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On 1/19/2020 at 6:12 PM, mikl_pls said:
 

They have longer half-lives and they also don't exhibit these crash-like side effects for be, so both. Just note that pdocs most often now are usually closed to the idea of prescribing TCAs. I personally wouldn't have any discomfort or concerns with hot-swapping a TCA with Fetzima. Fetzima has such a short half-life anyway it will clear out of the system in just a few days. However, if you're susceptible to side effects, you may wish to take 20 mg for a few days, then take 20 mg every other day for a week or so, then start a low dose of a TCA, like 10 mg or 25 mg at the very most, or if starting with protriptyline, 5 mg 2-3x/day.

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.

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For me, they are better insofar as they actually produce therapeutic effects, and they for most people have less side effects, except protriptyline, which for me the anticholinergic side effects can get nasty after a while sometimes (like urinary hesitation, constipation, dry mouth/throat, blurry vision, unable to focus close up, etc.) Nortriptyline is sedating slightly in lower doses and at first because of its affinity to the histamine H1 receptor. But after a while and especially at higher doses, it becomes stimulating because it is a relatively selective NRI (more of a SNRI though with much more emphasis on NE). Nortriptyline just so happens to be the "cleanest" and "safest" TCA, I use quotes because no TCA is actually 100% "clean" or "safe." IOW, they all are slightly dirty in their mechanism of action (targeting many receptors and transporters) and can have dangerous side effects (like cardiovascular in particular, some are worse than others, but nortriptyline is the safest supposedly).

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.

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Desipramine is actually cleaner mechanism of action wise because it is essentially just a selective NRI (most selective NRI and most potent NRI), with mininmum antihistaminergic, anticholinergic, antiadrenergic, etc., side effects. It's not necessarily safer than nortriptyline, but it's safe enough to be used in the geriatric and pediatric population somewhat commonly. It's used in the pediatric population for ADHD and geriatric population for depression not responsive to first-line agents. It's safe for use in geriatric population from the TCA agents because of its lack of anticholinergic and antiadrenergic side effects, causing less delirium, cognitive side effects, and orthostatic hypotension (leading to less falls) than other TCAs. It's also probably the least sedating, and for most, stimulating even in low doses.

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. 

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Protriptyline is an entirely different animal. Instead of being taken at night (except for desipramine which can be taken day or night), it is taken along 3-4 divided doses throughout the day. It comes only in 5 mg and 10 mg tablets, much like a stimulant (and it is rather stimulating from my experience, probably the most stimulating TCA... even more stimulating than desipramine for me). It also tends to respond to depression quicker than most antidepressants and the rest of the TCAs, sometimes taking just two weeks to respond to depresssion. So it has a good therapeutic mechanism of action. But this is offset by its rather dirty side effect profile. It's highly anticholinergic, almost as much as Elavil (amitriptyline). It has some affinity for the H1 receptor, so there is some potential for sedation despite the stimulant-like properties.

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). 

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It also is known for cardiotoxic side effects, like almost all TCAs... Might not be a good choice for a geriatric patient unless used in low doses, same for pediatric patients. But if you aren't taking too much meds already and can tolerate some potential side effects for a very good antidepressant with a good therapeutic profile, protriptyline is a good one.

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.

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If I had to summarize them, I would say this (these are my personal assessments about their effects on me):

  1. nortriptyline: "safest," (least side effects across dose span), probably most sedating of the three but goes away after a while, moderately anticholinergic but not noticeable, only "feel" the medicines effects in high doses (100-150 mg), somewhat stimulating in high doses (usually at max dose of 150 mg)
  2. desipramine: probably second "safest," cleanest side effect profile, effective as an adjunct but not monotherapy personally (even up to 200 mg, max 300 mg for most), least side effects aside from those caused by therapeutic effects, somewhat stimulating rather than sedating even in low-ish doses (~50 mg), high doses probably not necessary (150+ mg, 50-100 mg probably all that is needed), low doses can help with sleep yet help with depression a little (10-25 mg)

I wonder if I could replace Trazodone (and Fetzima) with this one too? It sounds similar in its effects.

