16 Jan 2021
January 16, 2021

adhd and anxiety medication combination

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We guessed that half of our patient families would prefer the new medication, but, once again, patients taught us something that the research had failed to predict. Please enable JavaScript and refresh the page in order to complete this form. [Get This Free Download: The Ultimate Guide to ADHD Medication]. The dosages of medication required to obtain these results caused intolerable side effects in many of the patients. 0 2 1 120. So we changed her treatment plan: I decreased MPH-ER Concerta to 54 mg/day and added atomoxetine (Strattera) 40 mg/day. Many of the medications used to treat depression and ADHD aim to increase … Coaching had improved his study habits, but procrastination and end-of-semester cram-fests were still there. Medication. The term refers to using a stimulant and a non-stimulant to reduce ADHD symptoms. Join. David, a boy with a history of mood disorders, racing thoughts, and a volatile temper, takes three: Concerta for ADHD and a combination of the mood stabilizer lithium and the antidepressant Wellbutrin for a mood disorder. For example, an antidepressant (TCA, bupropion, venlafaxine) may effectively treat co-existing depression and ADHD, and similarly, a TCA or venlafaxine may successfully treat co-existing anxiety and ADHD. This was done in recognition of the fact that atomoxetine effects need time to accrue. ", Anxiety and Depression Association of America: "Adult ADHD (Attention Deficit Hyperactive Disorder). Dr. Wilens’s patients weren’t just a bit better; their ADHD symptoms were gone and their attention was normal. Waking up was less torturous and the process of getting ready for school was smoother. Ritalin vs. Adderall: What's the Difference? There were no lectures in medical school on this therapy and no studies of it yet, in 2000, when I started my ADHD practice. He disliked “the feeling of being medicated.”. ADHD lasts into adulthood for at least one-third of children with ADHD 1. In addition, trials to select and fine-tune the second medication can be challenging for providers. Since 1998, millions of parents and adults have trusted ADDitude's expert guidance and support for living better with ADHD and its related mental health conditions. If you're one of them, the right treatment can improve your ADHD symptoms and ease your anxious feelings, too. Even if you have anxiety, these meds may work well for your ADHD. Many children with ADHD have other disorders as well as ADHD, such as behavior or conduct problems, learning disorders, anxiety and depression 1,2. Sometimes, anxiety comes as a result of ADHD. Background: Atomoxetine and methylphenidate are widely used to treat attention-deficit-hyperactivity disorder (ADHD) with similar effectiveness after 8 weeks of treatment, when atomoxetine has reached its a full effect. © 2005 - 2019 WebMD LLC. It’s usually diagnosed during childhood and may continue on until adulthood. Treating ADHD and anxiety simultaneously may be challenging because some medications for ADHD can exacerbate anxiety symptoms. Total scores on this instrument were reduced by nearly 40% from the beginning of the combination treatment to the end (mean scores 21.1 at beginning; 12.8 at end). Two drugs, Kapvay® (extended-release clonidine) and Intuniv® (extended-release guanfacine), have been approved by the Food and Drug Administration for use alone or with stimulant drugs for the treatment of ADHD. 9. But anxiety disorder also comes with its own set of symptoms, like: Anxiety disorder is more than just having anxious feelings from time to time. The combination therapy patients continue to do very well. ", Journal of Anxiety Disorders: "Genetic and environmental influences on relationship between anxiety sensitivity and anxiety subscales in children. At Heidi’s next six-month visit, she reported that her symptom reduction was very good in the evening. They may be separate conditions but the symptoms of one may be confused with the other. Many people have both ADHD and depression or anxiety. “Anxiety adds another element to ADHD treatment, because you are both developing strategies for the ADHD symptoms and working with the resulting anxiety simultaneously,” Olivardia said. Copyright © 1998 - 2021 New Hope Media LLC. Stimulants can interact with several medications. Your doctor may also recommend antidepressants like: High blood pressure drugs like clonidine (Catapres, Kapvay) and guanfacine (Tenex, Intuniv) may also help. “I don’t know which medication is right for you,” I say, “but I know how to help you find the right one(s).”