Serotonin Syndrome Explained (Serotonin Toxicity)

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  • Опубліковано 19 гру 2024

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  • @RhesusMedicine
    @RhesusMedicine  2 роки тому +9

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    Video Timestamps:
    0:00 What is Serotonin Syndrome?
    0:25 Serotonin Syndrome Pathophysiology
    2:03 Serotonin Syndrome Symptoms
    3:26 Serotonin Syndrome Risk Factors
    4:08 Serotonin Syndrome Diagnosis (Hunter Serotonin Toxicity Criteria)
    5:16 Serotonin Syndrome Treatment

    • @Panda-cp9cs
      @Panda-cp9cs Рік тому

      that heartbeat at the start has been the smartest intro that I have ever seen. You probably already know what I mean

  • @Badboybonsai
    @Badboybonsai Рік тому +189

    I had serotonin syndrome caused by citalopram, I spent a month in a coma and now have epilepsy. Ruined my life. Lost my job and driver’s license.

    • @inutero2068
      @inutero2068 Рік тому +7

      So sorry to hear that friend

    • @jbuddyman
      @jbuddyman Рік тому +5

      🙏🙏🙏 so sorry prayers

    • @greendevul
      @greendevul Рік тому +1

      How did u get it

    • @Badboybonsai
      @Badboybonsai Рік тому +31

      @@greendevul anti anxiety medication mixed with painkillers. I didn’t know you couldn’t mix them, I was on holiday and had a terrible headache so took some painkillers, next day I was in ICU on full life support.

    • @greendevul
      @greendevul Рік тому +2

      @Adam Murray dang I will be praying for u do u know if u can get that by also taken benadrills or melatonin wit it

  • @stevelindsay3643
    @stevelindsay3643 Рік тому +40

    WELL DONE. THE BODY TEMP SWING HAS ALWAYS BLOWN ME AWAY.
    IT CAN BE A 100 DEGREES IN HERE AND I'M STILL SHIVERING AND SHAKING, FREEZING MY ASS OFF.

  • @samr.3515
    @samr.3515 6 місяців тому +35

    I was on 6 different meds that affected serotonin production when i decided to experiment with Lsd. I didn't know about serotonin sydrome and i had 14 seizures in 2 hours and almost died.

    • @wattsnottaken1
      @wattsnottaken1 3 місяці тому +1

      Did you recover ?

    • @iamwonderfool1426
      @iamwonderfool1426 3 місяці тому +1

      Same, I had amphetamines and LSD in my system and was on the verge of death as well. I was preparing for my departure the whole time and having multiple seizures throughout. I thought my mother was taking me to the place where you cross over. I had an outer body separation during segments. My mom took me to the hospital and I woke up from a seizure in the hospital jumping up for joy because I couldn't believe I was still alive. When I would gather some of my senses back I was living in a state of deep nostalgia from the year I was born 1985. Everything I was witnessing was how things appeared in the 80s; very retro. The hospital equipment and everyone's clothing; what my mom was wearing was all from the 80s. There were some darker moments as well because some people appeared like they were close to death. I just kept mentally preparing myself for the worst. I was having seizures and nobody even knew, especially because no one knew what kind of drug interaction I was having. Eventually I was released without any treatment and had a few small seizures before I got in my mom's car and floated home back to her house (the house I grew up in). My son awaited me and is the reason why I think I pulled through. I couldn't leave my little guy, I'm supposed to be here to protect him. I was careless and made one mistake I'll never make again. Ps. I don't have any noticeable side effects except for the vivid memories I witnessed throughout the ordeal.

  • @m4ssee
    @m4ssee Рік тому +41

    I think I once had (a mild case of) this. Took DXM with beer while using 5-HTP and mirtatzapine regularly as I didn't know about the interactions. Felt very dizzy, jittery, sweaty and disoriented for like a week.

    • @Vengeance627
      @Vengeance627 Рік тому +3

      hey pal I have just recently and unfortuenly had the exact same experience with the same cocktail of substances you took minus mirta I took a low dose dxm dose with 300mg of 5htp (big mistake, folk may say it can't cause SS like ssris of any type do yet there are others out there who had the same thing), caused mild/moderate ss, went away, drank a few beers then it came back and I went to the ER. SS even mild is nightmare shit I felt like I was being scorched alive in tandem with a bad time of dxm the SS put me in.
      i see im far from the only one there are others on the reddit sub who experienced the same. it lasted a week for you :( sorry to hear it must of been awful it's day two-three for me I am fairly back to normal.