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  1. protriptyline: probably the most stimulating of the three (usually at 30 mg/day or 10 mg 3x/day), probably most cardiotoxic of the three but not as bad as clomipramine for example,

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).

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  1. anticholinergic side effects can be troublesome and are dose-related, hardly sedating at any dose, 30 mg is probably the best dose for balancing therapeutic effects and side effects, 40 mg is slightly more effective yet with much more side effects (mostly anticholinergic), max is 60 mg but I personally couldn't imagine taking that much

Roger that.

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It won't really do much good in the way for drive, but does have strange, random sexual side effects, that one happening in a minority of patients. I guess I was "lucky..." (???)

Hah.

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I stopped because the combo pooped out. I too have meds that don't work if I try them again, but some my brain seems to just "like," and no matter how many times I swap out for other meds and come back to them, they always work at least a little and for a longer period of time than other meds.

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.

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Zoloft + desipramine has been the most consistently-working combo for me ever. It has worked the most consistently, the longest, and has been the best-working, with least amount of side effects. Zoloft can cause sexual side effects in the higher dose range for me (150 mg and up), but I'm usually able to keep the Zoloft at 100 mg and the desipramine at 50 mg, only occasionally needing more of one or both agents. The temporary need of increased doses makes the side effects they cause more tolerable. If you need 200 mg Zoloft though, the side effects will eventually go away mostly, but will have some remaining side effects).

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?

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I don't get it, my pdoc has a lot of qualifications similar to your pdoc, but her prescribing habits are so much more conservative and guarded... I dunno lol.

I've not heard good things about reboxetine. I think I read that same article... Reboxetine is very similar to atomoxetine (Strattera) if I'm not mistaken. Strattera can help me but sometimes has this dysphoriant ettect on me, causing profound dysphoria and suicidality. I think one of its metabolites works a certain way on the opioid receptors that can be prone to cause dysphoria and suicidality. It's not working on the µ-opioid receptor, it's one of the other ones...

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.

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Desipramine, being the most potent and selective NRI (at least in the US), strangely enough, while helping immensely at moderate doses (±50 mg, like 50-75 mg, but my pdoc won't prescribe over 50 mg anymore for some reason), at higher doses like 150-200 mg, it doesn't help any more than it did at lower doses, produces a little more side effects, and may sometimes make me feel a little flat (the one time she did let me take 200 mg a few years ago when I was severely depressed. I was taking desipramine alone without the Zoloft at this dose, so I think I need both serotonin and norepinephrine reuptake inhibition for it to be therapeutic at all).

Weird. Gotcha.

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I don't know man... Abilify was great for me at first the first time I tried it, but then caused me to sink into what was theretofore the most dysphoric a depressive episode I had yet to experience. I am still in that depressive episode and haven't remitted from it, and that was about 5 years ago. I have not been able to shake this episode except for a few weeks or so at a time. Any subsequent time I tried Abilify, I would get very angry, irritable, and aggressive at low doses (2-5 mg).

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.

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So I tried starting it at 10 mg with my pdoc's permission and I did fine, but needed to keep increasing it until I was up to 30 mg.

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...

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That was awful because of the compuslivity reaction, which for me exhibited itself as compulsive spending/shopping.

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.

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I still haven't recovered completely from that either. I tell ya, Abilify was great while it lasted (the first month the first time I took it, and for about a year and a half a few more times after that), but it has permanently altered the way my brain works.

Oh don't say that 😬

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I have no imagination, no positive emotions (flattened affect), no creativity (haven't written a song in 5 years, not a single one... started on a handful only, and not finished any of them...), etc., am always depressed, suicidal, dysphoric, etc., can't shake obsessive thoughts especially when they're related to suicide... Ugh.

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?

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I have a very profound love/hate relationship with Abilify. I was so glad to get off of it last spring, but now I'm hating Vraylar and wanting back on Abilify despite the side effects it causes... I'm going to look for an alternative, but unless I can find one, it'll be Abilify for me all over again, and I'll be an happy yet empty shell of a person again without any personality.

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.

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It's a very strong, potent antipsychotic compared to the others... IMO... It works in a different way that is not nearly as well studied IMO.

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.

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I think these dopamine partial agonists need more trials and studies to be done before more of them come out. The dopamine antagonists are far more well studied simply because they've been around longer. 

