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About sming

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    PDoc Confounder

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    none - I have anhedonia

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  1. Man, sorry for the late response @mikl_pls . My OCD makes reading large posts very, very difficult I don't even know what the threat behind it is any more Anyway, thanks once more for the info. My PDoc as I mentioned, is great and experienced and isn't swayed by what's de rigueur or not - he just prescribes what the data proves most effective, but is willing to try left field stuff as well for me. Typical that he's out of network ¯\_(- -)_/¯ The crashes have alleviated somewhat of late, or have moved to 2pm. I've no idea why. It seems to rise and fall with intensity, perhaps with my OCD levels. Hah! - constipation. Due to my IBS-C, I haven't done an unassisted #2 for... over a decade? Lovely. Gotcha w.r.t. dirtiness of the TCAs. That might complicate things slightly and I might request Nortriptyline for that matter as it's the least-dirty. I have a ridonculous regimen at present already. Well I hate sedating drugs - they make my OCD (about being so depressed that I spontaneously off myself) go bananas as I interpret my slovenliness as increased depression. I guess I should opt for Desipramine. Cool. I tend to get hit by sedation/somnolence even by activating meds e.g. Bupropion, Provigil (which admittedly are completely different molecules and modes of action). Hmm. I like the quick response time. I also couldn’t care less about cadiotoxicity. At this rate I won’t be around long enough to die from heart problems, that’s for sure. I wonder if I could replace Trazodone (and Fetzima) with this one too? It sounds similar in its effects. Clomipramine has been suggested to me a number of times because IIRC it’s good for OCD. That might make this one a strong contender to try first, actually as OCD underpins a lot of my depression (e.g. repetitive, unstoppable self-blame). Roger that. Hah. I have those too, like Abilify and Lexapro. They always function like before. But very few of the other meds (including MAOI’s) I’ve taken twice or thrice do that. Interesting. A bit like Abilify+Lexapro for me. Except (I think) that I feel horrific on just those two - just less horrific than on everything else… Do you feel “OK” on these two? Or just “not as bad” as when on other regimens? Huh. That’s interesting because opioids are brilliant anti-depressants for me, if not the best. I actually feel well and content on them and no other med has ever given me those feelings. Weird. Gotcha. MAN. That's exactly what I just experienced - the dysphoria, somnolence, and for me - brutal anhedonia. I'm anhedonic without Abilify but I've literally discovered this last week whilst tapering down Abilify that Abilify has been making it much worse I normally feel so, so terrible yet unpredictably so (I can't ever get a baseline "mood"), it's very hard for me to ascertain whether I'm doing better or worse on a med. Generally what happens with any given med is that (if it does anything at all) it merely changes my OCD, depression and anxiety's texture in some way and/or changes the nature of the collective side effects. "Theretofore" - good word, didn't know that one. Holy holy shit. I've been at 2.5 forever and recently tried going up to 5 gradually and just became more and severely depressed, somnolent and anhedonic. I can't even comprehend what 30mg would do to me... w.r.t. what I just said, the 2nd time I tried Abilify I somehow managed to hit 7.5mg (I was on a totally different regimen) and was compulsively cleaning and playing video games at 3am. It was amazing but it didn't last. Oh don't say that 😬 Holy crap, that is a terrible turnaround for the worse. With your complicated and rapidly-changing regimen, are you double-sure it was the Abilify and not, say, a natural degeneration/progression of your MI? Or some other factor? I was a depressed empty shell but being happy and empty is not much better. It's like what makes you you is sucked out of you - your soul is just gone. You just become this mannequin version of yourself. None of them are! I liked one PDoc who was saying how much he hates the term "atypical antipsychotic", because when you look at them as a group, they have no common chemical properties whatsoever. He argued strongly that the whole "atypical AP" buzzword was marketing bumf to distance these expensive new AP's from the cheap (but equally effective), older ones. Agreed. It's used willy-nilly by even GP's as an augmentation agent but it's a serious, serious med. It's an antipsychotic. Should John Jones really be prescribed an AP because he's been feeling low for 3 months? I think it's insane. Many thanks, ditto to you. I am feeling more human since going down to 1.125mg at least - some of "me" is peeking out for a few hours a day. FML eh?
  2. That's me right there. My brain is irretrievably busted. By which means, I do not know but ultimately it doesn't matter - the fact is is that it's fooked.
