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What medications would most likely help me?


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Hello. I'm a 23 year old male. I'm struggling with depression. My ultimate question is: What medications would most likely help me? I've described my situation below - apologies for the length. Any input/help would be greatly appreciated.

Depression description:
    I get sporadic, unpredictable mood fluctuations. This kinda sounds like bipolar, but I do not feel 'manic episodes' - When at the peaks, I usually just feel like an upbeat version of me.
    I'm struggling with wild, illogical emotions. It’s really hard to explain the emotions I’m feeling because they are all over the place and hard to interpret, even when I’m feeling them. It kinda feels like trying to bring an unstable 2 year old along with me through my day. Sometimes I am hopeful and motivated; sometimes I am in a lot of emotional pain. When feeling down, there’s little escape from it, even through things I enjoy.
    The depression has developed since middle school when I was having a hard time getting homework done. Highschool was pretty sucky a lot of the time even though I got fairly good grades. I really was in a deep hole after highschool for a while. I have since been building back up and going through college, but have to take a reduced workload due to unpredictable performance.
    I've found my logical approach to things to be fairly sturdy, just my emotions are making everything shitty and out of my control no matter what I do. I think that's why therapy doesn’t really help much. I think I just have a chemical imbalance or something that causes my emotions to go a little haywire. Like imagine you take a 'normal' person and then artificially decrease their willpower and mood. They wouldn't want to do anything and end up doing things they don't really want to do. Their whole perception of reality would feel unfair and horrible. That's pretty much how I feel.
    Sometimes, if I try to get myself to work on homework, my emotions basically inflict emotional pain on me like my brain's reward system is malfunctioning. Sometimes it roughly equates to falling off a bike - just to try to start doing homework. The whole thing gets worse because I get so stressed about deadlines and finances and I feel like I can’t be who I want to be or do the things I want to do. I want to be productive and do my homework, ... but I can’t.
    When I'm down, I get little to no happiness from thinking about doing things I enjoy. Thinking about working on homework feels dreadful. My thoughts feel like I'm drugged and hazy and can't think straight. My awareness of time passing gets worse. Pessimistic thoughts enter my head without my permission and I struggle to see the upside of things.
    When I'm up (like when Adderall was working well), deciding to work on homework feels nice because it feels nice to have control over myself, be the person I want to be, etc. Not particularly enjoying the homework is no big deal. Hobbies sound more fun. I can think more clearly like I just stepped outside on a cool morning with fresh air. The day becomes a fun game of optimizing my focus, productivity, time, and challenging myself to wear out my thinking brain before picking a nice relaxing activity to veg into and enjoy before getting good sleep so I can do more tomorrow.
    From what I've found, the way I think about things in my current situation is kinda separate from the background emotional state I am in. The idea of there being a front-end emotional state and back-end stems from it feeling like a very apt description of what I was feeling in the shower once. It felt like a great explanation of how I felt where the shower was bringing clarity and optimism to the feelings my consciousness/logical brain was experiencing while the background pessimism was still there. If there's a front-end and back-end emotional state and I can only manipulate the front, then that limits how much I can manipulate my overall mood. Like if my background state is bad but I manipulate the front state to a good mood, I will feel kinda neutral overall. Not much seems to change that background mood. The front end state naturally tends towards my background emotional state over time. For example, sometimes I kept reminding myself that the background dread of life is fake and that re-lifts my front-end mood, but after not specifically thinking about it for a while, I find myself assuming I’m in a bad spot and things aren’t going well.