I'd recommend a trial of Abilify to anyone, but only after certain other trials have been done... That's how I feel about it. Most people don't consider it a "big gun" or a "sledgehammer," but personally because of my experience with it, I consider it a pretty heavy hitter.

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. 

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I wish you the best of results and the least negative side effects with it!

 

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?

Edited by sming
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1 hour ago, sming said:

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.

Oooh I'm sorry. I'll try to keep my responses brief then. ;)

True, I "updated" my insurance plan for this year and now my pdoc is out of network. But I haven't told them yet, and they haven't noticed a change, so...

1 hour ago, sming said:

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.

Have you tried anything for IBS-C like Linzess?

Nortriptyline IMO is dirtier than desipramine, which to me just feels cleaner, and is the least anticholinergic and antihistaminergic.

1 hour ago, sming said:

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'd say yes, desipramine or protriptyline (if you can manage your IBS-C with it). Nortriptyline is decent, but kinda meh for me.

1 hour ago, sming said:

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).

If I'm not mistaken, that may be a sign of ADHD—stimulant-like meds will tend to "calm" you down or even "sedate" some people. I have that reaction to generic Nuvigil (but not brand-name).

1 hour ago, sming said:

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.

Aww... :( Well it's just a possibility. Not necessarily a guarantee.

3 hours ago, sming said:

I wonder if I could replace Trazodone (and Fetzima) with this one too? It sounds similar in its effects.

You could, but as soon as you start increasing the dose, it will become stimulating, especially protriptyline.

3 hours ago, sming said:

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).

Yes, it's considered one of the gold standards for OCD treatment. Oh man, I feel you on the self-blame thing. I tried clomipramine and TBH, it was absolute pure hell. I couldn't pee, I couldn't get off, I couldn't see (blurry vision), I couldn't stay awake, I couldn't poop, and my depression and anxiety (and OCD) got waaaay worse. I must've had a paradoxical reaction in that regard (the last part), but I did give it a good college try for several months, and got almost to the max dose (225 mg where 250 mg is max dose). It was a nightmare experience, but YMMV. It has been said to take the longest for it to start treating depression and OCD.

Sometimes pdocs will add a tiny dose of clomipramine (25 mg) to an SSRI. That might also be something to consider.

3 hours ago, sming said:

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?

Most of the time I think I felt somewhere between "OK" and "kinda good" on this combo, occasionally with my mood lighting up to being "pretty good."

5 hours ago, sming said:

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.

It's the 4-hydroxyatomoxetine metabolite that works on the opioid receptors. It acts as an antagonist on µ-opioid receptors (the "main" opioid receptor) and a partial agonist at κ-opioid receptors. So it's not like a typical opioid. Naltrexone, a medicine for opioid and alcohol abuse/addiction, is a µ-opioid antagonist, for instance.

I'm glad there's something that makes you feel well. I don't take opioids often, but IIRC, they kinda make me feel pretty cruddy.

5 hours ago, sming said:

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.

Yeah, Abilify seemed to make things worse for me, but the most recent trial of Abilify it helped me more than any other drug I've taken almost, save for the compulsive spending habit. Yeah I feel the same way—very hard to get a baseline, because I'm constantly cycling. While I was on high-dose Abilify, I think I had the longest baseline somewhere close to euthymia I've ever had, with or without medication. That's really interesting, my OCD doesn't seem to really be affected for the better or for the worse by any medicine I've yet to try. Then again, I lack insight into my obsessions so badly that I don't realize when I'm obsessing.

Heh, I like that word. "Thitherto" is a synonym for it. I also like "heretofore" and "hitherto..." lol

6 hours ago, sming said:

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...

You might be surprised what it would do if you went up on the dosage. It makes me worse in low doses, but 10 mg and beyond, it's almost as good as amphetamines for me, save for the flattened/blunted affect, which I'm not sure if that's a symptom or a side effect... It's waaaaay worse than it has ever been.

6 hours ago, sming said:

Oh don't say that 😬

Well, I say that, but that's what I believe anyway. It may not be true. I just feel like a changed person since I was on Abilify even the first time I took it for just a few months. I'm no longer creative, I feel like I have no personality, I'm emotionally numb, but while I'm on it at moderate to high doses, I feel fine! Just a shell of a human being...