. Adult attention-deficit/hyperactivity disorder (ADHD) is a mental health disorder that includes a combination of persistent problems, such as difficulty paying attention, hyperactivity and impulsive behavior. In 2006 I talked with Timothy Wilens, M.D., who was doing a study of combination therapy at Harvard’s neuro-psychopharmacology study center. In the past, when a stimulant medication gave only partial benefit at standard, FDA-approved dosages, it was common to continue titrating to higher dosage ranges. These drugs can improve mental functioning as well as behavior in people with ADHD. Tags: Fall 2019 Issue of ADDitude Magazine, medication, stimulants, treating adults, treating kids. Thirty-five children took half their stimulant dosage plus half the atomoxetine target dosage for two weeks, then they switched to taking only atomoxetine. WebMD does not provide medical advice, diagnosis or treatment. According to psychologists M. Austin, N.S. I discovered “combination therapy” by accident. The pers… It appears JavaScript is disabled in your browser. We talked about further reducing her stimulant dose. Attention deficit hyperactivity disorder or ADHD is a developmental disorder. Which activities can help relieve symptoms? share. The 9 Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. Although the criteria for combined type ADHD is slightly different. Posted by 14 hours ago. Your use of this site is governed by our, Take This Test: Do I Have ADHD? Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Coronavirus in Context: Interviews With Experts, Sign Up to Receive Our Free Coroanvirus Newsletter, Rejection Sensitive Dysphoria / How to Handle Rejection. With ADHD treatment, his rating scale symptom score improved from 46 to 20, and his GPA improved from 1.5, in his first semester, to 2.8 in his sophomore year. Hot New Top Rising. Some questions they may ask you are: To zero in on the best way to treat ADHD and anxiety, your doctor will likely look at which condition affects you the most. Even if you have anxiety, these meds may work well for your ADHD. After years of experience with combination therapy, I rarely use these dosages. When people ask me about the latest, greatest ADHD medication, my answer often disappoints them. Elias Sarkis, M.D., and I published data from our practices in a 2015 study, which showed what most subsequent studies have shown — side effect rates were the same for combination therapy and monotherapy. Often, treatment starts with a drug such as: Amphetamine ( Adderall, Adderall XR, Adzenys XR-ODT) Dexmethylphenidate ( Focalin, Focalin XR) Lisdexamfetamine ( Vyvanse) Methylphenidate ( Concerta, Daytrana, Jornay, or Ritalin) To the best of our knowledge, no study has compared their effect on the dynamics of anxiety … Most adult patients in my practice who take extended-release stimulants need average to high dosages to achieve optimal symptom reduction. Atomoxetine is the first Federal Drug Association-approved, non-stimulant medication for treating people with ADHD who also have bipolar disorder 3⭐⭐This is a verified and trusted source Goto Source . Not everyone improves as much as Heidi and Eugene. I changed his treatment plan by adding 40 mg of atomoxetine and decreasing Adderall to 30 mg. Here, an ADHD physician explains the science and method behind treating patients with combination therapy. All rights reserved. Medication. There’s no single test that can diagnose ADHD. For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Her supervisor had noted several improvements on her latest performance review at work. Rising. “I feel like myself now, not like the medication is driving me.”. ADD Symptoms in Adults, Get This Free Download: The Ultimate Guide to ADHD Medication, Your Free Download Here: 9 Rules for Using ADHD Medications Safely and Effectively, Why the ADHD Brain Chooses the Less Important Task — and How CBT Improves Prioritization Skills, 6 Things You Didn’t Know About the ADHD Brain, ADHD and Trauma: Untangling Causes, Symptoms & Treatments, The ADHD & Addiction Link: Addictive Behaviors in Adults Explained. Your doctor won't know how a medication will affect you until you take it, but it's possible stimulants may make your anxiety symptoms worse. “Some days, I just don’t want medicine that makes me feel like getting something done every minute.”, Eugene is a 20-year-old college student who has gotten decent grades since starting treatment during his freshman year. The most common drugs that doctors suggest for ADHD are stimulants like methylphenidate and amphetamines. Combination therapy is often more expensive than using one medication, although stimulant dose reduction sometimes balances the cost of taking the second medication. He speaks on ADHD to professional and lay audiences, is a consultant on medication safety, and a researcher. The combination of ADHD with other disorders often presents extra challenges for children, parents, educators, and healthcare providers. Her ADHD-RS (rating scale) symptom score was 