    • @wattsnottaken1
      @wattsnottaken1 3 місяці тому +1

      @@Vengeance627are you okay now?. I’m experiencing serotonin syndrome right now will this eventually go away?

    • @Vengeance627
      @Vengeance627 3 місяці тому

      @@wattsnottaken1 yes i am no more ss wish you luck, how'd it happen for you

    • @Vengeance627
      @Vengeance627 3 місяці тому

      @@wattsnottaken1 u alright

    • @wattsnottaken1
      @wattsnottaken1 3 місяці тому +1

      @@Vengeance627 how long did it take you recover? I’m experiencing Serotonin syndrome right now

  • @Rat_Queen86
    @Rat_Queen86 8 місяців тому +14

    I had my SSRIS increased due to higher anxiety
    1 day later, I had the runs, headaches, trembling, muscles twitches, sweating…it was mild but still, I needed at least a week to recover at home 😮

    • @reginaharding9855
      @reginaharding9855 7 місяців тому +1

      Yup. Celexa with trazedone did it to me. Currently recovering

    • @wattsnottaken1
      @wattsnottaken1 3 місяці тому +1

      @@reginaharding9855how long did it take for you to fully recover ? I’m experiencing serotonin syndrome right now

  • @michelebunting6706
    @michelebunting6706 2 роки тому +59

    I think my mom had this last week. It was awful. She’s on 2 or 3 antidepressants. One benzodiazepine. And other meds. She was vomiting, pail, heart palpitations. Had falls and passed out once. It’s no joke!

    • @somethingbambi875
      @somethingbambi875 Рік тому +1

      Benzo is the worst thing I have ever experienced. No one (but mom) believes me because they never been experience anything on it, but it made me have a physcosis, which I had never experienced before and never after, had to be hospitalized, it was the scariest thing ever!!!

    • @Kaitlyn-Alba471
      @Kaitlyn-Alba471 Рік тому +5

      Benzos don’t cause serotonin syndrome. Benzos are a central nervous system drug. Matter or fact, benzos are the first line to treat serotonin syndrome. But may I ask which antidepressants? I just started one and one only. Taken remeron and celexa for years without having serotonin syndrome. But now I’m getting back on celexa to quit Kratom. I’m just curious for people who had it or know people what the actually drugs were that caused it

  • @clementine8008
    @clementine8008 4 місяці тому +2

    SSRI have this too. I was going to the birth of my nephew. I was rushing and I definitely took a double dose of my medication that day by mistake. The lights had a halo around them and it felt like the room was tilted. I was shivering and couldn't get warm. I didn't end up having an emergency situation but I was glad that I was in a hospital that day.

  • @15dust90
    @15dust90 Рік тому +18

    i might’ve had this one time i smoked like three blunts and i was also on a new dose of lexapro i got super sick, hella pale and my mind was super disoriented and i felt like i was gonna die
    but i was not greening out , trust me i’ve never in my life thrown up from smoking too much weed and my tolerance was very high, i know what greening out feels like and it’s never made me physically ill like that

    • @ramennoodles2589
      @ramennoodles2589 6 місяців тому

      That sounds exactly like a greenout, the same thing happened to me
      It's weird but sometimes you can suddenly have a completely different reaction to weed like flipping a switch

    • @15dust90
      @15dust90 5 місяців тому +2

      @@ramennoodles2589yeah it’s super weird probably did just green out that’s why i don’t smoke anymore it’s like russian roulette for me🤣

  • @sj2383
    @sj2383 3 місяці тому +3

    I was taking phentermine for weight loss and fluoxetine for ADHD. I had no idea that they couldn't be taken together. My doctor who prescribed was aware of my other medication taken but mentioned nothing about it. I felt so out of it, like a zombie, everything was going in slow motion. I'd also have these intense random flashbacks/hallucinations.
    I trusted my doctor before I had done my own research to find that my medications were not compatible with eachother.

  • @AikoTakahashii
    @AikoTakahashii Рік тому +9

    You’re a fantastic teacher.

