Iceberg

I’ve been able to discuss this in the past, with both my pdoc and tdoc.... sometimes I start with “I’m ok but... or I’m not in danger but...” my pdoc when I was a teen used to give me the beck depression Inventory and I would aomwtimes circle one of the options about feeling suicidal and he would ask me to elaborate but would always let me explain. My current tdoc isn’t a fan of hospitalizing patients in some situations when she thinks that the hospital won’t be able to help the situation Or may even make it worse. Maybe you could bring up these concerns and ask your doc to work with you to es

Do you mean you’re telling the doc that you have intent/plan or just that you are experiencing lots of suicidal thoughts?

Not trying to be lecture-y here, but just a reminder that those sites are biased towards people reporting side effects as healthy people are often less likely to report. For what it’s worth, hair loss is not listed as common on the adverse effects and I have not heard of anyone (of any gender) experiencing that. Also, even though the half life is long, I’d think that if you start low the potential damage could be mitigated before anything really manifests long term. also I *think that the difference of effect between zofran and trintellix is that zofran have more effect on the the 5h

The concern is more with the side effects (namely a noticeable tremor and unpredictable ibs) coming back, especially because it’s probably that the side effects would appear before any positive effects. That aside, I think you’re right in that going back to lithium is the least risky option, but I’m really worried about getting lots of side effect with not that much benefit. After talking with Tdoc tomorrow I will consider calling pdoc depending on her opinion. She has been seeing me 5 years so she’s aware of my spring cycling tendencies

So if anyone saw my last blog post, pdoc and I have worked my lithium dose down from 1350 to 900 over the past few months. Well, I am kind of turning into a ball of agitated depression-y rage. I want to scream. Currently living with parents for several months now. Been totally fine until a few weeks ago when i guess i hit a wall. Now I am tensing and bracing any time anyone coughs cuz i am honestly not sure I could survive 10 days of quarantine in a healthy manner. To be clear, its not their fault... they havent changed behavior, I am just reacting differently. I am having visions of what I wo

I would think it’d depend a lot on your particular brand of depression. Bupropion can be very activating so if you have lethargy, hypersomnia, lack of motivation type things it could make sense, but I’d just be careful about activation if that’s not what your going for.

I know that some older pdocs used to go to 30 all the time before the warning about long QT

I looked and psychotic disorder doesnt seem to be an absolute contraindication, but i know that when i went for infusions, they wouldnt touch you with a ten foot poll if you were experiencing psychosis or had been experiencing psychosis within a certain amount of time (this might have been an arbitrary decision at the discretion of the docs, I don't think it was a set number)

Off the cuff thought- cymbalta is maybe more likely than remeron to cause sexual side effects. I know you don’t think it’s the cause alone, but what about trying more remeron and a little less cymbalta. I’d imagine that at 120mgs tapering off the cymbalta to something else just isnt going to happen

I know you’re skeptical, but I I think that a slight reduction is a reasonable strategy, 15 of ambien is pretty high ... I’m not saying it’ll work, but it would at least establish that the 15 of ambien is a must have

yeah, know that ambien can be really love/hate in that it is the only option for some and be a total mess for others. have you ever tried any of the tricyclics? they can sometimes be sleep promoting, but they are side-effect heavy(ier) and im not sure if they would play nice with higher doses of ambien. sorry, im trying to not just start listing stuff and repeating things youve already tried

Would you be willing to try other sleep meds instead of the zolpidem? I’m thinking sonata or belsomra. Remeron is a bit unique in the us, there aren’t many 1-to-1 replacement options with the same action. For what it’s worth the trintellix is supposedly much better than traditional SSRIs in the sexual side effects department, but I agree that it may not make sense if u can’t tolerate activating meds.

It’s definitely done for BP depression, but I’m not sure if it’s off limits for any psychosis or just present psychosis in BP depression

What about Intuniv? It’s a blood pressure med approved for ADHD in people under 18 (I don’t know your age but I’m just mentioning that because I am unsure of it’s use in adults in the US, but it has been approved for adults internationally)

In that case, I don’t know much, but I think it’s encouraging that your doc is willing to try such an individualized program. Hope it helps!