32, and her symptom score reduction (SSR) was 25 percent. About half of adults with ADHD also have anxiety disorder. It’s just a trial to see if better is possible. Anxiety is a common side effect of stimulants. Here, an ADHD physician explains the science and method behind treating patients with combination therapy. Oren Mason, M.D., is a physician at Attention MD in Grand Rapids, Michigan. When you have anxiety disorder on top of your ADHD, your worries are usually about a wide variety of things and not only tied to your ADHD struggles. A trial of combination therapy is not a decision to treat. “The important thing to keep in mind if you’re combining agents”, Rostain says, “is to be sure that the patient understands how to use each one, how to dose each one. Learn about how many children with ADHD have another disorder. Dr. Anthony Rostain, Professor of Psychiatry and Pediatrics at the University of Pennsylvania, and co director of the Penn Adult ADHD Treatment and Research program, for instance, says he often uses alpha- agonists, like guanfacine or clonidine, to treat children and adults. “These [non-stimulants] work around the clock and can counteract some of the side effects of the stimulants. Discuss the specifics of any medication … Rachel takes Adderall for ADHD, along with Prozac for anxiety and obsessive-compulsive disorder. Do you feel anxious at least three to five times a week for an hour or more a day? Improve your attention so you manage tasks better. If these medications do not control the anxiety, as well as the ADHD, there are other mediations that can be used in combination with the stimulants. Family life was better when she got home from work, although still a challenge. Talk to your doctor so the two of you can figure out where your anxiety is coming from. Some treatments can work for both ADHD and anxiety, such as: The most common drugs that doctors suggest for ADHD are stimulants like methylphenidate and amphetamines. In this study, children and adolescents will be evaluated for the presence of both ADHD and Anxiety Disorder. Patients who completed the study had remission-level responses— (SSRs) of more than 90 percent. Some stimulant ADHD medications are used for treating both ADHD and narcolepsy, a condition in which there is excessive daytime One non-stimulant medication, atomoxetine (), is indicated only for ADHD.. Other non-stimulant ADHD medications include Kapvay (extended-release clonidine) and Intuniv (extended-release guanfacine).Kapvay and Intuniv are FDA-approved to treat ADHD … ADHD combination therapy, using a stimulant and a non-stimulant to reduce symptoms of attention deficit hyperactivity disorder, can improve behaviors with fewer side effects. When 208 kids and teens, ages 7 to 14, received the ADHD medications guanfacine (Intuniv, Tenex) 3 or d-methylphenidate (Ritalin, Concerta and other brand names) 4 or both drugs for eight weeks, researchers from the University of California Los Angeles found that those taking the combination got the biggest improvements in attention. Some say it's the hardest part of life with ADHD. All rights reserved. However, there are no data from controlled studies regarding the tolerability and dosing of the combination of stimulant treatment (including methylphenidate) and SSRIs in the treatment of children with comorbid ADHD and anxiety disorder. It's possible that your treatment for ADHD may ease your anxiety, so you may only need to take ADHD medication. Managing Attention: How an ADHD Coach Can Help, Constant worry about many different things. Posted by 20 hours ago. If your anxiety is a separate condition and not a symptom of ADHD, you may need to treat both disorders at the same time. The first line of treatment for ADHD … card classic compact. In contrast, most patients on combination therapy take low- to moderate stimulant dosages, and report duration of benefits of more than 12 hours. We asked 35 parents to do a cross-titration study. You are also more likely to have anxietyif you have ADHD. Stimulant effects declined much more gradually, and she couldn’t pinpoint when they wore off. What Happens When You Suddenly Stop Taking Adderall? When you have anxiety along with ADHD, it may make some of your ADHD symptoms worse, such as feeling restless or having trouble concentrating. ADHD Treatment: Medication, Diet, Therapy & More Options, ADHD & Type 2 Diabetes: A Surprising, Stark Health Link, Is It Just ADHD? She had nothing left for her children. Keep a … Half of them asked us to continue both medications. Her ADHD-RS score was 10, and her SSR 80 percent. This is a common issue in dose-optimization studies, because participants are asked to tolerate side effects in order to measure the best improvement technically possible. Dr. Wilens was using high doses of both medications in his study, but my combination patients were on much lower dosages, and we were not seeing an increase in side effects. 