  3. My OCD prevents me from reading loads of comments so I don't know if this has been suggested before but you know that the whole "action before feeling like action" is covered big-time in the "Feeling Good" (David Burns) book? I fucking hate that book. I naively followed all the exercises, expecting change and... nothing. To my knowledge, the prick who wrote it has never encountered someone with either TRD or anhedonia. He's such a condescending wanker. To be fair, I'm sure a huge chunk of non-TR folks he sees are "miraculously" transformed by these CBT techniques and he has to instill optimism but please, it's like us anhedonic folk literally don't exist.
  4. Yep. It's the worst. Same here. It's horrific depression OR soul-consuming emptiness, it would seem. Have you considered obtaining Provigil? I've had success with it - temporarily at least - numerous times. The last time, over New Year's, I felt "OK" for 5 whole days when I took 400mg (double the recommended). You need to convince your PDoc that you have daytime somnolence from your meds and/or sleep apnea or... I forget. Or you get it illegally, like I do ¯\_(ツ)_/¯ FWIW it's non habit-forming and 99.999%* of the time causes no withdrawal upon cessation. * Yep, I got severe withdrawals.
  5. No good suggestions unfortunately, compatriot*. Actually, one severe and/or crap suggestion is to get yourself on a med/meds that cause early waking. Due to my regimen, I involuntarily wake up - like wide awake - between 4 and 6 a.m. no matter how tired I was nor how late I stayed up (although I'm always in bed by 7pm because there's no point in being awake once my Adderall doses are done). But this is merely shifting the problem forward a few hours actually i.e. I go to sleep stupid early because of my depression and you get up stupid late because of your depression ¯\_(ツ)_/¯ On weekends, when I don't "have to" be at work (and I appreciate I'm lucky to be able to hold down a job), I struggle with the "futility & uselessness of life" all the more. In between kid-juggling (I have kids. I do not have a weirdo hobby of literally juggling kids or anything), I lay in bed, because sitting up is too much effort. I stare at the wall or sky most the day because I can't think of a single thing that I want to do. With any luck, I fall asleep. Life. Fucking. Sucks. * That's a crap joke that only other Welsh people will get.
  6. Thank you @mikl_pls, this is a really good idea. Do these TCA's have longer half-lives or is it that they just don't exhibit this crash-like effect for you? I will suggest this to my PDoc. Do you happen to know if such TCA's would be hot-swappable with the Fetzima? I get really, really rough side-effects - like horrific - when titrating down and up on meds. How are they better for you? Are they more betterer such that I should choose those over Nortriptyline. Really? That would be nice cos my drive is at -100 right about now. Cheers for the info. May I ask why you stopped it? Presumably it pooped-out? I've had precious little luck with meds I've tried already. My brain seems to "know" them and just ignores them. I've discussed Strattera (I think) with my PDoc. I think he'd be OK with TCA's, he's one of those rare PDocs: really-experienced (used to be a surgeon, is qualified to do TMS, has done tons of ECT...) and keeps on top of the latest developments. I can never catch him out knowledge-wise. w.r.t. NRA's, I LoL'd when I read "A meta analysis published in BMJ in 2011 concluded that the selective norepinephrine reuptake inhibitor reboxetine is indistinguishable from placebo in the treatment of depression" because reboxetine gave me unstoppable 24/7 suicidal ideation for 2 frikkin weeks before I quit it. Yes, I have actually. It worked fairly well (benzos) but I felt like a balloon that's about to burst - loads of pent-up / masked irritability. I've been on 5mg for 4 days now and this time I'm tolerating it. I have absolutely no idea why this time that's the case... Very helpful. Thanks again.
  7. no worries @ln009 wouldn't wish it on my worst enemy I sometimes think it's part of PTSD (I went through a period where I thought I was going to top myself). Sometimes I think it's just my biological makeup. To answer - I'm just not sure and I wish I knew. It's almost impossible to explain to people. I also get funny looks and misinterpretations e.g. I'm psychotic or BPD (which I'm definitely not). If you ever find out what it is or how to describe it, let me know!