6 hours ago, sming said:

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 feel very strongly that it was the Abilify. I didn't change regimen for almost a year and a half (which is a long time for me), and during that time is when all those effects happened. Really it has been since 2015 that I have started to feel this way, and that was the first time I was on Abilify. It has been progressively getting worse and worse. Maybe it is natural progression of MI, but maybe Abilify accelerated it? I dunno. I've struggled with ways to convey this to my pdoc and she doesn't quite seem to understand just how severe it is.

6 hours ago, sming said:

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.

EXACTLY. I couldn't have worded it better myself.

6 hours ago, sming said:

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.

I can totally see that. See, I had a wonderful experience with Stelazine! It improved my anxiety, but also improved depression and even cognition. My pdoc couldn't believe the effects it was having on me, but she continued prescribing it against her "better judgement." I wish I could just still be on that, tardive dyskinesia be damned.

6 hours ago, sming said:

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.

Well, in low doses, the "atypical" antipsychotics act primarily on serotonin receptors over the dopamine receptors. Abilify does not follow this paradigm. It works on dopamine receptors before anything else, but acts as a partial agonist. There are different theories about what this implies. Some say it means that if dopamine levels are low, it acts as an agonist, or if they're high, it acts as an antagonist. But I don't think it's that simple. There are presynaptic dopamine autoreceptors (which when stimulated by dopamine, shuts off dopamine release), and dopamine postsynaptic receptors (responsible for the effects of dopamine stimulation). Abilify being a partial agonist, it "regulates" the stimulation of the presynaptic autoreceptors and thus regulates dopamine efflux from the presynaptic neurons, and "regulates" the response to dopamine that the postsynaptic receptors have, sometimes even acting as a competitive antagonist depending on which meds are concomitantly administered.

6 hours ago, sming said:

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?

Glad to hear that you're returning to "you!" I hope you continue to feel more and more like you!

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  • 2 weeks later...

Hey @mikl_pls, please accept my customary apology for being so tardy replying. I'll try and address your feedback in one go this time. 

I tried Linzess and it's just like any other IBS-C med - it causes my pain to skyrocket and doesn't help me to go ¯\_(- -)_/¯ 

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If I'm not mistaken, that may be a sign of ADHD—stimulant-like meds will tend to "calm" you down or even "sedate" some people. I have that reaction to generic Nuvigil (but not brand-name)

Yeah, I've heard that a fair few times. I'm certain I have inattentive ADD but it's hard to tease that out from anhedonia, dysthymia and good old MDD 😞 

I like the sound of this protriptyline. I might ask for that. 

w.r.t. self-loathing, I think I'm some regional champ. Any "mistake" w.r.t. my OCD rules and I instantly, repetitively loathe myself for "jeopardizing my life". WTF. No amount of logical arguments against it can stop it once it's triggered. Wow you really went through the wringer on the Clomipramine eh? A lot of my med attempts go like that and then the PDoc's down the line look at you like you never stuck things out.

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@mikl_pls - am writing in segments as one long reply was really buggy with text disappearing...?

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Strattera can help me but sometimes has this dysphoriant ettect on me, causing profound dysphoria and suicidality.

Hah, that's exactly what happened to me last week on 1mg Guanfacine, which is like an NRI I think? My energy and focus were improved but I was purely focused upon SI! 

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Naltrexone, a medicine for opioid and alcohol abuse/addiction, is a µ-opioid antagonist, for instance.

I was offered Naltrexone (or even tried it..?) because of my chronic opiate use and IIRC it did not go well. They wanted me on  buprenorphine (Suboxone) as well but I read a lot of horror reviews online. Docs tended to dump people off of the opiate and onto Suboxone and pretend it was as effective as the opiate and that the problem was solved. Naturally that didn't go well for most folks...