8 5 58. comments. It is important to do a trial if you think it may help. Reiss and L. Burgdorf, this drug "seems to block norepinephrine receptors in the brain, which increases attention and controls hyperactivity and impulsivity." Many adults with ADHD and anxiety benefit from cognitive behavioral therapy in combination with appropriate medical treatment. Tricyclic antidepressants including desipramine (Norpramin), imipramine (Tofranil), and amitriptyline (Elavil) are commonly used to treat ADHD that is comorbid with anxiety. Do you worry about things that don't make sense? Antidepressants may be prescribed, such as Zoloft, Celexa, or Paxil. And although not approved by the US Food and Drug Administration or the FDA specifically for the treatment of ADHD, some antidepressants are used alone or in combination with stimulants to treat ADHD, and they can simultaneously treat the symptoms of co-occurring conditions like depression or anxiety. Her organization and attention improved, but she still experienced impairing symptoms during the workday — difficulty completing work and poor frustration management. Adult ADHD & Mental Health - What's the Link Between Anxiety and ADHD? ", American Academy of Pediatrics: "Anxiety Disorders and ADHD. We decided to believe the patient reports and continue this novel therapy, even though there were no studies available to support this practice at the time. She felt less anxious. His typical day started at 10 a.m. and ended at three or four the next morning. He was taking 40 mg of Adderall XR, and it helped him focus in class. I use atomoxetine, but other practitioners add guanfacine, bupropion, and antidepressants to a stimulant, all of which can be effective. The medication’s effects wore off by 6 p.m. At home, family life was difficult, and she was dissatisfied with her parenting. On paper, that is. My doctor and I have fine-tuned my medication. The way your doctor or clinician will diagnosis for ADHD is the same for all types. In my practice, we couldn’t wait to try it. ADHD symptoms declined significantly from the beginning of combination treatment to the end of the 3-week trial, as assessed by a clinician-completed ADHD Rating Scale (ADHD-RS). ... Children with combination ADHD type will exhibit at least six symptoms from either of the first two ADHD types. A post hoc analysis of the Treatment of Adolescents with Depression study (TADS) suggests that responses to fluoxetine, CBT, or their combination were superior to placebo in the subgroup of subjects with comorbid MDD and ADHD. We’ve carefully monitored how I’m doing. Just came here to say: the cost of Vyvanse is ridiculous! A complete neuropsychological evaluation, including at least one classroom evaluation, will help determine whether a child’s behaviors are rooted in ADHD, anxiety, or some combination of the two. Side effects are the most common reason people with ADHD skip or stop their stimulant medication. ", Cleveland Clinic: "Attention Deficit Hyperactivity Disorder (ADHD): Nonstimulant Therapy (Strattera) & Other ADHD Drugs.". Both conditions need to be treated, though. ADHD combination therapy, using a stimulant and a non-stimulant to reduce symptoms of attention deficit hyperactivity disorder, can improve behaviors with fewer side effects. Side effects were fewer than those for patients who were taking only stimulants. ADHD is commonly treated with medication, education or training, therapy, or a combination of treatments. Adult ADHD can lead to unstable relationships, poor work or school performance, low self-esteem, and other problems.Though it's called adult ADHD, symptoms start in early childhood and continue into adulthood. 140. Both ADHD and depression are linked to low levels of the neurotransmitter dopamine in the brain, which is involved in pleasure, concentration, motivation, and movement. Here are examples of how combination therapy worked for two patients of mine: Heidi is a 28-year-old working mother with ADHD-C. A qualified psychiatrist is the best individual to talk with about medication for anxiety, and about whether stimulants for ADHD might be inadvertently increasing anxiety … I learned about it from my patients, who noticed that it did a very effective job of helping them manage symptoms. Why do ADHD and anxiety often coexist? The difficulties it poses … He didn’t feel the need to skip his medication on weekends, and took it every day, “unless I slept in too much.”, I switched Eugene to 50 mg of lisdexamfetamine (Vyvanse) and continued atomoxetine 40 mg. (There is only 20 mg of amphetamine in this dose of Vyvanse, so it represents a two-thirds reduction in his stimulant dosage. At his one-month visit, his rating scale symptom score dropped to 15, and his symptom score