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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by PaulB on June 28, 2001, at 17:26:19
PaulB wrote:
I wanted to find out about the causes of the tolerance that can occur when exposure to a benzodiazepine is given for longer period of time. Going back to basics, benzodiazepines exert their anxiolytic, amnesic, muscle-relaxant, hypnotic and sedative effects by binding to the omega receptors and thus potentiating the brain natural supply of GABA. Can anyone tell me whether the tolerance that may occur with longer term exposure to these drugs is caused by a decrease in the sesitivity and/or no of bz omega reptors or lowered levels of the brain own supply of natural GABA that the benzodiazepines potentiate.
I would appreciate to hear from all those people who have experience and knowledge of this type of psych-babble and look forward to seeing the responses I get
Take care
PaulB
Posted by judy1 on June 28, 2001, at 22:00:06
In reply to Benzodiazepine Tolerance, posted by PaulB on June 28, 2001, at 17:26:19
Dear Paul,
My personal experience with benzo use is that I have developed no tolerance to it's anxiolytic effects after about 4 years at 2mgs tid. My pdoc has patients on xanax or klonopin for 2 decades at the same or lowered dose. There is a tolerance to it's sedating effects, but I do not know the brain chemistry that is involved. I can certainly ask my pdoc next week. Take care, judy
Posted by Anna Laura on June 29, 2001, at 0:55:34
In reply to Benzodiazepine Tolerance, posted by PaulB on June 28, 2001, at 17:26:19
> PaulB wrote:
>
> I wanted to find out about the causes of the tolerance that can occur when exposure to a benzodiazepine is given for longer period of time. Going back to basics, benzodiazepines exert their anxiolytic, amnesic, muscle-relaxant, hypnotic and sedative effects by binding to the omega receptors and thus potentiating the brain natural supply of GABA. Can anyone tell me whether the tolerance that may occur with longer term exposure to these drugs is caused by a decrease in the sesitivity and/or no of bz omega reptors or lowered levels of the brain own supply of natural GABA that the benzodiazepines potentiate.
>
> I would appreciate to hear from all those people who have experience and knowledge of this type of psych-babble and look forward to seeing the responses I get
> Take care
> PaulB
Hi Paul
I developed benzos tolerance very very quickly.
I' m not sure about the chemistry involved in this reaction, even if i actually took an anatomy of the nervous system examination years ago (it was long ago though, i don't remember much). If i remember correctly, benzos function like a kind of "covering" (i.e. : like a blanket if you're cold) the rebound effect thus leaving you "defenceless". I personally felt like my skin was peeled off, oversensitive and kind of vulnerable. I think that the reaction depends on your own personal brain chemistry though: some people get the opposite reaction : they feel undersensitive and kind of anhedonic after benzos usage instead.
Posted by PaulB on June 29, 2001, at 15:57:06
In reply to Re: Benzodiazepine Tolerance, posted by Anna Laura on June 29, 2001, at 0:55:34
> > PaulB wrote:
> >
> > I wanted to find out about the causes of the tolerance that can occur when exposure to a benzodiazepine is given for longer period of time. Going back to basics, benzodiazepines exert their anxiolytic, amnesic, muscle-relaxant, hypnotic and sedative effects by binding to the omega receptors and thus potentiating the brain natural supply of GABA. Can anyone tell me whether the tolerance that may occur with longer term exposure to these drugs is caused by a decrease in the sesitivity and/or no of bz omega reptors or lowered levels of the brain own supply of natural GABA that the benzodiazepines potentiate.
> >
> > I would appreciate to hear from all those people who have experience and knowledge of this type of psych-babble and look forward to seeing the responses I get
> > Take care
> > PaulB
>
>
> Hi Paul
>
>
> I developed benzos tolerance very very quickly.
> I' m not sure about the chemistry involved in this reaction, even if i actually took an anatomy of the nervous system examination years ago (it was long ago though, i don't remember much). If i remember correctly, benzos function like a kind of "covering" (i.e. : like a blanket if you're cold) the rebound effect thus leaving you "defenceless". I personally felt like my skin was peeled off, oversensitive and kind of vulnerable. I think that the reaction depends on your own personal brain chemistry though: some people get the opposite reaction : they feel undersensitive and kind of anhedonic after benzos usage instead.PaulB writes
First of all, Anna, I hope your anhedonia isnt getting too much(I had to look that one up). There really are lots of dopaminergic drugs that you can try other than L-Dopa and Judy, good to see Clonazepam still helping you.