Methods/meds tried:
    Zoloft (sertraline, SSRI) - Tried for 7 months, didn’t seem to work.
    Lamictal (lamotrigine, AED) - Got to 200mg and took it for months. Seemed to help at first but didn’t last. Possibly placebo/influenced by hope.
    Wellbutrin (bupropion) - Didn’t seem to do anything. My mom has tried it too and felt the same way. Might be worth trying again though.
    Adderall (75% d-amphetamine, 25% l-amphetamine) - (5-20mg, IR and XR) Helped a lot, but tolerance built up over 6 months. Tried taking different dosages, breaks, and med holidays, but I think my brain is just adapting to it (like a good little homeostasis bitch).
    Dexedrine (100% d-amphetamine) - Taking it now (15mg). Likely helping like Adderall but nervous of tolerance. My mood was much worse when I forgot to take it one day.
    Strattera (atomoxetine, NSRI) - Tried for 6 days while on Adderall and 5 days while not on Adderall. Both times seemed to randomly cause short but extreme dips in mood. Might be worth trying again through.
    Weed (THC/CBD, Wyld Raspberry (Sativa enhanced) THC 5.12/gummy, Wyld Marionberry (Indica enhanced) CBD ???) - Just felt weird.
    Other: Therapy, mindfulness, gratitude journal, melatonin, keto diet, fish oil, vitamin b, vitamin d, magnesium, exercise, cold showers, music

Notes:
    My mother has talked about having similar issues but in smaller amounts. My mother's father might have as well. This points towards genetic origins.
    I've had few major stressful events growing up and I seemed to be able to handle them surprisingly well anyways. Honestly they just felt easy compared to depression. This contradicts the childhood major stressor impact findings described at 49:00 in Sapolsky's lecture (https://www.youtube.com/watch?v=NOAgplgTxfc).
    I've been having some difficulties with memory of life events. One thing especially is that when I am down, it feels like it has always been that way. I've heard this could be correlated with depression.
    Taking action on fixing the depression and having hope I will get better lifts my mood considerably (this makes it much harder to test medications accurately). Likewise, things get considerably worse when I'm just doing the daily grind or lose hope I will get better (feedback loop)
    I usually shut down under stress. If it gets bad enough, it causes a spiral. I usually start healing only once I start to give up/not care about being productive and the stress reduces.
    I realize that Adderall is an ADHD med, but I'm pretty sure I don't have ADHD. I have no trouble 'focusing' on things I like doing. The problem with homework is the lack of motivation and the pain from working on it. I think the stimulant/euphoric aspects of Adderall are the parts that were actually helping me.

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@Treeness, have you tried any other SSRIs besides Zoloft?......Have you tried any SNRIs (Effexor, Cymbalta)?.....What dose of Wellbutrin did you try?

Have you told your pdoc about the continuing depression, and are you on any antidepressants now?

According to what you said that you've tried, there are many other options as far as antidepressants........However, your pdoc needs to be the one to decide what medications might be best for you.

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23 minutes ago, CrazyRedhead said:

@Treeness, have you tried any other SSRIs besides Zoloft?......Have you tried any SNRIs (Effexor, Cymbalta)?.....What dose of Wellbutrin did you try?

Have you told your pdoc about the continuing depression, and are you on any antidepressants now?

According to what you said that you've tried, there are many other options as far as antidepressants........However, your pdoc needs to be the one to decide what medications might be best for you.

The last point is a good one, however, some psychiatrists are ill-informed or are set on trying every single medication within a drug class before admitting that that drug class is not best suited for you. Don't endure that if you can help it.

A synergistic option for treatment-resistant depression, albeit with potential sedation and weight gain, is an SNRI+mirtazapine.

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7 minutes ago, basuraeuropea said:

 A synergistic option for treatment-resistant depression, albeit with potential sedation and weight gain, is an SNRI+mirtazapine.

Great suggestion......The combo of the SNRI Effexor + mirtazapine, is known by the slang term "Californis Rocket Fuel".

https://mentalhealthdaily.com/2015/01/26/california-rocket-fuel-remeron-mirtazapine-and-effexor-venlafaxine-combination/

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45 minutes ago, CrazyRedhead said:

Great suggestion......The combo of the SNRI Effexor + mirtazapine, is known by the slang term "Californis Rocket Fuel".

https://mentalhealthdaily.com/2015/01/26/california-rocket-fuel-remeron-mirtazapine-and-effexor-venlafaxine-combination/

yes, and while effexor+remeron work well together, so do cymbalta+remeron. great combos if the side effects for you are minimal and you respond well.