  8. Hey @mikl_pls, good to hear from you. Huh. I hadn't really appreciated we were similar in this regard. You've written about so many trials and tribulations about meds it's hard to know what does and doesn't help you! Wow, I've never heard of anyone having that before. I thought it was SAD and bought 3 different "Natural" lights, all to no avail - obviously. 6am typically. And my problem is that the anti-depressant effect of both Adderall and Ritalin is less than 2 hours Hence I have to take them every 2-3 hours or I regress into horrific feelings of emptiness and worthlessness and can't do a thing. Hence I tend to run out by 3-4 pm and the rest of the day I'm just suffering, basically. I frontload my day's work for this reason. I've not been on a night out in... years? Wow, that's super-similar. I wish mine lasted that long. They used to but my brain has up/down-regulated presumably. The stims are absolutely the key to my regimen. Without them I'd be staring at the wall literally all day long. At least they allow me to focus. Stim+Percocet allows me to actually want to do things, to be interested in things. Interesting. I am thinking of cutting it from my regimen as I don't think it's doing anything. It's a bugger that you can't easily split the dose. I suppose I could empty the capsule into water and take 1/2 in the a.m. and 1/2 in the p.m.? Out of interest, since we're similar in this regard, what was/is your most successful regimen and what is your current regimen?
  9. Thanks to all who have posted and suggested stuff. I think I've found a/the main culprit of this 5pm crash: I'd forgotten that my pure OCD (about spontaneously committing suicide) and the self-loathing it prompts kick-in at dusk in Winter For your efforts, here's a sneak-peek into my "special", TR-OCD, twisted brain that's causing most of this daily suffering: 1. I notice that it's getting dark early (as it's wont to do in Winter) 2. my OCD Spike "short, Wintery days are depressing" triggers, followed instantly by: I won't be able to bear this depression! I will spontaneously commit suicide!!! ==> This causes latent, stealth, paralysing feelings of pure skin-crawling terror 3. then my OCD's over-self-preservation function kicks in: I must avoid all avenues of depression. I will achieve this by blaming and punishing myself horrifically for jeopardizing my life: "I am a very bad person for jeopardizing my life" (i.e. for allowing myself to experience a "depressing" Wintery dusk). ==> An endless stealth mantra of telling myself this makes me feel worse than soggy dog poop; the very worst human on the planet. I feel utterly crushed from the self-loathing. And hence the majority of 4/5/6pm crash ¯\_(- -)_/¯ I am a fucking nutjob.
  10. Thanks, yeah it's tricky because I'm using the Opioid for its anti-depressant properties and like I said, that's an immediate no-no in America right now. I have told him to drill down on the dopamine because it's dopaminergic meds that actually have some positive (and sometimes negative) psychotropic effect on me. Most other meds just give me horrific side-effects. Yeah I know Adderall's not an opioid I was referring to the Percocet when I said "opioid" previously
  11. Ha ha ha, a fellow shit lager aficionado. I'm actually from Wales originally and came to NYC via London. Yeah that's entirely possible. I think it's also a mental blow when I take my last Adderall+Percocet because experience shows that that's the last time that day that I'm going to feel anything approaching human. It's very hard not to let this fact (and it is a fact - it's the only thing that lets me feel alive) affect your outlook for the rest of the day. Thanks for the suggestion.
  12. oh man that's a shame. It is rather specialised, there aren't that many in NYC in fact. I wonder if there's a good book from which you can get the gist of it?
  13. Just for the rounded-out picture, I have severe TR OCD and CBT made it much, much worse - all the thoughts about thoughts just exacerbated it. For me, ERP (Exposure Response Prevention) was the key and reduce my OCD tremendously. HTH. YMMV.
  14. Hah! It's funny you mention that... 2 weeks ago over New Years I bumped it to 400mg and got 6-7 hours of relief from my depression (!!!). This lasted for 5-6 days and began to poop-out severely so I quit it cold turkey, since Provigil does not cause withdrawal (this is documented). However, I went through a very severe withdrawal (I was literally catatonically depressed) until I realised what was going on and took 200mg and sprung out of the catatonia. It turns out there are 2-3 cases reported (like, ever) of it causing withdrawal, if you look for them. I guess I make number 4 Is that like Vyvanse? I tried Vyvanse to great effect when I first "discovered" that stims helped my depression. It lasted 6-7 hours initially and slowly the period of effectiveness shrunk down and down to like 2 hours. Hence I moved to multiple doses of Adderall as it gives me more coverage. Ditto for Concerta and Ritalin. Yeah I heard that too and tried it and hated it. It made me feel really just, horrible and icky and pissy and depressed. I am highly, highly refractory/atypical/TR/just plain weird ¯\_(ツ)_/¯
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