  • @narcissisticidiot1727
    @narcissisticidiot1727 7 місяців тому +6

    I took alcohol and Xanax (what I was told) and I believe I had this, I still have residual effects like a strange feeling every time I yawn, and a strange feeling that’s hard to describe in my stomach

    • @MorbidandSarcastic
      @MorbidandSarcastic 2 місяці тому +1

      Holy crap I have the same feeling when I yawn and I’ve only ever had that feeling when doing shrooms in the past, not on an SSRI. Now that I’m taking an SSRI I get that yawning feeling and it’s freaking me out. Do you still have that feeling now?

  • @dafni7085
    @dafni7085 Рік тому +6

    I took Valerian root + Duloxetine and was so sick had to go to er. Severe weakness, fever, sweating, vomiting etc it was awful. The Activated Charcoal I took at home helped alot. Unfortunately they didn't help me the hospital at all except for an anti- nausea pill. It was a joke

  • @somejansmind
    @somejansmind 27 днів тому +1

    2:46 myoclonus is also seizures (Myoclonic)

  • @shinjiikari5174
    @shinjiikari5174 7 місяців тому +21

    Oh shit, looks like I need to talk to my psychiatrist, how the hell did he not pick up on all the concerningly overlapping symptoms I've mentioned in relation to my medication?

    • @Bigf00t100
      @Bigf00t100 7 місяців тому

      Any luck with finding a solution?

    • @ryankelly7216
      @ryankelly7216 7 місяців тому

      i have it too. going through it right now. it is awful

    • @reginaharding9855
      @reginaharding9855 7 місяців тому +2

      . I was on trazedone and they added celexa and I was feeling so bad I added HydrOXYzine and promethazine to help. Bad idea. I kept going to hospital because I thought I was having seizures. Dizzy, nausea, vomiting, diarrhea, tremors, trance spells, head shaking, oxygen was bad, agitation, insomnia, sweating, clenching jaw, neurological issues, list goes on. I didn't have a fever. I'm currently recovering. Horrible

    • @belizejuliette7223
      @belizejuliette7223 6 місяців тому

      Exactly what my thought is 🥺

  • @sirseas5532
    @sirseas5532 3 місяці тому +2

    So I’m taking some medication and notices some twitching in my legs mainly, but also in my shoulders and stomach from time to time. But that’s it. It’s a twitch like you have when you’re sleeping and then jolt back awake. It happens when I’m in bed mostly

  • @mitacestalia7532
    @mitacestalia7532 Рік тому +9

    Uh, I might need to check to my doctor. I've been having heart palpitations, nausea, want to vomit and lost appetite, and twitching legs too.... It's been going for three weeks too...

  • @tggraham3321
    @tggraham3321 2 роки тому +17

    An unknown combo to be careful of is the OTC supplement 5HTP and onedestrone (zofran) os dangerous. But taking along with buspar, and hydroxizine even worse. Be sure you talk to your doctor before adding any supplements. I made this mistake and it was a terrible!

    • @Vengeance627
      @Vengeance627 Рік тому +1

      I think 5htp, unless used with major caution and knowledge is just a risky substance in general ya gonna take something else likely within the timeframe of using 5htp and then this happens.

    • @meaganyn
      @meaganyn 9 місяців тому

      Wait tell me more about this…

    • @tggraham3321
      @tggraham3321 9 місяців тому

      @@meaganyn what would you like me to elaborate on?

    • @meaganyn
      @meaganyn 9 місяців тому

      @@tggraham3321 well I take all of those except not buspar … I’ve def taken 5htp, hydroxyzine, magnesium, tart cherry, melatonin at night all together… why is it so bad?

  • @IK_59
    @IK_59 Рік тому +5

    Very nice work

    • @Panda-cp9cs
      @Panda-cp9cs Рік тому

      indeed

    • @Panda-cp9cs
      @Panda-cp9cs Рік тому

      Indeed is the #1 job site in the world1 with over 300M unique visitors every month2. Indeed strives to put job seekers first, giving them free access to search for jobs, post resumes, and research companies. Every day, we connect millions of people to new opportunities.

  • @helenalovelock1030
    @helenalovelock1030 2 роки тому +10

    My daughter (21 years) had this within hours/days of being put on starting dose 20mg of Citalopram.

