugar levels. Anxiety; dry mouth Nov 14, 2022 · Many have been prescribed SSRIs for 10 years or more. , off-label uses These antidepressants generally cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants. Some of the common ones include nausea, insomnia, headache, and weight changes. The cardiovascular effects and toxicity of TCAs have been well documented in depressed patients, including those without pre-existing cardiac disease [ 35 ]. Change or problem with discharge of semen. Common SSRI side effects include nausea, headache, and diarrhea. muscle spasm or jerking of all extremities. 2 Bupropion was initially marketed as an immediate-release (IR) product; a sustained-release (SR) formulation was approved in 1996, and in August 2003, a once Dec 9, 2022 · Despite being promoted as safer than earlier antidepressants, the past 3 decades have revealed a concerning set of adverse effects that can result after long-term use of SSRIs and SNRIs. not sleeping well (insomnia), or feeling very sleepy. pain or discomfort in the arms, jaw, back or neck. The symptoms vary for different people, but they may include: delayed orgasm. Your Aug 28, 2019 · More Americans are taking antidepressant medications like Prozac and Zoloft for extended periods of time: One-quarter of people on the drugs have used them for a decade or more, according to data Sexual problems are a possible side effect of antidepressants. 1 –4 To fill this gap, over the last 25 years, patients have developed a robust Internet-based subculture of volunteer peer Dec 14, 2022 · Physical dependence to antidepressants may occur in some patients, caused by adaptation of the brain to long-term use of the medication. reduced response to sexual stimuli. inability to have or keep an erection. Oral route (Tablet) Warning: Suicidal Thoughts and BehaviorsIncreased risk of suicidal thinking and behavior in pediatric and young adult patients taking antidepressants. irregular or slow heart rate. 033 Sep 5, 2023 · Warning. Feb 20, 2023 · Antidepressant Side Effects. “Some studies also suggest that compared Apr 22, 2021 · Depression and anxiety are the most frequent indication for which antidepressants are prescribed. In some people, the anti-anxiety drug buspirone (BuSpar) may help increase libido and restore the ability to have an orgasm. And those in drug trials — potentially millions of us — have a right to know that we are subjects in an experiment. Jul 10, 2018 · In the main analysis, a total of five studies evaluated the risk between selective serotonin reuptake inhibitor (SSRI) use and development of dementia. Nov 15, 2004 · Bupropion HCl was initially developed to improve on the safety and tolerability of existing antidepressants. Long-term SSRI use increases the risk of tachyphylaxis and discontinuation syndrome. Long-term antidepressant use may also be associated with an increased risk of Type 2 diabetes May 8, 2020 · To that end, I will focus mostly on antidepressants’ prophylactic effects, as relapse prevention is the main indication for long-term antidepressant use in people with (recurrent) depressive disorders. I (male 23) have low testosterone now and high prolactin, which the doctors say may or may not have been related to taking them. Large, prospective and long-term studies are needed to clarify the possible impact of SSRIs on emotions, cognitive functions, bone fractures and coagulation, as well to detect other possible still neglected side effects. In certain cases, they relieve depression Aug 22, 2023 · Seroquel side effects. Aug 17, 2021 · SSRI antidepressant side effects. Study characteristics. Hong explained. Vortioxetine hydrobromide is not approved for use in pediatric patients. Long‐term antidepressant use is driving much of the internationally observed rise in antidepressant consumption. In fact, most people who take an SSRI experience genital sensory changes within 30 minutes of taking the drug. Apr 29, 2022 · Together with the long-term studies reported in this review, this suggests that SSRI treatment can have an initial deleterious effect on memory but after reaching a steady state, these effects are no longer found. Common sertraline side effects are nausea, diarrhea, indigestion, loss of appetite, increased sweating, shaking or trembling, decreased appetite, inability to ejaculate, and decreased libido. Serious long-term Paxil effects can include: Cardiovascular events, stroke, heart attack; Tardive dyskinesia 26; Increased risk of death 5 Jan 25, 2024 · fever. In 2006, reports appeared of a condition now termed post-SSRI sexual dysfunction (PSSD), in which the genital numbing, pleasureless or absent ejaculation/orgasm, and loss of libido remain and may become more pronounced after treatment stops (Bahrick, 2006; Csoka and Nov 10, 2021 · Long-term use is defined as two or more months at a therapeutic dose and when used long-term, BZDs pose potential harmful effects. muscle tightness. Weight gain. As with all medicines, they said, antidepressants have potential side effects which are diarrhoea or constipation. 