Iceberg

Ha well- ketamine. But that’s kinda cheating. so low dose clozaril with adderall

If your nervous you could always start with a super low dose to see how it makes you feel

Do you take any PRN meds?

I might consider going back to the Dexedrine if you think that’s the major issue- it could give you time to get something stabilizing on board and then try a switch back...cuz you don’t want to hit the point we’re it gets bad enough that adding Dexedrine back won’t fix the mood issues, cuz then ur kinda stuck...especially since you’ve tried the usual suspects What’s ur current AP?

Vistaril maybe if pdoc doesn’t do benzos?

Really depends... sedation can lessen pretty quickly, and tolerance I’ve heard can be significant at 3/4 weeks, obviously longer or shorter depending on the person. Also, that’s for constant therapeutic dose, which I don’t think your taking. However, if taking it for sleep it definitely can be less effective over time, again less so If your doing PRN. There are lots of differing opinions about this. My current doc is ok with long term use ( but won’t go above a ceiling dose) because he feels that while the effect is diminished it is still there, especially in treatment resistant cases. Other docs will feel the need to taper or switch benzos. It’s a good conversation to have with your pdoc if you are concerned about planning/future issues.

That’s another way to address tolerance- although I don’t think you’re there- I know of some pdocs who will set a hard limit for mg/day of the benzo. That way if your heading towards the limit you know that a new/changed sustainable treatment might be warranted and you can get ahead of maxing out a benzo and then getting screwed when it doesn’t work as well and you have to come up with a whole new plan

You can build tolerance...but many pdocs will dose benzos regularly anyway if they feel other options can’t cut it so the benefits outweigh the risks

Well...id day the fact that you both acknowledge what’s going on is a start. I feel like lots of relationship involving MI end up with people trying to avoid the issue, hope it just gets better, or become super codependent to the point that it causes serious issues. So it sounds like you both respect each other’s space- which is really important. My first relationship as I was getting Dx’d was fairly awful cuz I’d feel shitty, person would try to help but then be upset when I didn’t just magically feel better or decided I didn’t want to talk, then I would see her upset and get more upset and round and round and round. Seems like your trying to avoid that too, which is probably well advised. However, if these fights and hostilities are getting in the way of your lives- it might warrant a serious conversation about if this is really healthy going foreword...or if you think there is going to be a pattern of tension. I’m not saying you can’t date someone with MI- but that first while of new meds/new Dx is especially hard, and if you move foreword your going to have to accept that this relationship might be a hell of a lot of work on top of the stresses of dating/possibly getting married/etc. my advice would be maybe try couples therapy- maybe even once just for a feel...cuz when there’s MI involved an objective perspective usually doesn’t hurt- and maybe try to establish a “protocol” ...an agreed upon way to approach things as far as signaling when you really need to be alone or when you really need to talk. But: if things seem like it’s getting unhealthy or causing consistent problems you need to evaluate whether this is what’s best for you...because forcing something too much may not be good for you or your SO. Also, meds are a wildcard in this department- yes they can really help with irritability/mood liability but it’s often a “gets worse before it gets better” thing. I’m not saying this cuz I think you should end the relationship or that it can’t work...more that in the new d’x new meds figuring it out stage...you really do need to put your health above all else. I wish you the best!

Maybe it’s just the combined effect of all of them

My doc says he has patients who do scheduled meds through mail order- so delivery may be possible though I’ve never tried myself

How’s your relationship with this pdoc? Sounds like you maybe aren’t on the same page as far as how urgent things are

Did it once- helpful cuz they got me off the problem meds quickly and avoided a super long cross titration

By overshot I just meant that you titrated past your ideal spot. Like I said though that doesn’t make as much sense with a stim. Could the low dose just be not treating the symptoms well as opposed to actually causing the issues?

Well, there are definite issues, but if your mental health is really problematic and nothing else works then you might have to take the chance. I had little weight gain on 10mg but I was pretty young and seemed to have a really high metabolism as I didn’t gain much on 800mg seroquel either. If you do a trial, and monitor things carefully and frequently you could probably catch issues before they get really bad