Obsessive compulsive disorder OCD is classified as an anxiety disorder. There are some who think that there are several psychiatric and psychological conditions that are related. The notion of a spectrum of obsessive-compulsive related disorders that is comprised of such disparate disorders as obsessive compulsive personality disorder, body dysmorphic disorder, certain eating disorders such as bulimia and anorexia nervosa, pathological gambling, and autism, is gaining acceptance within the psychiatric community. The fact that these disorders share obsessive-compulsive features and evidence similarities in patient characteristics, course, comorbidity, neurobiology, and treatment response raises the question of whether obsessive compulsive disorders are best thought of as an anxiety or an obsessive compulsive spectrum disorder.
Some patients with obsessive-OCD often have other psychiatric disorders, such as depression, bipolar disorder, psychotic disorders, and eating disorders, which present challenges to the treating physician.
Natural treatment of
Obsessive Compulsive Disorder with dietary supplements, herbal remedies,
Standard treatments for OCD include selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavior therapy. There is little research regarding the natural treatment of obsessive compulsive disorder. However, since SSRIs have been found to be helpful in some patients, it is interesting to wonder whether 5-HTP, the serotonin precursor, may also have some benefit. I personally have not used 5-HTP for obsessive compulsive disorder in my practice, but I do have experience using this supplement for anxiety. The adult dose is normally 50 mg once or twice a day, and half or a third for a child. Other interesting options could be kava and inositol. Kava should not be used all the time, but perhaps every other day. Please discuss these natural treatment options with your doctor before using them.
5HTP or 5-hydroxy-tryptophan
I have personally not tried 5-HTP with patients who have OCD, however, since SSRIs seem to have an influence, it would be reasonable to assume that 5 HTP may also play a role.
I had read your article about 5-HTP and it's benefits and would like to add that yes, it really does help. I'm 42 yrs old and have had severe OCD my entire life. I started using 5-HTP about 6 months ago to replace the Luvox that I was taking. In combination with the 5-HTP, I take the max dosage of Anafranil, and it really does work well that way.
I have been on 100 mg of 5-htp for obsessive compulsive disorder and anxiety for about 10 days as well as inositol 8gm a day and 2 mg of xanax. I noticed the most obsessive compulsive disorder improvement when I started the 5-htp though the inositol helps.
Ashwagandha root extract
Withania somnifera, also known as ashwagandha, has been found to be helpful in a study done on rodents.
Hum Psychopharmacol. 2017. L-carnosine as an adjuvant to fluvoxamine in treatment of obsessive compulsive disorder: A randomized double-blind study. Dysregulation of glutamate is implicated in the pathogenesis of obsessive-compulsive disorder (OCD). Consistently, glutamate-modulating agents, such as riluzole and memantine have been used in OCD treatment. Here, we assessed the efficacy of L-carnosine as adjuvant to fluvoxamine in OCD treatment. Forty-four patients diagnosed with moderate to severe OCD were recruited in a randomized double-blind trial. Patients received either L-carnosine or placebo as adjuvant to fluvoxamine for 10 weeks. L-carnosine results in significant reduction of obsessive-compulsive symptoms when used as an adjuvant to fluvoxamine.
Email- I am a long time agoraphobic and OCD sufferer. I went through a tough time and started to use Inositol. I believe it helped me a great deal. How much to use and how to take it. I take about 12-15 grams a day in pill form. Generally I take it throughout the day, breakfast 3 lunch 3 snack time 2 dinner 3 and so forth. I understand that large amounts are needed to cross the blood brain barrier. So my concern is, do I have to take it all at the same time or can I spread it out like I have been? Also is it more effective with or without food or at certain times of the day?
A. There are no easy answers since this topic has not been studied too much but the general aim is to use the least amount that works and reduce the amount used in the evening. Spreading it out is a good option.
Taking passion flower herb it changed my life to the better. I used to have obsessive compulsive disorder and obsessive thoughts and with passion flower the thoughts are almost gone completely. I prefer using passion flower herb instead of those drugs in the market their side effects are much worse.
Passion flower does help with relaxation.
Folate and folic acid, vitamin
Serum folate and homocysteine levels in patients with obsessive-compulsive disorder.
Psychiatry Clin Neurosci. 2005; Atmaca M, Tezcan E. University, School of Medicine, Department of Psychiatry, Elazig, Turkey.
