Iceberg

Clozaril has been my most effective single med. my parents described it as “making me a whole new person.” Took me awhile to get there as (for some reason I. Can’t imagine) they are reluctant to start teenagers on cloz. It’s helped, but it is also a fucking pain in the ass to manage. with regular bloodwork and dealing with the REMS, the fact that it is somewhat slow so we have often overshot dosing changes, the sedation and hypersomnia it is easy to imagine why the dropout rate is so high and that many docs are probably botching the trial

Have you called your doctor? If you’re hitting mania despite the lithium, you might need a full-time add on to control it, not just a sleep PRN

I went on remeron for depression, but especially to help the insomnia that came with it. I didn’t really feel it for sleep either and we had to add on another sleep med I’m not saying it doesn’t work, just that I can relate to it not making you sleepy

Shit sorry, totally missed it being your pcp.

I guess if you feel better from the placebo it’s technically still working just in a different way

I was on 600 tid for awhile and had no issues coming off probably over several weeks (I was also on klonipin and I have the super lucky trait of being able to withstand most fast tapers so I wouldn’t put any stock in that.) in the interest of open mindedness, I might see what the pdoc says first and then go from there. I know you are in no way going out on your own here, bur also it might be good to get a sense of direction first so that you’re both starting out on the same page

I sometimes wonder if that is often a placebo with ADs when it works that fast.... I feel like it is statistically suspicious. Can it happen? I’m sure. But it seems to be reported more than the science would suggest. Oh, and no offense to your aunt. Obviously I don’t know anything about your family, It just triggered some thoughts about people in mine on ADs

Actually it’s the opposite now- all nurse practitioners specialize and their focus is actually more narrow. After getting registered as a nurse, their advanced training is focused in just their specialty area, so they end up with a lot of hours on therapy and focus on med management - but the med management is limited to the psych scope of practice (plus some general stuff obviously). Many nurse practitioner programs require you to declare a specialty to study right at the start

My pdoc has also been around since clozaril came out and he said that he’s never had to take anyone off it due to WBC

I believe @Wonderful.Cheese Has already tried clozaril at significant doses?

Cheese your not annoying. I have had similiar time periods of doubting and second guessing my meds constantly on a loop in my head. I wish I had the right answer, but I don’t, I’m sorry you’re going through this

How recently exactly? I had to take klonipin tid for full effect, but I would take a little extra at night to last to the am. I used to do 1mg, 1mg, 2mg -... not saying you should take that much just that you Might be able to alter your dosing

I do think that for very complex cases people will lean towards a psychiatrist... which makes sense they probably have a better range of experience when it comes to treating outside the box. But I think standard combinations are probably well within the scope. Like I said, that doesn’t matter if you just don’t like the APRN then that’s a whole other issue

There are lots of states where Nps can practice all on their own, so they are definitely trained to handle such things. I have a family member with APRN treating, and she has her on multiple classes of meds together that seem to be working. AD plus AP is very common, especially since some APs are specifically designed to go with ADs. GPs also use that type of combo frequently, and while they are MDs they have less training in the psychiatric area. soooo.... am I saying that you have to stick with that person? Not at all. But I think that you should evaluate the situation on whether you feel like that person is capable of getting you adequate care rather than their title. NP scope of practice has expanded a lot. Maybe what you could do is ask the person if they would feel comfortable managing more complex treatments. I’d imagine if they didn’t they would refer you to a psychiatrist

3.5 -ish years, but ongoing. She actually does less structured sessions, occasionally in a humanistic way because she acknowledges that problems should be recognized and considered instead of the typical CBT type thing about reframing and strict procedure. Before I had a CBT oriented therapist for a little less than 3 years. She was a good first therapist because she gave me the cognitive foundations to approach things. I’m a big fan of everyone doing at least a crash course CBT/DBT because I think it gives really good tools, but now it just annoys me