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No, I have not tried any other SSRIs, nor any SNRIs (at least as far as I can remember). For Wellbutrin, on two different occasions I tried [100mg bupropion HCL 12HR SR from Solco Healthcare] and [150mg bupropion 24HR XL from Par Pharm].

Yes, I have filled in my pdoc on my current situation. Currently, I am taking Dexedrine [15mg dextroamphetamine ER from Actavis/Teva], but no antidepressants.

Yeah, it looks like there's still a good number of medications out there I haven't tried (like I haven't even touched TCAs). I wish I could just let my pdoc guide me through the medication playing field, but she is currently swamped because of covid. My appointments with her are months apart which makes it very hard to test and react to medications. Unfortunately, she doesn't have the time to fully investigate. Sometimes she's asking me what I'd like to do next. Because of this, I'm trying to do as much research and getting a feel for things myself to see which medications would be most likely to work. I'm trying to stay on top of my responsibilities and out of the depths of hell at the same time, and testing a medication can end up costing me a significant period of productivity, so if I can reduce the number of guesses to take, that would be very helpful and cause a lot less pain. I've been reading through drug descriptions (that were) on crazymeds.us and other websites, but thought it would be good to get some other opinions too. I'm actively reminding myself not to get smarty pants or locked into a train of thought about it though, as my pdoc still will have formal education and experience on her belt.

Thank you @basuraeuropea, I will keep the SNRI+mirtazapine in mind. I am slightly underweight and have trouble sleeping right now, so it might be a good fit (though I do wish I had more energy during the day currently).

I did get some Effexor [37.5mg venlafaxine 24HR ER from Aurobindo Pharma] a while ago but didn't end up trying it. Maybe since I already have it, I can talk with my pdoc about trying it next.

Thanks for the help

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2 hours ago, Treeness said:

I will keep the SNRI+mirtazapine in mind.

While this can be very effective, my advice would be to try one thing at a time first. @basuraeuropea is right, there is probably no need to try everything in one category, but my suggestion would be either one more SSRI with a different profile or one SNRI before doing a combo. Or trying Trintellix. if you felt literally no benefit from Zoloft then a class switch may make more sense, depending on your pdoc's comfort zone. 

Another thing- do you find your depression to be more situational than episodic? Some feel (not necessarily me please don't yell at me for this one folks) that talk therapy is the first-line treatment for situational depression. I saw in your note you mentioned therapy. is that onging? any specific type? do you like your therapist? 

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I think the suggestion to try one thing at a time first is a good one, I will keep that in mind.

I have tracked my activities along with mood very closely for the last year and have found that my mood does change from situation, but only in the normal way one would expect. The majority of the depressive symptoms have come and gone regardless of my current situation (with lows during times where everything is going well and optimism during times where many things are going wrong).

I originally talked to multiple therapists towards the start of treatment and found that they provided some new ways of thinking, but mostly were telling me things I already knew. I am not currently seeing a therapist as they didn't seem to be helping me. I highly recommend therapy for others though, as I've found one's frame of mind is half of the battle when fighting depression.

I have done a lot of research over the past few days using crazymeds.us and reddit experiences. Crazymeds.us provides a more digestible format than research papers or drug 'package inserts'. While Reddit has many false messages from people who had a specific experience one way or another and then make assumptions it will be the same for others, they seem to give a more real-world feel of how the meds affect people. Reading large amounts of them can start to give a 'feel' for things. Here is the takeaway of what I found. Hopefully it can help people who are also searching.