I myself build up tolerance to ''possibly'' addictive medicines/drugs quite quickly. I think its great that Judy has done so well on Clonazepam for so long although a psychiatrist I saw suggests that it is not all that uncommon, writing
'Continuous exposure(benzodiazepine) for an extended period results in tolerance and some degree of dependance. However, the drug will still produce a therapeutic effect. The biggest problem is the withdrawal'
I think of myself has being sesitive to addictive substances because of a time two years ago when I drank a lot. I quickly built up a tolerance to alchol(1 week or so) and I think thats quite uncommon when all my university friends spend 4 years boozing 90-100% of the time so I would be very interested in just how quickly the therapeutic effects of the benzodiazepines took to wore off for you Anna.
It was my understanding, you see, that benzodiazepines may certainly cause tolerance over extended period of time but for 2-4 weeks, at least, they are the original 'mothers little helpers and a cure to all that ails you' and tolerance during this time is v-uncommon? Any ideas about this theory?
Posted by stjames on June 29, 2001, at 16:25:41
In reply to Re: Benzodiazepine Tolerance, posted by PaulB on June 29, 2001, at 15:57:06
I would say that many build tolerance to the "high" that benzos can cause, and mistake
that for a drop in the anti-anxiety effects.
Actually the 2 are not the same.James
Posted by Elizabeth on June 29, 2001, at 22:23:30
In reply to Re: Benzodiazepine Tolerance, posted by stjames on June 29, 2001, at 16:25:41
> I would say that many build tolerance to the "high" that benzos can cause, and mistake
> that for a drop in the anti-anxiety effects.
> Actually the 2 are not the same.I still have a hard time believing anybody gets high on benzos! < g > I need fairly large amounts of the high-potency bzds just to relieve panic and abnormal movements in sleep (2 mg of Xanax prn, or 4 mg/day of Klonopin with 2 mg taken at bedtime), and I don't feel high or even lightheaded on them. (I do sometimes get unusually hungry, though.)
What's interesting to me is that supposedly the sedating effect and the anxiolytic effect are the same, yet people do become tolerant to the sedation (whether they're taking the benzo as a sleeping pill or for daytime anxiety), but not to anxiolysis. People with panic disorder take the same dose for years.
Also, some people who say they developed tolerance also do not identify the benzo experience as a high. So what's up with that, anyway?
-elizabeth
Posted by rmshed on June 29, 2001, at 23:23:35
In reply to Benzodiazepine Tolerance, posted by PaulB on June 28, 2001, at 17:26:19
> PaulB wrote:
>
> I wanted to find out about the causes of the tolerance that can occur when exposure to a benzodiazepine is given for longer period of time. Going back to basics, benzodiazepines exert their anxiolytic, amnesic, muscle-relaxant, hypnotic and sedative effects by binding to the omega receptors and thus potentiating the brain natural supply of GABA. Can anyone tell me whether the tolerance that may occur with longer term exposure to these drugs is caused by a decrease in the sesitivity and/or no of bz omega reptors or lowered levels of the brain own supply of natural GABA that the benzodiazepines potentiate.
>
> I would appreciate to hear from all those people who have experience and knowledge of this type of psych-babble and look forward to seeing the responses I get
> Take care
> PaulBPaul: My experience with benzodiazepines has been fairly text book. I maxed out several years ago taking 4mg of Xanax per day. That was considered a theraputic dose for me. It was hard to taper down to 2.25 mg per day that I am on now. I read in a book called "Anxiety and Phobia Handbook" that the tolerance may be down in the liver. Your liver never gets rid of xanax (benzo) by making enzymes which destroy the benzo. After you are on a benzo for awhile, your liver gets confused when you add more benzos and makes more enzymes to destroy the benzos. I have read that when you decrease your dose of benzodiazepine it must be very slowly because it takes your liver a long time to stop making the enzymes that kill the benzodiazepines. I have a very low level of GABA production and that it also takes awhile for the brain to produce more GABA. Although most of this is way over my head, I know understand about the need to increase benzodiazepines. If I had it to do all over again, I would try to find another drug that works with anxiety and panic disorder, my body is dependent on benzodiazepines.
