Iceberg

Ad to not violate the 3rd party rule, I was suggesting that because maybe you could speak with her doctor to set up ways to manage the difficulties

Does she have a doctor?

I am stuck on how to handle the recently appearing mixed episode symptoms that are becoming concerning. Pdoc often suggests cutting back on adderall during mixed/mania. Ok, but the problem is that my main AP, clozaril, is too sedating for me to bump the dose to fight the mixed episode without rendering me non functional... unless I have the adderall. I know that sometimes the strategy is to knock someone out during a mixed episode... but last time we did that with the clozaril I lost weeks, if not months, of function... to the point where I couldn’t drive or even really interact. Other past options have included adding a second, non sedating AP.... perphenazine (fail) abilify (fail) rexulti (fail) latuda (not a total fail but also not non-sedating at high enough dose)... the only one that was tolerable AND not totally useless was Vraylar, but that is expensive and really slow (not counting the lag time from the probable PA). Given the quarantine making it impossible to see my pdoc in person I doubt he will want to be experimental and that might be for the best. In the past, benzos have addressed symptoms but have not really defused the underlying situation.... and there have been cases of really piling on the benzos. Unfortunately, I have a tolerance for the adderall now, so attempts to lower the dose are not really successful even without others med changes. Unfortunately, this conversation happens every time symptoms come back, just cuz there hasn’t been a “right” med or “right” dose that is effective short term but also tolerable long term. anyone got a potential way to sneak around the adderall issue?

is your doc open to the possibility of switching out the zoloft? does it feel like maybe this could be the onset of a mood episode?

What about a combo of XR and ir. For instance (with the adderall).5 ir plus 5xr But I’d say that if the evekeo is working for you I’d work with your doc to optimize that rather than having to start all over

I kinda know what you mean about up then crash, I get that somewhat on high doses of adderall. Have you ever tried any methylphenidate options?

It’s bad. My concern would be that even if you improve depression-related fatigue it would just be replaced with med induced fatigue

I’d be really worried about adding clozaril into a situation when a main symptom is fatigue though.

Only reason I didn’t say parnate was I though the adderall washout might be brutal in the ops situation, and we all know that lots of “modern” docs won’t touch stim + Maoi what about California rocket fuel?

are you on xr or ir Adderall? I found that 60/3 ir doses was more helpful than 60/2 er doses. that won't make you an emotional zombie but maybe if you can get off the couch easier you might feel better.... idk... anything I took to zombify also brought tons of fatigue. did you try the other SNRIs (Fetzima or Pristiq)? I am not pretending youre gonna find a magic bullet or something but I'm just thinking about something that could aim for "slightly less shitty" or if nothing else cause some of the emotional blunting youre looking for

Those things you described could definitely count as psychosis, acute meaning severe and rapid-onset. As opposed to chronic, which would mean they have been constantly present over a long time.

If you go in voluntarily and are not ruled an immediate threat to self or others, involuntary commitment rules aren’t applied (at least in full) that said, if they think there is a way to help you with meds or whatever, that would probably entail staying more than three days. Some of your other questions - it’s up to the facility. First time in I had the psychiatrist overrule the ‘no naps” policy for various reasons and in another place people occasionally were allowed “alone time.” Cell phones probably a no, although I know one place that allowed like a couple hours of tech time every so often. They might allow some approved toiletries - but not when your admitted they’d have to come later. Books are usually fine, cuz there is a lot of boring time. Is your psychiatrist read in to your plan? Sorry ignore my last post then... you posted update right before I hit the button

Do you have an endocrinologist?

Do you think the Doral is even worth taking? or do you think it has something to do with the brand and not necessarily the med.

Ouch... american healthcare is so frustrating. Any public clinics around where you live? This isn’t always an ideal setup but it’s good if you need to start getting care again. Do you have a gp? Sometimes they can refer you to appropriate people