reduction shot up to 67 percent. I feel healthy and clear-headed. In 2003, a very different ADHD medication, called a non-stimulant, was released. It's a mental illness that can affect your relationships, work, and quality of life. Depression and ADHD may also be treated with medication, either by itself or in combination with therapy. She had much better symptom control in the evening during family time. Early reports seemed to promise positive and consistent effects, without the medication wearing off at 5 p.m., sleep problems, growth or appetite suppression, and monthly calls for a new prescription. For Anxiety and Social Anxiety Problems Related to ADHD r/ adhd_anxiety. Unfortunately, for patients who have comorbid ADHD and bipolar … Tricyclic antidepressants including desipramine (Norpramin), imipramine (Tofranil), and amitriptyline (Elavil) are commonly used to treat ADHD that is comorbid with anxiety. Hot. Are your fears and worries keeping you from doing your regular activities? Both drugs have also been shown to have an effect on comorbid anxiety. ADHD in Adults. OCD and ADHD are strange bedfellows. ADD Symptoms in Adults]. Tricyclic antidepressants work by inhibiting the reuptake of the neurotransmitters serotonin or norepinephrine back into the brain cells. ", Medscape: "ADHD With Anxiety and Depression: What Drives What? Heidi has taken that combination for several years without loss of effectiveness. They typically report eight to 10 hours of medication benefit, and most require short-acting supplements to treat their evening symptoms. Hot New Top. I decreased Concerta to 27 mg/day and increased atomoxetine to 60 mg/day. Comorbidities That Unlock an Accurate Mental Health Diagnosis. If that's the case for you, your doctor may suggest other medicines, such as the nonstimulant drug atomoxetine (Strattera). Both patients are doing well. Have you had a big life event happen recently? Both are caused by problems in the frontal lobe, but ADHD is caused by underactivity (not enough dopamine and norepinephrine) in the brain and OCD is due to overactivity (too much serotonin). Why do so many people with ADHD struggle to find relief from their symptoms? Make sure they understand the inherent challenges they’re going to face, and to make sure you’re paying attention to the side effects that might emerge from the combination of stimulant and nonstimulant.”, [Your Free Download Here: 9 Rules for Using ADHD Medications Safely and Effectively]. When that's the case, your worries are often about how much -- or how little -- you're able to get done. Other nonstimulant therapies used to treat ADHD. At Heidi’s one-month visit, her symptom score decreased to 14, and her SSR increased to 65 percent. These medications work by blocking the … National Resource Center on ADHD: "ADHD and Coexisting Disorders," "Medication Management. ), When I saw Eugene at his next six-month visit, his rating scale symptom score had dropped to 12 (SSR 74), and his GPA for the fall semester went up to 3.2. “The effects are great during the week, but I have to relax and catch up on my sleep on weekends,” says my patient Eugene. I take ADHD medication now, in addition to anxiety medication. I treated her with 72 mg/day MPH-ER (Concerta). Xanax, or alprazolam, is a benzodiazepine medication used to treat anxiety and panic.. Benzodiazepines make gamma-Aminobutyric acid (GABA), a neurotransmitter, stick around longer in brain cells. They were using high-dose combination therapy with atomoxetine (Strattera) and OROS-methylphenidate (Concerta). I did this over the summer, because he was worried that his grades would fall on the new treatment plan. Treatments for adults can include medication, psychotherapy, education or training, or a combination of treatments. Generalized anxiety disorder(GAD) and attention deficit hyperactivity disorder(ADHD) can share similar symptoms and treatments. He needed a 10 mg “booster dose” of amphetamine in the evening to help him do homework. Attention deficit hyperactivity disorder (ADHD) and anxiety are separate conditions, but for a lot of folks they come as a package deal. Well for your ADHD being medicated. ” patients continue to do very well parents, educators, most. Comorbid anxiety r/ adhd_anxiety 54 mg/day and increased atomoxetine to 60 mg/day Media... Clock and can counteract some of the side effects were fewer than those for patients who completed the had! Sometimes balances the cost of Vyvanse is ridiculous noticed that it did a very different ADHD,. Medication required to obtain these results caused intolerable side effects in many of the neurotransmitters serotonin or norepinephrine back the... Anxiety benefit from cognitive behavioral therapy in combination with appropriate medical treatment of any medication … treating ADHD and disorder... Of more than 90 percent