I feel like I understand a lot more about what's going on, and that understanding is that we (humans) don't fully understand what's going on.
From what I can tell, everyone has unique genetic/biological things about them that cause certain antidepressant meds to work and certain ones to not work and currently we have no way to predict them ahead of time.
However, it seems like there are patterns in effects between them, i.e. if someone has a side effect from one, they seem more likely to have that side effect from another (on average) (guessing from the feel of what I read).
But the overall feeling I'm getting is that plugging in an antidepressant kind of 'reshuffles' your brain chemicals, and that reshuffle may be better or may be worse.
Sometimes it works, sometimes it doesn't, sometimes it works for a while but then stops, sometimes it doesn't work for a while but then starts.
Sometimes it works in a few days, sometimes it takes months, sometimes people wake up different one day a few weeks later, sometimes it is very gradual from the start.
Sometimes people lose libido, sometimes people don't, sometimes it goes away temporarily, sometimes people permanently lose all libido even after stopping the med (PSSD).
It's really a wild west/mixed bag/pandora's box.

I feel like I might be able to use the info I have on what meds I've tried to make some sort of predictions on what subclass of antidepressant to try (as in which neurotransmitter to mess with) but I'm just not sure where to start and how to figure that out with any level of confidence because of how much data I'd have to go through. I'm kind of to the point where I might just need to accept the risks of what could happen and start carefully opening the nearest pandora's box, but I don't want to go into the depths of a depressive episode when I have a project that needs my help and grades to keep afloat. I think that's the sacrifice I have to take.

Overall, if we take out the therapeutic/psychological part of things, the situational impacts from life, and focus on just the impact from genetics and biological factors (after ruling out imbalances like low thyroid and other deficiencies), it seems that the major players with these conditions (depression, anxiety, ADHD) are the big three: dopamine, serotonin, and norepinephrine. I probably have some combination of imbalance with these. I realize that this is a lot of things to ignore, but I've investigated the other things a fair amount. (Though I do keep revisiting to make sure. For example, I recently found that jumping around my apartment can provide a good deal of short-term clarity. 3 mile jogs were just making me tired.)

Anyways, I plan on getting a blood panel to rule out any obvious deficiencies and then start trying Effexor or Prozac, per my pdoc's recommendation.

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25 minutes ago, Treeness said:

I feel like I might be able to use the info I have on what meds I've tried to make some sort of predictions on what subclass of antidepressant to try (as in which neurotransmitter to mess with) but I'm just not sure where to start and how to figure that out with any level of confidence because of how much data I'd have to go through.

Its really great that you're being so invested in your own care, that is an important aspect of MI treatment for many. Just be careful not to overthink too much, because inevitably a large chunk comes down to trial and error, even for the smartest docs out there. Its great to be involved, but just be careful you don't drive yourself crazy. 

 

29 minutes ago, Treeness said:

don't want to go into the depths of a depressive episode when I have a project that needs my help and grades to keep afloat.

Sticking with the good old "low and slow" approach can be helpful in these situations. Obviously you need to be aggressive enough for the meds to work, but for many taking it really slow allows them to see problems far off in the horizon and adjust accordingly

sorry if i missed- do you have a date for next pdoc? 

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@Treeness - Welcome to Crazyboards. As you have seen from the responses you have so far received to your inquiry, we have a number of members who have personal experience with a range of psychoactive medications they have tried in the treatment of their own mental conditions. I must emphasize to you, however, that no one here is qualified to diagnose you or prescribe any medical treatment of any kind for your personal condition. Even if a member did happen to work in the mental health care field, it would be unethical for that person to attempt to diagnose you on the basis of your self-description of your case over the internet; a diagnosis leading to a recommendation of treatment requires more clinical rigor. We therefore do not permit anyone to offer counsel under here under color of professional license.