75 (95% CI: 1. following patients who have suffered serious side effects. Since the known set of adverse effects in short-term trials may in fact linger during maintenance treatment, these have been included in the summary below. Although psychiatric drug withdrawal syndromes have been recognized since the 1950s – recent studies confirm antidepressant withdrawal syndrome incidence upwards of 40% – medical information about how to safely go off the drugs has been lacking. headaches. Jan 31, 2018 · Answer From Daniel K. Nov 28, 2023 · SSRIs work by preventing your blood from absorbing some of the serotonin from your brain. May 28, 2024 · fast, pounding, or irregular pulse. decreased or loss of nocturnal erections. Feb 1, 2024 · Side effects: SSRIs vary in their risk of causing side effects such as weight gain, sexual dysfunction, and nausea. Jan 26, 2024 · However, 25% to 73% of people who take SSRIs experience sexual side effects. High doses or long-term use of quetiapine can cause a serious movement disorder that may not be reversible. R. There do not seem to be any lasting harmful effects from taking it for many months, or even years. Hall-Flavin, M. We examined the prevalence and nature of patient-perceived side effects and their determinants during long-term antidepressant use in a naturalistic setting. Adverse effects. If you have a penis, you may also experience: failed erection. These problems are usually temporary or mild or both. loss in sexual ability, desire, drive, or performance. Oral route (Solution; Tablet) Antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies. , doxepin, mirtazapine, trazodone) rapidly improve sleep, but may cause problems in long-term treatment due to oversedation. muscle twitching. It only makes sense to use antidepressants if the diagnosis is correct. loss of memory. numbness or tingling in the arms or legs. S. These side effects may include sexual May 28, 2024 · Symptoms of PSSD can include: reduced genital sensation. In men, one of the most common side effects is difficulty achieving orgasm and ejaculating. Surveys of antidepressant users suggest that 30% to 50% of long‐term antidepressant prescriptions had no evidence‐based indication. Methods: Sixty-seven consecutive patients, successfully treated with SSRIs in monotherapy for at least six months for MD or AD, were assessed for side effects, with a special focus on cognition. 7 For example, up to 43% of patients with major depressive disorder (MDD) stopped taking antidepressants due to side effects. change in sleep habits, including increased sleepiness and insomnia. decreased interest in sexual intercourse. menstrual changes. Common examples include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), and May 28, 2024 · The 2017 antidepressant use study found that a little over 11% of respondents reported taking Prozac for depression. As pharmacologically defined, this physical dependence is a distinct phenomenon from addiction, and is manifested by a drug withdrawal syndrome. Feb 5, 2024 · Fluoxetine is a widely used antidepressant that can cause various side effects, ranging from mild to serious. mental depression or anxiety. Celexa (citalopram): Celexa works as well as other SSRIs and has similar side effects. Call your doctor for medical advice about Apr 25, 2024 · Long-term use can bring other side effects, including weight gain or emotional dulling. Drowsiness. Speak to your doctor if you are worried. A few people may get sexual side effects, such as problems getting an erection or a lower sex drive. A more serious potential problem is reduced blood clotting capacity because of a decreased concentration of the neurotransmitter Jul 1, 2011 · Lexapro can cause night sweats and increased sweating overall (night and day) was one of the most common side effects reported with Lexapro, reported by 3% to 8% (depending on the dose) of people. Antidepressants can cause unpleasant side effects. It may be that the weight gain some people using antidepressants experience increases the risk of them developing type 2 diabetes. Sexual side effects of SSRIs may include: Erectile dysfunction (ED), and inability to achieve or maintain an erection sufficient for penetrative sex. skin rash or itching. spontaneous orgasm. in men, difficulties obtaining or maintaining an erection (erectile dysfunction) These side effects should improve within a few weeks. A 1-year, open-label multicenter study assessing the long-term safety of vilazodone found the drug to be safe and well tolerated by MDD adults, with no clinically important changes in physical Feb 5, 2024 · Warning. difficulties achieving orgasm during sex or masturbation. D. In some cases, however, antidepressants cause side effects that don't go away. loss of appetite. Sep 24, 2023 · Serious