Posted by Elizabeth on June 30, 2001, at 1:49:00
In reply to Re: Benzodiazepine Tolerance, posted by rmshed on June 29, 2001, at 23:23:35
> Paul: My experience with benzodiazepines has been fairly text book. I maxed out several years ago taking 4mg of Xanax per day. That was considered a theraputic dose for me. It was hard to taper down to 2.25 mg per day that I am on now.
I guess I'm confused. *My* textbooks all say that panic and anxiety patients *don't*, as a rule, develop tolerance to benzos. But it sounds like you kept needing ever-increasing doses. Or am I reading you wrong?
> I read in a book called "Anxiety and Phobia Handbook" that the tolerance may be down in the liver.
I'm not convinced. Tolerance is usually thought to be centrally mediated, a result of receptor down-regulation. Also, people who are tolerant to, say, Xanax, don't have cross-tolerance to other drugs whose metabolism is mediated by the same enzymes.
> I have a very low level of GABA production and that it also takes awhile for the brain to produce more GABA.
Xanax doesn't increase the amount of GABA; it makes GABA more effective at what it does.
> Although most of this is way over my head, I know understand about the need to increase benzodiazepines.
Most anxiety patients don't need to increase their dose, actually. I never experimented with long-term round-the-clock benzo use, myself (the closest I've come was taking Klonopin for a month at 4 mg/day and taking Xanax about once or twice a week for six months or more).
> If I had it to do all over again, I would try to find another drug that works with anxiety and panic disorder, my body is dependent on benzodiazepines.
Dependence (the experience of withdrawal symptoms upon discontinuing benzos) is a normal response. It's not the same as tolerance, though.
-elizabeth
Posted by PaulB on June 30, 2001, at 9:59:46
In reply to Re: Benzodiazepine Tolerance » rmshed, posted by Elizabeth on June 30, 2001, at 1:49:00
> > Paul: My experience with benzodiazepines has been fairly text book. I maxed out several years ago taking 4mg of Xanax per day. That was considered a theraputic dose for me. It was hard to taper down to 2.25 mg per day that I am on now.
>
> I guess I'm confused. *My* textbooks all say that panic and anxiety patients *don't*, as a rule, develop tolerance to benzos. But it sounds like you kept needing ever-increasing doses. Or am I reading you wrong?
>
> > I read in a book called "Anxiety and Phobia Handbook" that the tolerance may be down in the liver.
>
> I'm not convinced. Tolerance is usually thought to be centrally mediated, a result of receptor down-regulation. Also, people who are tolerant to, say, Xanax, don't have cross-tolerance to other drugs whose metabolism is mediated by the same enzymes.
>
> > I have a very low level of GABA production and that it also takes awhile for the brain to produce more GABA.
>
> Xanax doesn't increase the amount of GABA; it makes GABA more effective at what it does.
>
> > Although most of this is way over my head, I know understand about the need to increase benzodiazepines.
>
> Most anxiety patients don't need to increase their dose, actually. I never experimented with long-term round-the-clock benzo use, myself (the closest I've come was taking Klonopin for a month at 4 mg/day and taking Xanax about once or twice a week for six months or more).
>
> > If I had it to do all over again, I would try to find another drug that works with anxiety and panic disorder, my body is dependent on benzodiazepines.
>
> Dependence (the experience of withdrawal symptoms upon discontinuing benzos) is a normal response. It's not the same as tolerance, though.
>
> -elizabethPaul B writes > > > > > > > > > > > > > > > >
I look to benzodiazepines because I have failed to respond to SSRI's and MAOI's for anxiety and feel strongly that I would like to play by the rules rather than try other less recognised treatment that have been used with some success i.e.Gabapentin. Benzodiazepines, arguably, are second line therapy. I havent taken the plunge towards taking a benzodiazepine daily because they bother me-They completely block my ability to think clearly. I couldnt even read a book the other day and take any of it in. Yet by giving the pams a trial then I may realise that these intolerable cognitive problems as well as amnesic effects may decrease quite rapidly
Did this concern you guys/gals initially and did you find that when you started taking a benzodiazepine daily these severe cognitve defects and extreme sedation lessened quite quickly.