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I'm glad there's something that makes you feel well. I don't take opioids often, but IIRC, they kinda make me feel pretty cruddy

Oh man, they let me fly. I just developed post-op thoracic radiculopathy (squished root nerves - oww) and I'm on 15mg Oxycodone doses up from 5mg. It is bliss. My depression is so, so much better. But will I be allowed to stay on it? Of course not. I had to fight to get barely enough pain suppression before returning home 😞 

I def know hitherto, but wasn't aware of thitherto - most splendid.

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You might be surprised what it would do if you went up on the dosage. It makes me worse in low doses, but 10 mg and beyond, it's almost as good as amphetamines for me, save for the flattened/blunted affect, which I'm not sure if that's a symptom or a side effect... It's waaaaay worse than it has ever been.

you've got me thinking now. Perhaps I can take time off of work just to push through the somnolence/anhedonia barrier and onto 10mg and up... Hmm. If it's potentially like Adderall then that would be nothing short of magic for me.

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I'm no longer creative, I feel like I have no personality, I'm emotionally numb, but while I'm on it at moderate to high doses, I feel fine! Just a shell of a human being...

Oh, bugger. That sounds like my anhedonia. I just feel soulless, vacuous, devoid of meaning and purpose.

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I feel very strongly that it was the Abilify. I didn't change regimen for almost a year and a half (which is a long time for me), and during that time is when all those effects happened. Really it has been since 2015 that I have started to feel this way, and that was the first time I was on Abilify. It has been progressively getting worse and worse. Maybe it is natural progression of MI, but maybe Abilify accelerated it? I dunno. I've struggled with ways to convey this to my pdoc and she doesn't quite seem to understand just how severe it is.

Oh man, we are tragic twins again. This is exactly the sort of thing I'm struggling with. As you age (I'm 44), your MI tends to get worse and more set in. So is my increasing anhedonia down to that, or to just being really depressed, or Abilify, or Abilify + Fetzima, or ... you get the picture 😕 

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...Some say it means that if dopamine levels are low, it acts as an agonist, or if they're high, it acts as an antagonist. But I don't think it's that simple. 

You're absolutely right. I can't stand it when someone tells me exactly how my 4 psychotropics are interacting, or even how just Abilify does. No-one really knows why they affect mood, MI, cognitions.

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Glad to hear that you're returning to "you!" I hope you continue to feel more and more like you!

Of course it's not that simple with me. I felt better for a few days and then back down the toilet. I think I mentioned that I might start oscillating between 1.125mg and 5mg - try and keep my down/up-regulating asshole of a brain guessing, you know?

Thanks again dude.

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7 hours ago, sming said:

Hey @mikl_pls, please accept my customary apology for being so tardy replying. I'll try and address your feedback in one go this time. 

I tried Linzess and it's just like any other IBS-C med - it causes my pain to skyrocket and doesn't help me to go ¯\_(- -)_/¯ 

No worries!

Oh dear... that's no good...

There's also Zelnorm (more expensive I think depending on your insurance), Amitiza, and Trulance. Meclobemide is a prokinetic anti-nausea medicine that might work but can't be used in long term because it blocks D2 receptors like an antipsychotic and can cause movement disorders.

7 hours ago, sming said:

Yeah, I've heard that a fair few times. I'm certain I have inattentive ADD but it's hard to tease that out from anhedonia, dysthymia and good old MDD 😞 

I like the sound of this protriptyline. I might ask for that. 

w.r.t. self-loathing, I think I'm some regional champ. Any "mistake" w.r.t. my OCD rules and I instantly, repetitively loathe myself for "jeopardizing my life". WTF. No amount of logical arguments against it can stop it once it's triggered. Wow you really went through the wringer on the Clomipramine eh? A lot of my med attempts go like that and then the PDoc's down the line look at you like you never stuck things out.

I love protriptyline. I wish my pdoc would prescribe it for me. She hates prescribing it though, I don't know why. Seems like she hates prescribing anything nowadays...

I'm a pretty high-caliber self-loather myself. Pretty good at it, if I say so myself. I punish myself and self harm by overdosing on benzos, which is apparently a borderline trait, as the hospital pdoc proposed that I might have instead of bipolar.