    • @danielsan3681
      @danielsan3681 2 роки тому

      😢

    • @user-ri4fy3td1e
      @user-ri4fy3td1e Рік тому +4

      Is she okay, i hope so. I am having it right now too and anxious

    • @pixeljoker8759
      @pixeljoker8759 Рік тому

      ​@@user-ri4fy3td1eI hope everything was ok I'm not sure if I was having it but the symptoms were bad all day

    • @jadrobe3492
      @jadrobe3492 11 місяців тому

      @@user-ri4fy3td1edid you recover alright?

  • @edgarcasey1840
    @edgarcasey1840 Рік тому +8

    How about mdma and using 5htp to help r
    Heal the serotonin receptors

    • @DxmAddict
      @DxmAddict Рік тому +13

      If you have seretonin syndrome Just take a long break from all drugs, go smoke some weed

    • @edgarcasey1840
      @edgarcasey1840 Рік тому

      @@DxmAddict I don't have it. Never have just wondering about mdma and 5htp to help revover

    • @Kaitlyn-Alba471
      @Kaitlyn-Alba471 Рік тому +4

      @@edgarcasey1840if you happened to be a rare case of getting serotonin syndrome, because it is rare which people don’t realize. Why on earth would you combine those 2?! That’s asking your serotonin syndrome to amplify

    • @lavafixer8477
      @lavafixer8477 9 місяців тому

      @@edgarcasey1840Mdma is neurotoxic to the serotonergic neurotransmission system, I can’t imagine that would help at all. 5-htp would probably be fine a while after you have serotonin syndrome, as it’s not a serotonin releasing agent or SERT inhibitor.

  • @melankoIi
    @melankoIi Рік тому +8

    had this yesterday for the second time lmao it feels hard to breathe for days afterwards

  • @GoonEntertainmentOfficial
    @GoonEntertainmentOfficial 4 місяці тому +3

    Stopped smoking for 3 months because of anxiety. Doctor put me on sertraline, been taking for about a month, smoked a small bowl, was fine. Next day smoked a bowl again about 2hrs after taking medication..got very disoriented, felt like I was tripping on LSD, heart rate was 170 and I had tremors and abdomen was spasming..
    What happened? Lol

  • @ZaddyGohan
    @ZaddyGohan Рік тому +28

    So I take Zoloft on a regular basis. Last night I was under the influence of marijuana, and realized I had forgotten to take my Zoloft during the day. I took it while high and what I experienced was scary to say the least. Uncontrollable shaking, everything looked fuzzy, and I almost passed out at one point. Could the combination of Zoloft with being high have cause Serotonin Syndrome?

    • @DeltaReviews420
      @DeltaReviews420 Рік тому +21

      No you were just probably too high lol weed doesn’t effect serotonin receptors

    • @jobalogo383
      @jobalogo383 Рік тому +5

      @@DeltaReviews420 WRONG
      FU

    • @DeltaReviews420
      @DeltaReviews420 Рік тому

      @@jobalogo383 ? Please do some research, your language indicates your arrogance.

    • @walterstanford8162
      @walterstanford8162 Рік тому +2

      ​@@DeltaReviews420 sadly depending on the strain it can be a downer also.

    • @DeltaReviews420
      @DeltaReviews420 Рік тому

      @@walterstanford8162 strain has little to no effect on the high it’s all placebo

  • @michelleelle97
    @michelleelle97 Рік тому +5

    This has happened to me I’m having really bad anxiety because of it and I don’t know how to get rid of it I feel like nothing is helping and my doctors can’t see me til Wednesday

    • @crazykida3130
      @crazykida3130 11 місяців тому

      Sleep

    • @tealeafs3824
      @tealeafs3824 7 місяців тому +1

      Because of anxiety and panick attacks I quit caffeine( coffee, chocolate, green tea, coca-cola/pepsi, energy drinks) two weeks ago. My panick attacks were so bad I also had them in my sleep.
      At first I quit for a week, no more p.a, so I drank only one coffee and panick attacks came back the same day.
      Caffeine fu*ks up your brain's sensitivity. I drink only water now.
      I still have withdrawals, and can't concentrate, but my sleep improved, no panic attacks, anxiety, etc. Is hard but totally worth it. It will take a month I guess to clear up completely.
      Hope it helps.