It was interesting to note what StJames said about a difference between tolerance occuring to the 'high' associated with benzodiazepines and the anxiolytic effects. I wouldnt call the initial benzodiazepine effects a 'high' but they are much more potent and can help with co-morbid depression too. Down the line they may very well worsen it. The anxiolytic effects may last a long time so Ive heard.
Posted by rmshed on June 30, 2001, at 13:56:25
In reply to Re: Benzodiazepine Tolerance » rmshed, posted by Elizabeth on June 30, 2001, at 1:49:00
> > Paul: My experience with benzodiazepines has been fairly text book. I maxed out several years ago taking 4mg of Xanax per day. That was considered a theraputic dose for me. It was hard to taper down to 2.25 mg per day that I am on now.
>
> I guess I'm confused. *My* textbooks all say that panic and anxiety patients *don't*, as a rule, develop tolerance to benzos. But it sounds like you kept needing ever-increasing doses. Or am I reading you wrong? YES, you are reading me wrong.
>
> > I read in a book called "Anxiety and Phobia Handbook" that the tolerance may be down in the liver.
>
> I'm not convinced. Tolerance is usually thought to be centrally mediated, a result of receptor down-regulation. Also, people who are tolerant to, say, Xanax, don't have cross-tolerance to other drugs whose metabolism is mediated by the same enzymes.
>
> > I have a very low level of GABA production and that it also takes awhile for the brain to produce more GABA.
>
> Xanax doesn't increase the amount of GABA; it makes GABA more effective at what it does.> Elizabeth: Mostly what I said is what I read and it was written by Stephen Cox MD, Asst. Clinical Professor of Psychiatry, UKMC. Go to xanax.com and click to discontinuing Xanax, it explains the liver enyzmes and GABA.
> > Although most of this is way over my head, I know understand about the need to increase benzodiazepines.
>
> Most anxiety patients don't need to increase their dose, actually. I never experimented with long-term round-the-clock benzo use, myself (the closest I've come was taking Klonopin for a month at 4 mg/day and taking Xanax about once or twice a week for six months or more).
>
> > If I had it to do all over again, I would try to find another drug that works with anxiety and panic disorder, my body is dependent on benzodiazepines.
>
> Dependence (the experience of withdrawal symptoms upon discontinuing benzos) is a normal response. It's not the same as tolerance, though.
>
> -elizabethI have taken Xanax for 14 years and know all about tolerance and dependence. I know the difference. And actually, I need less Xanax now that when I first started.
Elizabeth, are you a doctor?
Posted by judy1 on June 30, 2001, at 14:41:21
In reply to Re: Benzodiazepine Tolerance, posted by PaulB on June 30, 2001, at 9:59:46
Paul,
Just a couple of observations- alcohol is the #1 substance used in panic patients to self-medicate (according to my pdoc, with pot a close second). So I don't think your worries about dependency (psychological or physical) really apply in this case. Second benzos are considered second line because the pharm cos. have made paxil et al first line treatment because it is in their fiscal interest to do so. Every anxiety specialist I have seen consider benzos the first choice in treatment of panic disorder. I agree with you that when a person suffering from panic disorder goes the route of medication (benzos) it should be considered pretty much a long term decision, even though there are cases that have periods of remission. This is why my pdoc wants me to start my 10 year old (who is exhibiting anxiety symptoms) with a therapist so he can develop coping skills w/o the use of drugs. He feels if he is started early enough, he will never need to take medication, unlike me who will most certainly be on it for life. Take care, judy
Posted by Elizabeth on June 30, 2001, at 18:30:11
In reply to Re: Benzodiazepine Tolerance » PaulB, posted by judy1 on June 30, 2001, at 14:41:21
> Just a couple of observations- alcohol is the #1 substance used in panic patients to self-medicate (according to my pdoc, with pot a close second).
The pot thing is surprising; a lot of people with panic disorder find that their anxiety can be triggered or worsened by pot.
> Second benzos are considered second line because the pharm cos. have made paxil et al first line treatment because it is in their fiscal interest to do so.
Indeed. One question I like to ask any potential pdoc, just to see where s/he's at, is: "what would you consider to be some first-line treatments for panic disorder?" They should at least consider benzos a reasonable option or component of treatment.