Oh yeah, the Anafranil was abhorrent. I hated that medicine probably the most of any medicine I've taken, probably on up there and if not surpassing my hatred for Fetzima and Luvox. My pdoc complains about me switching too often, but it's literally because these meds don't work very long for me. She says to stick it out and it will eventually work again, but I'm in so much pain and holding on to the ledge for dear life against my will that I'm like "ok do something now or I'm going to die," although I haven't explicitly said it like that.

7 hours ago, sming said:

Hah, that's exactly what happened to me last week on 1mg Guanfacine, which is like an NRI I think? My energy and focus were improved but I was purely focused upon SI! 

Guanfacine is an alpha-2A agonist which decreases norepinephrine release, but directly stimulates alpha-2 noradrenergic receptors. It is a very depressogenic medication.

7 hours ago, sming said:

I was offered Naltrexone (or even tried it..?) because of my chronic opiate use and IIRC it did not go well. They wanted me on  buprenorphine (Suboxone) as well but I read a lot of horror reviews online. Docs tended to dump people off of the opiate and onto Suboxone and pretend it was as effective as the opiate and that the problem was solved. Naturally that didn't go well for most folks...

Buprenorphine is supposed to have very strong antidepressant properties, but I have heard nightmare stories about it too, mostly from people who were on one opioid and were switched to it. Suboxone I believe is a combination of buprenorphine with naloxone, which is another mu-opioid antagonist. Pure buprenorphine is supposed to be better than Suboxone for depression. Suboxone is specifically indicated for opioid abuse patients, not pain patients like buprenorphine is. What a dimwit.

7 hours ago, sming said:

Oh man, they let me fly. I just developed post-op thoracic radiculopathy (squished root nerves - oww) and I'm on 15mg Oxycodone doses up from 5mg. It is bliss. My depression is so, so much better. But will I be allowed to stay on it? Of course not. I had to fight to get barely enough pain suppression before returning home 😞 

I def know hitherto, but wasn't aware of thitherto - most splendid.

Ouch!! That's gotta hurt! Yeah, I know people who get hit by cars and the people in the ER tell them to take some ibuprofen... !!!!!!!!!!!!!!!! WTF???

7 hours ago, sming said:

you've got me thinking now. Perhaps I can take time off of work just to push through the somnolence/anhedonia barrier and onto 10mg and up... Hmm. If it's potentially like Adderall then that would be nothing short of magic for me.

I love Abilify, I just can't take it because it worsens my already off-the-charts impulsiveness.

I just got switched to Latuda. Copay is $110 with the coupon card. FML.

8 hours ago, sming said:

Oh, bugger. That sounds like my anhedonia. I just feel soulless, vacuous, devoid of meaning and purpose.

Precisely! That's exactly how I feel.

8 hours ago, sming said:

Oh man, we are tragic twins again. This is exactly the sort of thing I'm struggling with. As you age (I'm 44), your MI tends to get worse and more set in. So is my increasing anhedonia down to that, or to just being really depressed, or Abilify, or Abilify + Fetzima, or ... you get the picture 😕 

I've heard bipolar gets better when you age, but it's certainly not for me. Maybe my hospital pdoc was right that I have MDD instead. Anheadonia is a main feature of my depression. It is absolutely takes center stage in the performance of my MI. I don't talk because nothing I think of has any meaning, and the conversation moves too quickly anyway with groups of friends. I don't do anything when they're playing games or board games because I'm super sensitive to not winning or at least doing well, I always come in last. Even co-op games get me down because I feel inadequate in participating and don't know how to do what is needed to be done. But I end up just sitting there. I bring my laptop with me to post on here or do some research, but I end up staring blankly at it, so I shut it down and just lay down and sometimes fall asleep.

8 hours ago, sming said:

You're absolutely right. I can't stand it when someone tells me exactly how my 4 psychotropics are interacting, or even how just Abilify does. No-one really knows why they affect mood, MI, cognitions.

They all are theories. There's not enough funding into research into mental illness. Suicide is one of the top killers of people in the US, and it's growing, and no one wants to address the issue because they're too pussyfooted to get past the stigma of mental illness. BUT OH IF THEY'VE GOT GOD ON THEIR SIDE THEY CAN GET THROUGH ANYTHING, AND SO COULD YOU IF YOU ACCEPT GOD IN YOUR LIFE. Not to make fun of Christians, and no offense to any on here, I've just had that speech countless, COUNTLESS times, and I'm sick of it. That and "IF I ACCEPT GOD INTO MY LIFE AND STOP 'PRACTICING' HOMOSEXUALITY AND ACCEPT JESUS THEN I'LL BE CURED AND HAVE A FAMILY AND FOLLOW GOD'S PLAN." Someone shoort me in the face please. Sorry, not sure how I got onto that subject.