    • @michelleelle97
      @michelleelle97 6 місяців тому

      @@tealeafs3824 I wish I saw this ages ago I don’t really use UA-cam on my phone but I’m way better now I’m on new meds and they’re helping so far so good still a bit anxious but since then I broke my ankle and that kind of restarted it again because I was stuck bed bound basically and it depressed me but as long as I’m not how I was at this point in time I’m happy I hope things are going well for you I appreciate the comment!

  • @reganaudrey5573
    @reganaudrey5573 Рік тому +8

    So I’m on lexapro and a while back I was doing cocaine and ketamine while on the lexapro. I believe I had serotonin syndrome but it only lasted for 5 mins. It felt like a panic attack coming on except my hands and lip muscles because stiff as a board and I couldn’t talk or move my fingers. I started panicking. I was sweating profoundly and my pupils were dilated. I’m sure it was the interactions between everything but does it sound like that’s what happened? Should I have gone to the hospital?

    • @Quick_thumbs
      @Quick_thumbs Рік тому +10

      You should probably stop doing so much coke

    • @fernandosalazar3366
      @fernandosalazar3366 9 місяців тому +1

      Any amphetamine being mixed with a ssri is extremely inadvisable and yes you could have experienced that. Please be careful

    • @pamlatham5851
      @pamlatham5851 6 місяців тому +1

      It’s a thousand wonders you’re still alive !!!!

  • @jdogagt
    @jdogagt Рік тому +8

    I took 100mg of 5htp and 4 days later 50mg of 5htp. My calves locked up for 3 days, i had extreme dry eyes, tingling in toes and fingertips, felt like my heart was racing and had major anger swings. I have been to the emergency room and to a regular doctors have gotten no help at all. They referred me to a neurologist but cant get in until two months from now. I really don't no what to do but need serious help.

    • @princess555o4
      @princess555o4 Рік тому +3

      Stop taking the medication

    • @sheenanguyen4347
      @sheenanguyen4347 Рік тому +2

      Just stop taking all these medications, most doctors don’t know these ADR…

  • @lamplight1636
    @lamplight1636 8 місяців тому +3

    I'm on ssri and I took 450 mg of dxm and gave Myself this it sucked

    • @wattsnottaken1
      @wattsnottaken1 3 місяці тому

      How long did it take you to recover ?

  • @michalbrz
    @michalbrz Рік тому +6

    Small correction at 1:13, N in SNRI is not noradrenaline but norepinephrine :)

    • @KezzaPwNz
      @KezzaPwNz Рік тому +8

      They are exactly the same thing mate. One is just an American convention.

    • @michalbrz
      @michalbrz Рік тому +5

      @@KezzaPwNz oh nice, you're right. Thanks for teaching me something new!

    • @KezzaPwNz
      @KezzaPwNz Рік тому +5

      @@michalbrz No worries - wouldn't be medicine if you weren't constantly learning new things each day.

  • @johnshawdocherty7594
    @johnshawdocherty7594 24 дні тому

    I'm on buvidol injection and just been prescribed floxatine should I be ok ? brurnophine soz about spelling I'm sure u get me

  • @ainsleymatthews8099
    @ainsleymatthews8099 3 місяці тому

    I think I had this last night, I was jittery, sweaty, had diarrhea, couldn’t focus on anything, felt lightheaded and exhausted, and extremely agitated, to the point of just laying into my boyfriend for everything for no reason. I feel horrible for how I treated him, but I also know how that medications can people act in crazy ways. Idk

  • @dolliesubs222
    @dolliesubs222 4 місяці тому

    I'm taking lexapro. Going well. Now after knowing this I will stop it. It cam save my life but it could create me this??? I'm so depressed I will just end it all, I'm only 18 but I'm ending it.

    • @Jewell55737
      @Jewell55737 3 місяці тому +1

      Dollies please tell me you have some support?

    • @dolliesubs222
      @dolliesubs222 3 місяці тому

      @@Jewell55737 Hi dear thank you for asking. I'm going well!!!! 🎀💋

  • @anoopsagar8911
    @anoopsagar8911 6 місяців тому

    Had this yesterday with a combination of Lexapro and paroxatine i almost died last night.

  • @K-yu-ko8dv
    @K-yu-ko8dv Рік тому

    watching this so I remember to follow the week per plat rule of dxm

  • @blinkersarentfree
    @blinkersarentfree 6 місяців тому

    can seritionine syndrome get cause my zofran and smoking pot?