-elizabeth
Posted by PaulB on July 1, 2001, at 20:30:38
In reply to Re: Benzodiazepine Tolerance » rmshed, posted by Elizabeth on June 30, 2001, at 1:49:00
> > Paul: My experience with benzodiazepines has been fairly text book. I maxed out several years ago taking 4mg of Xanax per day. That was considered a theraputic dose for me. It was hard to taper down to 2.25 mg per day that I am on now.
>
> I guess I'm confused. *My* textbooks all say that panic and anxiety patients *don't*, as a rule, develop tolerance to benzos. But it sounds like you kept needing ever-increasing doses. Or am I reading you wrong?
>
> > I read in a book called "Anxiety and Phobia Handbook" that the tolerance may be down in the liver.
>
> I'm not convinced. Tolerance is usually thought to be centrally mediated, a result of receptor down-regulation. Also, people who are tolerant to, say, Xanax, don't have cross-tolerance to other drugs whose metabolism is mediated by the same enzymes.
>
> > I have a very low level of GABA production and that it also takes awhile for the brain to produce more GABA.
>
> Xanax doesn't increase the amount of GABA; it makes GABA more effective at what it does.
>
> > Although most of this is way over my head, I know understand about the need to increase benzodiazepines.
>
> Most anxiety patients don't need to increase their dose, actually. I never experimented with long-term round-the-clock benzo use, myself (the closest I've come was taking Klonopin for a month at 4 mg/day and taking Xanax about once or twice a week for six months or more).
>
> > If I had it to do all over again, I would try to find another drug that works with anxiety and panic disorder, my body is dependent on benzodiazepines.
>
> Dependence (the experience of withdrawal symptoms upon discontinuing benzos) is a normal response. It's not the same as tolerance, though.
>
> -elizabethpaulB writes
I think there are elements of tolerance down in the liver and the the CNS. This was mentioned in my former post but to continue this thread I think Elizabeth and Rmshed's theories on the decreasing effectiveness of the benzodiazepines are correct. There are two mechanisms via which the pams can cause tolerance. Benzodiazepines cannot be metabolised in the liver if the enzyme that metabolises them has been inhibited by the drug(Tolerance 1). The drug however will build up in the liver, druft into the blood stream and into the brain. After a while and continuous exposure to the drug in the brain receptor sesitivity and number will inevitably decrease(Tolerance 2)
Posted by gilbert on July 2, 2001, at 0:28:15
In reply to Re: Benzodiazepine Tolerance, posted by PaulB on July 1, 2001, at 20:30:38
I have found xanax to be fairly dependable as far as dose and efficacy. I have the same dose now after an increase on the initial script 2 years ago. I started out a 3 x .25mg per day and after about 2 months went to 3 x .5mg and most days I only take two of the three pills. I have not developed a tolerance to this dose. Some days the drowsiness will catch me by suprise. If I am having a very relaxed week it seems like the xanax will put me to sleep.....If I am having a panic week it brings me back down to level....I also agree with Judy I think most panic and anxiety experts who have been in the field and have a large client bases agree that benzo's are a first line treatment not third. I would refer anyone to read some of Stuart Shipko's interviews or website commentary on just this thing. Over the long haul xanax long term is very safe with much less adverse effects than ssri's. Even if the xanax was only half as effective as an ssri I would still opt for the xanax. The ssri's just killed me with side effects.....and the short term ssri's gave me rebound worse than xanax. Try skipping a paxil or luvox dose......you will get a little jumpy let me tell ya......
My two cents,....Gil
Posted by Neal on July 2, 2001, at 12:13:39
In reply to Re: Benzodiazepine Tolerance, posted by gilbert on July 2, 2001, at 0:28:15
Gilbert,
Was it you who said in an earlier thread that Klonopin gave you some libido problems? If so then I take it that Xanax does not?