The suggestions given to you above may, or may not, be applicable to your particular situation, and the persons suggesting them have no way of knowing because they are not privy to every important detail of your medical and case history, nor the individual nature of your brain chemistry, nor the overall chemical environment of your body as such medications might interact with other medications that you take. Crazyboards is a peer-support site, meaning we're all in the same boat as you are - while none of us may know the way to land, we all have pretty good stories about how we beat off the sharks climbing into the boat. Take us for what we're worth.

On 2/20/2022 at 9:20 AM, basuraeuropea said:

some psychiatrists are ill-informed or are set on trying every single medication within a drug class before admitting that that drug class is not best suited for you. Don't endure that if you can help it.

You say this, basuraeuropea, as though you are more well-informed about psychiatry than the psychiatrists. You'll forgive me if I give them the benefit of their extensive study, training, and professional qualifications over your opinion. Please note that in general we take a dim view of psychiatry-bashing on CB, especially if the suggestion seems to imply that the person you are talking to should lose confidence in his or her care team. I've had my share of pdocs whose approach didn't fit my situation, and there are always those cases of incompetence or malpractice out there, as in any other branch of medicine, but by and large, psychiatrists are licensed because they know, as well as anyone knows, what they are doing when it comes to the brain.

Cerberus
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@Iceberg Yeah, I think you are right, I will slow down a little with this. I tend to get hyper-focused and perfectionistic on things. I suppose I am just trying to do as much as I can before trying the medications because it sounds like they can end up causing long term damage.

I met with my psychiatrist today and have not scheduled another appointment yet (it's on my list). Last time it was two months out though.

@Cerberus Thank you for reminding me of the authority that comes from psychiatrists and to seek their guidance as a professional. I would like to assure you that I am not posting on here to necessarily receive a professional diagnosis or treatment recommendation, but to gain more experience and knowledge of the subject through wisdom from the crowd. As such, I am not solely taking any one person's advice, but rather adding other's thoughts to my own research to take to my psychiatrist and get their opinion and guidance. As it is now, my psychiatrist has asked me which of two medications I would like to try. For this and similar reasons, I am trying to get more of an understanding to make an informed guess and the more data I can gather, the better.

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@Treeness - And good for you for being such an active and informed participant in your own care. A psychiatrist may have the training to know how to approach these problems, but no psychiatrist is any use if the information the patient provides is bad or lacking. The more you understand about what you're feeling and experiencing yourself, the better the information you can convey, and the more targeted treatment you can hope for.

22 hours ago, Treeness said:

I am trying to get more of an understanding to make an informed guess and the more data I can gather, the better.

Even now, in 2022, the state of medical knowledge of the working of the brain amounts to not much more than informed guesses when it gets down to the cause-and-effect of the dysfunctions we experience. Leveraging your own cognitive ability to draw some order from the distress in your mind is a valuable resource for your care team. They cannot, after all, lift off the top of your skull and peer inside.

Well. I suppose they could try trepanning, but I would object if it were me.

What Is Trepanning and When Was It First Practised? - HistoryExtra

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  • 3 months later...

I wish I had an answer for you. The simple truth is that nobody knows (and yes, that includes your pdoc, as educated about these things as they are, as they are still remarkably clueless much of the time). You can possibly get lucky after just a quarter spin on the med-go-round, or else you can spend a lifetime on it without really ever finding anything that works well.
 

I have Bipolar 1, and absolutely nothing works on my depression, save for stims (adderall and/or ritalin). And even then, they only work a little bit,* and only when taken in a very specific way (with a large front-loaded dose to start the day). And they both make my hair fall out, too. Fun, fun. OTOH, I have other meds that work much better for other things (psychosis & mania/mixed). Then again, nothing helps my OCD or likely ADHD.
 

The good news is that you are still quite young, which means this condition hasn’t been “metastasizing” for years and years in you (google the “kindling effect”). So early intervention with proper meds could potentially save you from the treatment-resistant nastiness. It’s no guarantee, of course. After all, I was only a tad older than you when I first went full-tilt on meds, and it didn’t help save me from my ultimate mess. Then again, my condition started when I was very, very young (tremendous difficulty sleeping since age 3; depression starting at age 8; first suicide attempt at age 10; and first mania at age 15).