Previous studies have shown that folate deficiency, increased homocysteine, impaired metylation have been identified in depressive disorder. Recently, growing research has resulted in the biological association between obsessive-compulsive disorder and affective disorders. Therefore, in the present study it was evaluated whether or not folate and homocysteine levels changed. We identified that a group of patients with OCD might have folate deficiency, higher homocysteine levels and probable impaired metylation and monoamine metabolism.
came across some documentation on excessive folic acid exacerbating OCD. Do you
know of any link between the two?
I am not aware of studies that show excessive intake of this B vitamin causes or aggravates this condition.
Vitamin B12 and folic acid serum levels in obsessive
Acta Psychiatr Scand. 1988.
Vitamin B12 and folate serum levels were studied in 30 patients with obsessive compulsive disorder and in two control groups comprised of 30 chronic schizophrenics and 30 normal healthy subjects. Six patients (20%) of the OCD group had abnormal low levels of vitamin B12. This prevalence was significantly higher than that of the control groups. No clinical neurological or haematological abnormalities accompanied the reduced vitamin B12 levels. Possible implication of this finding for the pathophysiology of OCD in a subgroup of patients and the possibility that the B12 deficiency could be the consequence rather than the cause of OCD are suggested.
Role of diet and food
Does diet play a role in obsessive compulsive disorder?
I don't know. Diet does influence brain chemical levels, but I don't know if the course of obsessive compulsive disorder can be altered by food or diet. I doubt diet or food selection has a strong influence on OCD symptoms although some people may benefit from eating less sweets and sugar and more fish and omega-3 oils.
Obsessive compulsive disorder treatment
While both psychotherapy and medication can be effective for children and adolescents with obsessive-compulsive disorder, therapy may be the best choice. Such non-drug treatment, specifically a process involving exposure and response prevention (ERP), is not as widely available as medication, but it appears to be associated with fewer residual symptoms. ERP is more effective in the short term and it lasts longer than medication. ERP gives kids with OCD skills that no one can ever take away from them for life, whereas with medication they're relying on the pill. Cognitive-behavioral therapy involving exposure and response prevention (ERP) is the preferred treatment for children and adolescents, according to 1997 Expert Consensus Guidelines, but few therapists are trained in its use. Individuals treated with ERP are taught to face their fears by engaging in repeated and prolonged confrontation with whatever stimuli evokes their obsession, and refraining from responding with compulsive behavior. For example, those who frequently wash their hands after opening doors -- because of their fear of germs would practice touching doorknobs without washing their hands afterwards. Or, those with an irrational fear of bad luck associated with the number 13 may repeatedly be taken to the 13th floor of a building. When ERP therapy is unavailable, refused, or does not have the intended effect, SSRIs represent a viable treatment strategy.
A significant body of evidence documented that the orbitofrontal cortex (OFC) and the head of caudate nucleus are involved in the mediation of obsessive-compulsive disorder (OCD) symptoms. Potent serotonin (5-HT) reuptake inhibitors (SSRIs) are the only antidepressant agents thus far shown to be effective in the treatment of OCD.
People with obsessive-compulsive disorder (OCD) have high
levels of brain inflammation, a discovery that could lead to new treatments.
Medication for obsessive compulsive disorder - How to Treat
Medications most commonly used are the selective serotonin reuptake inhibitors (SSRIs) group of drugs such as fluoxetine. Prozac is the more widely available treatment for OCD. Patients may experience relapse upon discontinuation of their medication, however, so SSRI treatment is typically long-term. If you do use a SSRI for obsessive compulsive disorder, use the lowest effective dose.
Cause of obsessive compulsive disorder and symptoms
The cause of the condition is unknown. There is growing evidence that OCD represents abnormal functioning of brain circuitry, probably involving a part of the brain called the striatum. Some etiologic theories of OCD suggest a biological origin, including hypotheses involving the serotonergic system, the glutamatergic system, the orbital cortex and the basal ganglia, and streptococcal throat infections in children.
OCD is characterized by recurrent, unwanted, and distressing thoughts (obsessions) and repetitive, irresistible, behaviors (compulsions). Individuals with OCD recognize that the obsessions and compulsions are senseless or excessive yet they are unable to stop these behaviors. Symptoms such as frequent hand washing and fear of germs or frequent checking (of locked doors, for example) and fear of mistakes or disasters can appear at any age, but are not usually recognized until around age 5. See below of a longer obsessive compulsive disorder symptom list.