Posted by gilbert on July 2, 2001, at 19:28:31
In reply to Re: Benzodiazepines » gilbert, posted by Neal on July 2, 2001, at 12:13:39
> Gilbert,
> Was it you who said in an earlier thread that Klonopin gave you some libido problems? If so then I take it that Xanax does not?.....Yeah it was me....that was so unexpected it kind of came on slow and progressively got worse with each dose. Xanax does not causes any problems...at most once in a great while it will take me longer to er.....you know finish but I think some of that is mental....and that is only once in a while. This is strange too but body builders use xanax because it has been known to reduce exercise induced cortisol levels and increase dhea which would indicate a prosexual effect. I have noticed that I do seem more like tungsten instead of pine so to speak...not bragging just seems to be what happens for me. I also notice xanax appears to give me more nocturnal and morning wood for lack of a better word. The klonopin was a much smoother ride and there are studies in that post you speak of where vets were put on 4 different benzos and only klonopin caused sexual dysfunction. I don't know why but that paticular study is on pub med under the klonopin published listings. The same group of vets had no sexual dysfunction on xanax or valium but did on klonopin. I would prefer the klonopin for its wonderfull blanket coverage against panic but will not tolerate the limpness. I also think women do not experience this phenomenom on klonopin....I had sensation just not good blood flow....There now you know me as well as my wife...LOL
Gil
Posted by Elizabeth on July 5, 2001, at 23:53:35
In reply to Re: Benzodiazepine Tolerance, posted by PaulB on July 1, 2001, at 20:30:38
> I think there are elements of tolerance down in the liver and the the CNS. This was mentioned in my former post but to continue this thread I think Elizabeth and Rmshed's theories on the decreasing effectiveness of the benzodiazepines are correct.
I'm afraid I can't take credit for the "theory" that I cited: it's well established that patients with panic disorder who are taking benzodiazepines do not become tolerant to them, as a rule -- by any mechanism.
Some anticonvulsant drugs (such as Tegretol) do induce their own metabolism with chronic use. Benzos don't do this, though.
rmshed: I'm not a doctor; I'm a student (see reference to textbooks). "Xanax.com" takes you to the web site of the pharmaceutical company that makes Xanax. http://www.lexington-on-line.com/naf_xanax.html has some of Dr. Cox's comments about Xanax. He never says that tolerance *is* caused by increased production of liver enzymes; he just speculates that it *could* be. In any case, his claim that Xanax causes tolerance in the treatment of panic disorder is inconsistent with any available data. (Patients do commonly grow tolerant to sedation and some other effects of benzodiazepines, though.)
See, e.g.:
J Clin Psychopharmacol 1998 Dec;18(6 Suppl 2):12S-18S. Panic disorder: long-term pharmacotherapy and discontinuation. Rickels K, Schweizer E.
Neuropsychopharmacology 1995 Apr;12(2):147-57. Benzodiazepine sensitivity in panic disorder: effects of chronic alprazolam treatment. Cowley DS, Roy-Byrne PP, Radant A, Ritchie JC, Greenblatt DJ, Nemeroff CB, Hommer DW.
Arch Gen Psychiatry 1993 Jan;50(1):51-60. Maintenance drug treatment of panic disorder. I. Results of a prospective, placebo-controlled comparison of alprazolam and imipramine. Schweizer E, Rickels K, Weiss S, Zavodnick S.
Int Clin Psychopharmacol 1993 Summer;8(2):115-8. Three-year follow-up of patients with panic disorder after short-term treatment with alprazolam and imipramine. Lepola UM, Rimon RH, Riekkinen PJ.
J Psychiatr Res 1993;27 Suppl 1:127-42. Maintenance drug therapy of panic disorder. Curtis GC, Massana J, Udina C, Ayuso JL, Cassano GB, Perugi G.
J Clin Psychopharmacol 1992 Oct;12(5):352-4. Discontinuation of alprazolam after long-term treatment of panic-related disorders. DuPont RL, Swinson RP, Ballenger JC, Burrows GD, Noyes R, Rubin RT, Rifkin A, Pecknold JC.
Arch Gen Psychiatry 1989 Nov;46(11):993-9. Clinical and medication outcome after short-term alprazolam and behavioral group treatment in panic disorder. 2.5 year naturalistic follow-up study. Nagy LM, Krystal JH, Woods SW, Charney DS.
Acta Psychiatr Scand Suppl 1987;335:39-46. Pharmacology of the benzodiazepines; with special emphasis on alprazolam. Soderpalm B.
-elizabeth
Posted by Elizabeth on July 5, 2001, at 23:55:58
In reply to Re: Benzodiazepines, posted by gilbert on July 2, 2001, at 19:28:31
> I also think women do not experience this phenomenom on klonopin....
I think that sedative drugs often have opposite effects on men and women in the sexual department. Not sure why, but it seems to be true.
-elizabeth
This is the end of the thread.
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