My advice is to try various meds until you find the one(s) which work, and with the least problematic side effects. And once you find that/them, stick with the regimen. Don’t. Go. Off. Your. Meds. I repeat: don’t do it. Many of us older folks have learned that lesson the hard way. Sure. Stop your meds when they cease working (and find something new that does work). But don't stop before then, or else you may be giving this same advice to someone else down the line from experience, and I don’t wish that on anyone. 

Another thing: try to find a pdoc who will listen to you and who will be willing to actually adapt your treatment plan based on your input. I’ve actually benefitted as much from the advice given to me by others on sites such as this as what I get from my own pdoc. I just finally happen to have a pdoc who gives me a lot of latitude for experimentation in my treatment program now, and so is open to it.
 

In the past, I didn't have that, which royally sucked. This change has made a huge diff in my treatment, because sometimes novel treatments/doses/etc., unknown to your pdoc, can be the diff between something working and something not working. I once convinced my pdoc to triple my AP dose based on someone’s input from a site like this (their personal experience). And that was the diff between something working vs. no effect at all. And it was not ever supposed to be anywhere near that high, at least not for my condition. I am deeply indebted to my friends on places like this for that reason, among others. 

*If I’m having a a grade D day, they can maybe lift me to a grade C. Or from a C to a B … sometimes. But if I’m starting at an F, I’m SOL. And if I’m at a B to start with, rare as that is, the stims can only very, very rarely lift me any at all (e.g., to an A-).

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@Goofball Thank you so much for your thoughts. All this context is extremely helpful.

To give an update:
I tried Effexor for a while but found it to make things dull (and made my dick lazy). At that point I was taking Dexedrine and Effexor daily and felt not much different than I did before meds, so I said "f*** it, what's the point?" and stopped both. The usual withdrawal slump happened (as well as some tingly skin once in a while which concerningly hasn't gone away yet which I'm guessing was the Effexor). I decided to then try taking different amounts of Dexedrine to try to not let my brain adapt to it so easily. This seemed very effective but alas I think my brain has caught on and pushed me back to where it thinks the right balance is. Looking back, this seems like an excellent description of what has happened with most of the other medications I've tried.

Here's a graph of the last 2 months:

681196835_2022-06-1318_51_57.thumb.png.dbe87f1d6c006e08de9058ee4fde23c3.png

Light blue: my guess on where my 'depression brain' is at (scale of -10 to 10, 0 is neutral, 5 samples per day). Dark blue: running average of light blue. Yellow: Calculated amount of Dexedrine in the body with a half life of 0.5 days (the highest was 15mg per day). Green: Calculated Effexor, half life of 0.2 days (the highest was 75mg per day).
There seems to be a cyclical pattern with a period of ~5 days. No idea why it's there or what's causing it.

This whole thing has been very lonely. I have friends and family here, but they can't do anything to help - they don't know about medications or the brain that well (they aren't doctors!) and I don't expect them to stop living their lives to try to fix mine. My psychiatrist left the company and now I'm on a waitlist and talk with my general doctor, but my healthcare provider has been extremely absent in general. I ask them in detail about whether taking different amounts of Dexedrine can cause issues in the body, and then a week later I get the response "The medication is better to be taken daily in order to work properly." This does not sound like someone who's here to help figure things out. This sounds like someone who doesn't really care and is reading from a textbook or the paper handout medication guides. For a topic as complex and non-cookie-cutter as the brain, this is not going to work. It feels more effective to just figure things out myself.