side effects of Bupropion. hives, itching, skin rash. Related side effects included sexual difficulties (71. The latter notes that the SSRIs “have ‘broad spectrum’ efficacy in both short-term and long-term treatment, and are generally well tolerated; and for these reasons are widely considered to be the first-line pharmacological approach in patients with anxiety disorders” . Home | NAMI: National Alliance on Mental Illness . indigestion. Finally, antidepressants may interact with other drugs. Dizziness. Everyone reacts to medicines differently, but some side effects are typical. Watch the video to learn more. 4%), and a reduction in positive feelings (45. But depending on your side effects and the severity of your depression, you may Aug 9, 2017 · However, at least in short-term treatment, many antidepressants with so-called activating effects (e. Longer duration of treatment with antidepressants may increase Jul 5, 2023 · Selective serotonin reuptake inhibitors (SSRIs) are medications commonly used to treat many mental health conditions, including depression. Oct 8, 2015 · However, it appears to have a lower risk of weight gain and sexual side effects than the SSRI or SNRI, based on various noncomparative FDA trials. Mar 16, 2021 · Introduction. shakiness in the legs, arms, hands, or feet. Trazodone is safe to take for a long time. pleasureless or weak orgasm. Therefore, the aim of this paper was to present a comprehensive literature review search of these SSRIs side Sep 25, 2023 · More common. Increased serotonin can help relieve depression Introduction. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and be Mar 15, 2021 · Antidepressant use (mainly TCAs, tetracyclics and SNRIs, and to a lesser extent SSRIs ) is frequently associated with cardiovascular side effects such as arrhythmia and conduction delays . Jun 19, 2023 · The scale of long-term use - and concerns about withdrawal symptoms - are revealed by BBC Panorama. reduced nipple sensitivity. trouble thinking, speaking, or walking. Aug 13, 2022 · Introduction. These side effects occurred in 5% or more of patients using this medicine. There is limited information comparing SNRIs to SSRIs. It's unlikely you'll become dependent on zolpidem (Ambien). Oral route (Capsule, Delayed Release) Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies. Serotonin and norepinephrine reuptake Remember to consider not only the potential long term side effects of taking antidepressants but also the potential long term side effects of NOT taking them. However, cyclic antidepressants may be a good option for some people. anxiety. Antidepressants can help relieve the symptoms of depression and anxiety. SSRI use is significantly associated with an increased risk of dementia when compared with nonuse. Side effects that emerge or persist after 1 month of treatment include sexual dysfunction and weight gain. Less common side effects. Genetics: If a close family member had a good result from an SSRI, the odds are Sep 18, 2023 · loss of consciousness. fever. 1 It is the only antidepressant available with a dual effect on norepinephrine (NE) and dopamine (DA) neuro-transmitter systems. They are often used as first-line pharmacotherapy for depression and numerous other psychiatric disorders due to their safety, efficacy, and tolerability. Diarrhea. Specialists believe that some people are prescribed May 27, 2024 · Common sertraline side effects. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e. pain, redness, or swelling in the arm or leg. painful or prolonged erection of the penis. pains in the stomach, side, or abdomen, possibly radiating to the back. lack or loss of strength. Ambien and similar sleep medications can be effective, and they're much less likely to be habit-forming than some other drugs sometimes prescribed for sleep problems — for example, benzodiazepines, such as alprazolam (Xanax), lorazepam (Ativan) or Feb 14, 2024 · Long-term use of fluoxetine is safe if a person takes it as the prescribing doctor directs. Long-term use of SSRIs and TCAs has been linked to an increased risk of developing type 2 diabetes, although it's not clear if the use of these antidepressants directly causes diabetes to develop. They're effective, but they've generally been replaced by antidepressants that cause fewer side effects. muscle trembling, jerking, or stiffness. 6%). Although these adverse events are serious, they can be managed successfully if recognized early. Get emergency medical help if you have signs of an allergic reaction to Seroquel: hives, difficult breathing, swelling of your face, lips, tongue, or throat. If you need it and do not get side effects, there's no reason to worry about taking trazodone for a long Jan 23, 2024 · Some of the common side effects with long-term use of antidepressants are weight gain, sexual dysfunction, libido changes, and mood disturbances. Dry mouth. rb vi ps uo mi nj pg rv hs gx