Late-onset OCD is characterized by female gender, lesser familial loading for OCD, and presence of precipitating factors, suggesting that it may have a distinct pathophysiology compared to juvenile- and adult-onset OCD.
Obsessive compulsive disorder in
This disorder affects about 1 percent of all children and adolescents and up to 3 percent of adults. When symptoms go untreated during the early years they usually persist throughout adulthood.
There are many signs and symptoms that could indicate a child has obsessive compulsive disorder or a tendency towards such behavior. And parents should keep in mind that there degrees of OCD, from mild to severe. In certain cases, if the behavior is channeled towards something constructive, then everyone is for the better. Concern is aroused when the behavior is excessive and prevents the child from going on with activities of daily living. Look out for these signs and symptoms to determine whether your child has obsessive compulsive disorder: Is your child excessively concerned over germs or disease? Does he or she casue harm to self or others? Are there irrational fears? Does your child constantly worry about symmetry -- needs to have possessions / surroundings arranged symmetrically and/or to move in symmetrical ways, way beyond normal behavior? Actually certain OCD behaviors if not extreme can lead to future success at school or career. What about hoarding useless or meaningless objects such as old newspapers or food? Does your child have certain compulsions such as washing hands until they are red and chapped; brushing teeth until gums bleed. Checking -- returning to check that the door is locked more than once. Counting -- counting of steps while walking; insistence on performing a task a specific number of times. Repeating or redoing things over and over again?
Q. I read an article on obsessive compulsive anxiety disorder that said GABA was helpful. Have you heard of this?
A. No, I have not come across research on GABA and obsessive compulsive disorder.
Is there a blood test for
obsessive compulsive disorder?
Not that I am aware of.
Q. I have started giving L tyrosine to my son (
adult- sized 17 year old) for obsessive compulsive disorder (he has mild
OCD which was diagnosed when he was 5. It mainly manifests as slightly
obsessive behavior which he is able to manage w/o medication. He is also a
bit grumpy and depressive plus gets anxious when stressed. I started
taking L Tyrosine
myself recently ( for depression) and I found it to be very helpful so
thought it might be good for my son to try for his grumpiness. He seems to
be doing well on 500- 1000 mg plus a
supplement - a marked improvement!. I recently read about
Inositol as a
treatment for OCD
and am considering it for him. I cannot find info anywhere regarding the
interaction of inositol and tyrosene. Do you know if it is safe to combine
them? I would like to give him 500- 100mg tyrosene combined with 500- 100
inositol (or possibly more if safe) From what I read, the studied dosage
of Inositol for OCD is around
1.8 gm . I hope you will respond as I don't know where else to find this kind of info.
A. We have not seen any research with this combination for obsessive compulsive disorder or other conditions, so it is difficult to predict. Over the long run, the use of 500 to 1000 mg of tyrosine may be too much for most people, particularly children. Under medical supervision one could try inositol by itself, starting with lower amounts, and once one has a good understanding on how inositol is working, then perhaps the combination could be tried with reduced dosages at first. Unexpected reactions can sometimes occur when nutrients or medicines are combined.
Q. I was wondering if you had any information as
to what is the best possible herb (s) for obsessive compulsive disorder OCD patients. I have been reading different things on the internet and the
two best ones I can come up with is St. John's Wort and Passion Flower.
A. Perhaps St. John's wort could help in some people. 5HTP could also be tried, it may take trial and error to find the right supplement.
Q. I went on to your website to gain some
knowledge on alternative remedies for obsessive compulsive disorder OCD. I
found it extremely helpful and interesting and am emailing you to let you
know how handy this was. I gave birth to my son via emergency caesarian on
the 15th August 2006. It was a traumatic birth because I went through
labour and then when that didn't work out, I had an emergency c section.