But, really, there's not many options left. It's nerve wracking to think about trying different meds because of how much they seem to screw with your body. My brain's homeostasis continues to be prevalent, but at least Dexedrine gives me *some* control over which days I feel good. I'm trying to find some way to get a good pdoc like you've described along with help from my parents, but with covid it seems like availability is few and far between. I'm realistically thinking I'll be in the 'lifetime of not really finding something' category and this truly breaks my heart. This is all very pessimistic, but I'm in a trough right now so that's what you're going to get.
 

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  • 2 weeks later...
On 6/14/2022 at 3:15 AM, Treeness said:

@Goofball Thank you so much for your thoughts. All this context is extremely helpful.

To give an update:
I tried Effexor for a while but found it to make things dull (and made my dick lazy). At that point I was taking Dexedrine and Effexor daily and felt not much different than I did before meds, so I said "f*** it, what's the point?" and stopped both. The usual withdrawal slump happened (as well as some tingly skin once in a while which concerningly hasn't gone away yet which I'm guessing was the Effexor). I decided to then try taking different amounts of Dexedrine to try to not let my brain adapt to it so easily. This seemed very effective but alas I think my brain has caught on and pushed me back to where it thinks the right balance is. Looking back, this seems like an excellent description of what has happened with most of the other medications I've tried.

Here's a graph of the last 2 months:

681196835_2022-06-1318_51_57.thumb.png.dbe87f1d6c006e08de9058ee4fde23c3.png

Light blue: my guess on where my 'depression brain' is at (scale of -10 to 10, 0 is neutral, 5 samples per day). Dark blue: running average of light blue. Yellow: Calculated amount of Dexedrine in the body with a half life of 0.5 days (the highest was 15mg per day). Green: Calculated Effexor, half life of 0.2 days (the highest was 75mg per day).
There seems to be a cyclical pattern with a period of ~5 days. No idea why it's there or what's causing it.

This whole thing has been very lonely. I have friends and family here, but they can't do anything to help - they don't know about medications or the brain that well (they aren't doctors!) and I don't expect them to stop living their lives to try to fix mine. My psychiatrist left the company and now I'm on a waitlist and talk with my general doctor, but my healthcare provider has been extremely absent in general.

I ask them in detail about whether taking different amounts of Dexedrine can cause issues in the body, and then a week later I get the response "The medication is better to be taken daily in order to work properly." This does not sound like someone who's here to help figure things out. This sounds like someone who doesn't really care and is reading from a textbook or the paper handout medication guides. For a topic as complex and non-cookie-cutter as the brain, this is not going to work. It feels more effective to just figure things out myself.

But, really, there's not many options left. It's nerve wracking to think about trying different meds because of how much they seem to screw with your body. My brain's homeostasis continues to be prevalent, but at least Dexedrine gives me *some* control over which days I feel good. I'm trying to find some way to get a good pdoc like you've described along with help from my parents, but with covid it seems like availability is few and far between. I'm realistically thinking I'll be in the 'lifetime of not really finding something' category and this truly breaks my heart. This is all very pessimistic, but I'm in a trough right now so that's what you're going to get.
 

I feel your pain. As someone who's in the "lifetime of not finding anything" category, been on this pony ride way too long (decades), and nothing ever works consistently long term. My brain just adapts to it or starts to sort of reject it.

With the meds that I do tolerate, they ALL eventually start to give side effects of emotional dulling, apathy, fatigue, and I lose any benefit/ mood improvement. Especially stimulants (for depression). I was told to experiment to see what works best (taking stimulant holidays for tolerance issues) I messed around with formulations & doses and just continued to feel worse physically, cognitively, psychologically. I think they actually damaged my brain.

I now quit everything and although I'm still depressed, at least I'm not taking 3-4 psych drugs yet STILL feeling depressed & non functional!! I feel like it's really all just a crapshoot.... providing brief short-lived benefit. The psych docs I've been to (even the more attentive ones)  it's  like a guessing game. You just cycle through & keep trying different things, increasing doses, swapping things out. The process alone is crazymaking and exhausting.

 

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