8 hours ago, sming said:

Of course it's not that simple with me. I felt better for a few days and then back down the toilet. I think I mentioned that I might start oscillating between 1.125mg and 5mg - try and keep my down/up-regulating asshole of a brain guessing, you know?

Thanks again dude.

That's exactly how I was with Abilify in the beginning the first time I took it. 2 mg was like hypomania for a month then down the toiet. 5 mg was a tiny little spark for a few days then even further down plus akathisia. Went back down to 2 mg and it was EVEN worse. Danced around until I got to 15 mg and all hell broke loose with akathisia and dysphoria and wanting to come out of my skin. That was when I switched to Rexulti and then began my weight gain journey to going from 170 lb to 282.9 lb (not just from Rexulti alone). Sounds like it could possibly work. Anytime! 🙂

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On 2/6/2020 at 12:21 AM, mikl_pls said:

There's also Zelnorm (more expensive I think depending on your insurance), Amitiza, and Trulance. Meclobemide is a prokinetic anti-nausea medicine that might work but can't be used in long term because it blocks D2 receptors like an antipsychotic and can cause movement disorders.

 

Tried Zelnorm and Amitiza - same deal, gah. My gut just does not like being told to empty itself. If you pull the plug on it (from the other end), it doesn't seem to go into crazy cramping ¯\_(ツ)_/¯  I couldn't find anything on "Meclobemide" and Moclobemide is obviously the old MAOI.

 

On 2/6/2020 at 12:21 AM, mikl_pls said:

 

I'm a pretty high-caliber self-loather myself. Pretty good at it, if I say so myself. I punish myself and self harm by overdosing on benzos, which is apparently a borderline trait, as the hospital pdoc proposed that I might have instead of bipolar.

OK, here's the deal: if I don't do it, you don't do it - capiche? (sure that's gonna work...). 

On 2/6/2020 at 12:21 AM, mikl_pls said:

My pdoc complains about me switching too often, but it's literally because these meds don't work very long for me.

Exactly! We wouldn't be on the bloody med merry go round if they bloody worked, would we!!?? That really pisses me off. It also pisses me off that I get berated and preached-at for ordering extra stimulants online. I wouldn't have to do it if I was allowed a sufficient amount, would I!??

On 2/6/2020 at 12:21 AM, mikl_pls said:

She says to stick it out and it will eventually work again, but I'm in so much pain and holding on to the ledge for dear life against my will that I'm like "ok do something now or I'm going to die," although I haven't explicitly said it like that.

Really? I've stuck out a bunch of meds that I've had bad reactions to and none, literally none that I can recall have somehow majestically risen up and become helpful. They typically just get worse and worse.

 

On 2/6/2020 at 12:21 AM, mikl_pls said:

Suboxone I believe is a combination of buprenorphine with naloxone, which is another mu-opioid antagonist

Speaking of naloxone, when negotiating (cause getting logical/obvious post-op painkillers now is like getting blood from a stone...) how much Oxy I can get for my severe post-op pain with my pharmacist, she offered up that they have naloxone and it doesn't need a script. You know, just in case like... like I'm an addict. 😞 

On 2/6/2020 at 12:21 AM, mikl_pls said:

Anheadonia is a main feature of my depression. It is absolutely takes center stage in the performance of my MI. I don't talk because nothing I think of has any meaning

THIS

 

On 2/6/2020 at 12:21 AM, mikl_pls said:

I don't do anything when they're playing games or board games because I'm super sensitive to not winning or at least doing well, I always come in last. Even co-op games get me down because I feel inadequate in participating and don't know how to do what is needed to be done.

THIS. I love Hearthstone. But I can only watch others play it on YouTube because I'm terrified of feeling too hurt from losing, or being humiliated. Or both. I've tried every trick in the CBT, REBT, ACT and ERP books to no avail. I just can't do it -_-...