Anyhow, after this, I was feeling low and down and because I couldn't
breastfeed for long, it made me feel I wasn't a good mother. The worse was
still to come. After approximately a month after he was born, I started
developing intrusive thoughts about him. It began with the iron. I put him
in front of me so i could see what I was doing, and then all of a sudden,
I though "what if I put this to his face" God Forbid. This scared me and
it made me wonder for days where this thought came from. I dont have any
mental illness, never have, neither does it run in my family. So I was
shocked when it came. These thoughts developed further and became more
intense and scary. I saw knives close to his neck (in my mind of course)
and this worried me lots. Everytime I would enter the kitchen, the 'knife'
thought would pop into my head and it made me so panicky, that I would
just break down in tears. This has been continuing for 8 months now. I
decided to get some help so opted for homeopathy and vibrational therapy.
They have helped me immensely but the thoughts are still there. They
calmed my nerves and lessened the thoughts however, those thoughts are
still lurking in the background, waiting to arise. It always is on my min,
'what shall I do', 'why did this happen to me', 'what can I do to solve
it', these questions run in my head all day long even till this day. I
have thoughts about harming him with sharp objects, basically anything my
stupid mind wants to think, it comes up and the more I ignore it, the more
it comes out. I also used to get thoughts about 'abuse' and the different
types which put me in a great amount of mental anguish, because I could
not accept my mind was thinking in such a horrid way. And it comes at the
most oddest times of the day, whether I am shopping or watching TV, even
if I am keeping myself occupied it still comes and it makes me shatter and
weep, because I hate the thoughts, they disgust me and scare me. I would
never act on them but its the fear of the thoughts coming. Its horrible,
its sick and I want them to go away. I have steered clear from western
medicine as I know the side effects of anti depressants so have chosen to
go the alternative way. Today I bought Inositol, powder form, to see if
this may help. I hope it does. Can u please suggest any tips for me. This
is called post partum obsessive compulsive disorder. I have also taken up
counseling - Cognitive Behavioural Therapy (CBT), which I am going to
start next week some time, so hoping that plays a huge role in assisting
me with this nasty condition I may have. What can I do to help me more?
What else can I use to assist me? Would what I have be classified the same
as ordinary OCD obsessive compulsive disorder? I would be very grateful
for ur help, I have searched everywhere to find an answer. I love my son
and just wish the bond between us could get strong. 8 months of his and my
life have been disturbed emotionally with this upheaval.
A. This is scary yet quite interesting how it developed post partum. We don't have any experience in the treatment of post partum obsessive compulsive disorder but it is worthwhile, under medical care, to try different supplements as listed on our page, and if they are not effective then the temporary use of medications could be tried.
Q. I had post partum obsessive compulsive disorder. I had this happen to me after my child was born. The thoughts are very scary indeed. However, I found out that my thyroid glad TSH was a 10 at that time! after they found out that my thyroid was causing my brain to malfunction and they set me on the road to fixing the thyroid. I am on Armour thyroid, it works very well for me and I recommend it to anyone. It took awhile to get back my normal mind and mental state, but, I am totally normal now with no obsessive compulsive disorder or bad thoughts! The thyroid and the mind connection is a huge factor and I thought maybe if someone reads this it would help them tremendously to know they are not crazy and to have the thyroid checked if you are having obsessive compulsive disorder symptoms or obsessive bad thoughts. It could very well be that is all it is, and when you can fix the thyroid the neurotransmitters start working again.
Q. In your article you state in the very beginning that obsessive compulsive
disorder and obsessive compulsive
personality disorder are one and the
same. I would like to suggest that they are two very different disorders.
While I am not a doctor, I have been diagnosed with
obsessive compulsive personality disorder and in doing much research to learn about the disorder
that I have struggled throughout my whole life, I know with little doubt
that they are different disorders.
A. Perhaps you did not read the first paragraph correctly. It says that they share similar characteristics, not that they are exactly the same disorder.
Q. I have read your
articles on Sam-e and i am really impressed. I am suffering from Obsessive
Compulsive Disorder since 18 yrs i initially took Prozac before and it
helped me but side effects. I stopped taking it. Now i am ok but still
suffering from OCD and a anxiety. I am working on computers as programmer
i need to think logic a lot. I am scared to take any medication as it
might make me not think or drowsy as i need to do job for my living. I
want to try herbal supplements and am not sure which is good for obsessive compulsive disorder and little anxiety. i
usually doest have courage to speak on stage or cant talk to boss with
confidence) So can you please help me ,which is the best herbal medicine
for my obsessive compulsive disorder problem with less side
effects and should not obstruct my job.