  • @mt.billings1234
    @mt.billings1234 Рік тому +2

    I tried to od on trazodone,took about twenty pills went to sleep its going on day four after and my ideation went away should I go to the doctor or will it go away on its own, I threw all my meds out

    • @crazykida3130
      @crazykida3130 11 місяців тому +1

      go check in with you doctor man better safe then sorry

  • @CosmicinnerPeaceAncientScience
    @CosmicinnerPeaceAncientScience 5 місяців тому +3

    Remember serotonin is produced in the gut. This is why it's important to eat foods based on your culture or your spirit. Only 10% is produced in our brain.
    If you eat bad foods you will reflect the energy that FOOD . anxiety, fear, and satiety.
    Remember healthy serotonin levels can help people feel calmer, happier, more focused, and less stressed.

  • @scottthomas5819
    @scottthomas5819 Рік тому

    Good 👍

  • @milanimorales2645
    @milanimorales2645 Рік тому

    I'm just trying to make sure if I eat a full pie of spinach quiche I wont get these symptoms... I heard spinach and eggs have serotonin and I am about to pig out✌

  • @takyc7883
    @takyc7883 Місяць тому

    but can you explain WHY it happens?

  • @quantumpower
    @quantumpower Рік тому +1

    3:16

  • @ashishgurung5215
    @ashishgurung5215 Рік тому

    Does serotonin syndrome cause hypertension tension

  • @канал-б4т6ч
    @канал-б4т6ч Рік тому +1

    I became pale as a paper sheet and my mouth was red and extremely dry, I had tachycardia and vomited on my friends, I woke up at 6am with a lot of diarrhea, almost shat in my underwear and my bed 😂💩
    I took Escitalopram 20mg, Vyvanse 50mg and a looot of weed 🌿.
    Everytime I mix this substances I have diarrhea and serotonin syndrome symptoms.

  • @belizejuliette7223
    @belizejuliette7223 6 місяців тому

    How come a psychiatrist bescribe SSRI, benzodiazepines, adhd drugs together? Isn’t that dangerous 😊

  • @SmokyMcbongpot
    @SmokyMcbongpot 14 днів тому

    Basically a night out on MDMA.

  • @PeaceLuvDojah
    @PeaceLuvDojah 10 місяців тому +8

    Came her to learn why my seratonin is so high. Jesus made me this way. I don’t eat a certain way or take medication I’m just uncharacteristically happy. 😂😅😂

  • @DoNotPirateNoPiracy
    @DoNotPirateNoPiracy 8 місяців тому +2

    buspar!

    • @dandez1000
      @dandez1000 3 місяці тому

      I just started taking this should I not?

  • @bee_ba
    @bee_ba 3 місяці тому

    Cyclobenzaprine

  • @olgamora4613
    @olgamora4613 Рік тому

    You are on the right track. The voice needs to change so that people can take it seriously!

  • @savannasias
    @savannasias Рік тому +3

    what heppens when we drug kids..

    • @bostonb4kedbeans
      @bostonb4kedbeans Рік тому +4

      This is not drugs like coke or crack. This is medically necessary for some people to live functioning lives.

  • @purp3870
    @purp3870 7 місяців тому +1

    Asswashganda

  • @emmamclaughlin6413
    @emmamclaughlin6413 10 місяців тому +3

    JESUS saves Roman’s 10:9-11!!!

    • @One-z6y
      @One-z6y 9 місяців тому

      HE saves our soul but not always the body.

    • @luckpup2766
      @luckpup2766 8 місяців тому

      AMEN

    • @samr.3515
      @samr.3515 6 місяців тому +4

      It certainly wasn't Jesus that treated me in the ambulance and er when I had 14 seizures in 2 hours and almost died from serotonin syndrome. They looked more like doctors.

    • @luckpup2766
      @luckpup2766 6 місяців тому

      @@samr.3515 Anothwr axample of atheista being dumb 😂😂😂😂 no one needs to even say anything more to this fool right here. We're praying for you, lil bro.

  • @ChonkyAsmr
    @ChonkyAsmr 5 місяців тому +1

    I had a very severe experience. I had a burst of energy, then suddenly, Ice cold, white as a ghost, but clammy and sweating, vomited my entire stomach contents and then some, delirious, dizzy spells,
    It’s awful, you really feel like you are dying.