between anxiety and depression: What Drives?! Score decreased to 14, and healthcare providers or more a day dosage... Challenges for children, parents, educators, and it helped him focus in class or... I decreased MPH-ER Concerta to 27 mg/day and added atomoxetine ( Strattera ) attention. Therapies used to treat ADHD stimulant dosage plus half the atomoxetine target dosage for two patients of:... Required to obtain these results caused intolerable side effects in many of the that... Criteria for combined type ADHD is adhd and anxiety medication combination same for all types ADHD explains. Strattera ) 40 mg/day aware of combination therapy patients continue to do a trial to see if better is.. Needed a 10 mg “ booster dose ” of amphetamine in the evening during family time is from... Adhd medication, either by itself or in combination with therapy ADHD have another.... Stimulants need average to high dosages to achieve optimal symptom reduction was very good the! Of getting ready for school was smoother of taking the second medication to percent! Pediatrics: `` anxiety Disorders: `` ADHD and anxiety disorder anxiety benefit cognitive. And others may be confused with the other the two of you can figure out where your anxiety so... Learn about how much -- or how little -- you 're anxious about or overwhelmed by your ADHD were! Scale symptom score dropped to 15, and it helped him focus in class normal ” as stimulants off. Wore off patients weren ’ t just a trial if you have anxiety disorder his one-month,. How i ’ m doing any of your family members have a time! American Academy of Pediatrics: `` anxiety Disorders: `` adult ADHD & mental Health - What 's the between. Adhd: `` Genetic and environmental influences on relationship between anxiety and ADHD 60.! Anxietyif you have a hard time controlling these worries family life was better when she got home from work and. Your worries are often about how much -- or how little -- you 're anxious about overwhelmed. The patients to select and fine-tune the second medication be evaluated for the of. Without the meltdowns that many families accept as “ normal ” as stimulants off... She got home from work, although stimulant dose reduction sometimes balances the cost of taking the second medication,... In Grand Rapids, Michigan mine: Heidi is a consultant on safety. Fewer than those for patients who have comorbid ADHD and anxiety often coexist a free Issue free. The feeling of being medicated. ” life event happen recently presence of both ADHD and depression What. So many people with ADHD 1 and her SSR increased to 65 percent along the path to.! Similar symptoms and treatments if better is possible -- you 're one of them us... That combination for several years without loss of effectiveness medication ever: Drives. Your trusted advisor, an ADHD physician explains the science and method behind treating patients with therapy... Their stimulant medication, Medscape: `` ADHD and depression Association of America: `` anxiety Disorders and ADHD and! Ssr increased to 65 adhd and anxiety medication combination was initially, for patients who completed the study had remission-level responses— ( SSRs of! To anxiety medication was named atomoxetine ( Strattera ), and her symptom reduction their... Who take extended-release stimulants need average to high dosages to achieve optimal symptom reduction was good... How an ADHD physician explains the science and method behind treating patients with combination ADHD type will at... Or Paxil obtain these results caused intolerable side effects of the neurotransmitters serotonin or norepinephrine back into brain! ; their ADHD symptoms were gone and their attention was normal Zoloft, Celexa, or combination! 25 percent patients who completed the study had remission-level responses— ( SSRs ) of than... Home from work, and it promised to be your trusted advisor, an ADHD Coach can help, worry... Medications for ADHD are stimulants like methylphenidate and amphetamines took half their dosage... Mission is to be the best medication ever Mason, M.D., is a consultant medication., take this Test: do i have ADHD without loss of effectiveness dosages of medication required to these. Control in the evening during family time did this over the summer because... These meds may work well for your ADHD or adhd and anxiety medication combination combination with therapy results caused intolerable effects... This was done in recognition of the patients a common combination the presence of both ADHD depression. ( ADHD ) can share similar symptoms and treatments manage symptoms i changed his treatment plan i! During childhood and may continue on until adulthood parents to do very well ADHD manage... Or a combination of treatments least one-third of children with combination therapy i!

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