A. Some of the supplements listed above could be tried under medical supervision.
Q. i have been
diagnosed with Obsessive Compulsive Disorder and tried Effexor and Celexa
for about 1.5 months each and they both made me feel worse. Does 5htp help
for ocd and anxiety? My GP tried to get me on Paxil and i said no thank
you, I am afraid of these SSRI drugs.
A. 5-HTP can help some people with obsessive compulsive disorder and anxiety but it is impossible to predict whether it will work in any individual person.
Q. I don't have any control on mind.
My mind wants to remember the songs and will recollect without my
permission. While at work I am not able to concentrate. If I listen to any
song my mind recollects it and will stay in my mind forever. I am not able
to concentrate. Please help me on this. If I require herbal medication
then I am very much interested on it. Is this OCD?
A. Good question. We have not studied this area of psychiatry and don't know if this falls under the category of obsessive compulsive disorder.
Q. I read something at the beginning of your OCD
page that I wish to present a different opinion. In this line of an
article regarding obsessive compulsive disorder, "Also known as
obsessive compulsive personality disorder, obsessive compulsive disorder is
classified as an anxiety disorder in the DSM-IV-TR [American Psychiatric
Association, 2000. " For what I have read OCD and OCPD are different.
A. The first line will now reads: Obsessive compulsive disorder OCD is classified as an anxiety disorder in the DSM-IV-TR [American Psychiatric Association, 2000. The latest thinking is that there is a large overlap between the two and some psychiatrists are starting to think that separating them into different categories may not be as necessary. OCPD could be considered within the obsessive compulsive spectrum and the treatment for these conditions has some similarities.
Q. I am a patient suffering from obsessive compulsive
disorder. I used to take Prozac and it was working very well for the obsessive
compulsive disorder but I noticed that I had no sex drive so my doctor has
recently changed my medicine to Zoloft. I have been on Zoloft for almost a
month now and has noticed a little change in my sex drive. I wonder if
there is anything wrong taking Zoloft and ginseng? I was reading a lot
about natural herbs and how they can improve sexual dysfunction. I was
just wondering if mixing the two would be a bad idea.
A. Depending on the dosage used of the medication and the supplements, side effects could occur. It is not easy to give a specific answer since different people may react differently regarding the combinations.
Which natural supplements are consider to be
helpful in treating Obsessive compulsive disorder? If taken natural
supplements for OCD, how long before results are noticed? Is there any
studies none on natural supplements
for treating OCD?
Each person is different as to the effectiveness of the natural supplements for their condition and how long it takes to work.
Q. I thought I'd add a few comments to your
obsessive compulsive disorder page. I'm a 55-year-old woman and have
suffered from obsessive compulsive disorder since childhood. I'm now using
a couple of diet and lifestyle changes that help me mitigate its effects.
When I neglect one of these things I see more obsessive compulsive
disorder symptoms within hours or days. What's beneficial to me in terms
of a natural obsessive compulsive disorder treatment:
1) Eating a low glycemic index diet
2) Increasing omega threes in diet; cutting back on omega sixes. (I started doing this during menopause and it seemed to help with anxiety generally.)
3) Getting vigorous physical exercise -- by this I mean getting enough exercise to sweat through a T-shirt. I go to the gym a couple times a week.
4) Getting plenty of sleep. For reasons I don't understand my brain tends to reset itself overnight. Obsessive fears from the previous day tend to fade after a good night's sleep. If I get over-tired the OCD gets much worse.
Recently, I've also tried increasing my dietary magnesium intake. I cannot vouch for this with certainty, but I believe it helps. Thanks for the information on your site. I wish I'd had access to this much information decades ago!
Q. If someone suffers from a mild case of OCD, specifically obsessive thoughts is there something natural that may help alleviate this? Thanks for a great website and great information.
I have two different areas for which I am considering
products. One is my son, who has been diagnosed only recently with OCD and my
grandson who is ADHD. My grandson is currently taking B'Calmed. This seems to
have helped and, perhaps over a period of time, this will prove to be sufficient
to aid in this disorder. But, I was looking at some of the other products you
have available and since dopamine and serotonin seems to be involved in ADHD, I
was thinking that one of your products may be more effective. My grandson is 11
years old. I was looking at the Mind Power Rx, perhaps one a day. I noticed that
you recommend only taking for 6 days and skipping a day. My son, who has been
diagnosed with OCD, is now 41. He has been on medication, but it has had some
bad reactions to the medications, and the doctor he went to put him on very high
doses as opposed to starting out on smaller doses and increasing them over time.
He is currently on two different medications. I do not recall the names of
either, but I can get those if you need them. However, in reviewing information
on your web site, I was thinking the L Tyrosine or 5HTP, together with the B
Vitamin supplement may be helpful for him. I would appreciate any suggestion you
could provide. I know that each person is different and may respond differently
to supplements, but any information you could give would be appreciated.
I am not in a position to provide individual suggestions, but perhaps some of the information on this page and the one on ADHD may be helpful.
I just finished reading your book Mind Boosters. It was
so jam-packed with great info, Iíll need to read it over and over! I loved it. I
was reading the book primarily to get nutritional supplement info for my
daughter. The problem is sheís only 10 and Iím not sure if the recommendations
in your book could carry over to the pediatric population. Therefore, Iím hoping
you can recommend a supplement that would be safe for her. My daughter has many
challenges. She was diagnosed with dyseidetic dyslexia about a year ago. She has
a long history of worry and sensory problems and most recently has been
diagnosed with ocd. She has had the ocd since June 2009. In appeared to come on
overnight. We have ruled out P.A.N.D.A.s. She works with a cognitive behavioral
therapist but is making little progress because of the severity of the ocd. We
have tried SSRIs. First, Celexa which made her feel extremely restless and had
to be in constant motion and secondly, Lexapro, which after 3 days, caused so
much involuntary motor activity, that she ended up at the emergency room. She
has been off of all prescriptions since August. She has tried SAM-e 200mg once a
day and inositol 1600mg 3x/day along with co-enzyme B complex for a couple of
months. There was initially a slight improvement in her condition, but that
passed and we took her off of the Sam-e and inositol. Right now she is only on B
complex and 1200mg of omega 3s. We avoid (as much as possible) any artificial
food colorings / flavorings and preservatives. Trying to feed her a wholesome,
balanced diet. Any suggestions on supplements we should try? She does not have
any known allergies, but does have ďadverse reactionsĒ to Benedryl (makes her
hallucinate and completely lose control).
Perhaps some of the suggestions on this page could help. It is not easy to predict which therapy will work without giving a try. The dosages used in children are lower than those in adults.
I am hoping that you can share with me if
you aware of any studies where nutritional supplementation has been helpful in
treating young patients with mild - moderate OCD circumstances related to
PANDAS. My daughter just turned 7 and within a week went from a kid that you had
to force to take a bath, to a kid that washes her hands 30-40 times per day and
wants to get in the shower the minute she gets home from school. Though our
family doctor was not aware of the syndrome, I contacted a family therapist who
we are scheduled to see early next week, who suggested it could be PANDAS. Her
health history would certainly indicate that it is. She had a very high fever
that lasted 5 days about a month ago and has had strep 4 times in the last 3
years. Our family doctor did prescribe a 10 day course of antibiotics which the
case studies that we found recommended as a first course of treatment and we are
hopeful that her symptoms will improve soon. That said, I am big believer in
nutritional supplementation, and am wondering if there has been any studies that
demonstrate an improvement in symptoms for OCD patients, even those where the
condition is brought about as a result of PANDAS. I just bought some St. John's
Wart liquid in hopes that would help with the anxiety.
I am not familiar with the natural treatment of this condition.
I read some questions on your site about women, who after having given birth, develop post partum ocd and recalled something I heard from a naturopath, Vaughn Lawrence, who I believe stated that when a woman is pregnant, her body gets depleted of Omega 3 fatty acids because she has to transfer her stores to the baby for it's well-being, so when the baby's born the mother is has a serious deficiency of Omega 3s. Which is why, I believe, he recommends supplementing Omega 3s during pregnancies.
I wanted to let you know that my teenage son participated in a clinical trial at Yale for OCD with N-acetylcysteine with very good results. They used an effervescent NAC formula (PharmaNAC) of 900 mg a day for the first two weeks, 1800 mg a day the second two, then 2700 mg per day after that. I have also tried it to reduce cigarette cravings and had significantly reduced cravings, although it irritated my bladder too much to continue. I wanted to share our experiences with you.