On 2/6/2020 at 12:21 AM, mikl_pls said:

Suicide is one of the top killers of people in the US, and it's growing, and no one wants to address the issue because they're too pussyfooted to get past the stigma of mental illness.

Also because there's not as much money in depression as there is in cancer or obesity... And that religion "if only you could see..." trip. I don't get it that much because I no longer interact with a wide range of people but it's just the worst. The thing is, if "seeing" God worked, I'd bloody well do it! I WANT to see because then I'd feel better!!!

 

On 2/6/2020 at 12:21 AM, mikl_pls said:

That's exactly how I was with Abilify in the beginning the first time I took it. 2 mg was like hypomania for a month then down the toiet. 5 mg was a tiny little spark for a few days then even further down plus akathisia. Went back down to 2 mg and it was EVEN worse. Danced around until I got to 15 mg and all hell broke loose with akathisia and dysphoria and wanting to come out of my skin. That was when I switched to Rexulti and then began my weight gain journey to going from 170 lb to 282.9 lb (not just from Rexulti alone).

Jesus. It's powerful for you too as well then. I tried the oscillating dose and it... didn't help. Perhaps I need to do 5 days @2mg, 5 days @5mg, alternating or something like that. God knows. 

That is a severe weight gain. Christ. I'm 200lb but normally am 175lb and I hate it. I'm so sorry (for us both) dude 😞 

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36 minutes ago, sming said:

Tried Zelnorm and Amitiza - same deal, gah. My gut just does not like being told to empty itself. If you pull the plug on it (from the other end), it doesn't seem to go into crazy cramping ¯\_(ツ)_/¯  I couldn't find anything on "Meclobemide" and Moclobemide is obviously the old MAOI.

Oh wow... Your gut does not like you, does it?

Oops! Oh crap, I meant metoclopramide (Reglan).

38 minutes ago, sming said:

OK, here's the deal: if I don't do it, you don't do it - capiche? (sure that's gonna work...). 

I'll do my best to abide by that. 🙂

38 minutes ago, sming said:

Exactly! We wouldn't be on the bloody med merry go round if they bloody worked, would we!!?? That really pisses me off. It also pisses me off that I get berated and preached-at for ordering extra stimulants online. I wouldn't have to do it if I was allowed a sufficient amount, would I!??

Exactly!! There shouldn't be quantity limits with insurance... They're not the doctors, are they?? So why play doctor?

39 minutes ago, sming said:

Really? I've stuck out a bunch of meds that I've had bad reactions to and none, literally none that I can recall have somehow majestically risen up and become helpful. They typically just get worse and worse.

Exactly! That's how it is for me too!

40 minutes ago, sming said:

Speaking of naloxone, when negotiating (cause getting logical/obvious post-op painkillers now is like getting blood from a stone...) how much Oxy I can get for my severe post-op pain with my pharmacist, she offered up that they have naloxone and it doesn't need a script. You know, just in case like... like I'm an addict. 😞

Or like you're going to OD on it or something.

41 minutes ago, sming said:

THIS

If I try to talk, I'm usually so soft-spoken that my voice gets lost in the cacophony of conversation that's going on, and the only one to notice it is usually one of my very closest friends, @THE_REAL_Bryan. (I sure wish he'd get his ass on here and post in all the threads I've tagged him in... lol.) He is literally closer than a brother to me. I think he knows my brain more than I know it myself.

44 minutes ago, sming said:

THIS. I love Hearthstone. But I can only watch others play it on YouTube because I'm terrified of feeling too hurt from losing, or being humiliated. Or both. I've tried every trick in the CBT, REBT, ACT and ERP books to no avail. I just can't do it -_-...

Atypical depressive symptoms are I believe responsible for the sensitivity to losing/not doing well in games played with other people. I can play Smash Brothers with my best friend aforementioned but only as long as we're on teams, and even then, if I'm in a certain mood, if my KOs aren't comparable to his at the end of the match, I get pouty and self deprecating. It's one of my most hated traits by myself. I haven't read any books on those types of therapy, perhaps I should try it.

My therapist I think is really going to get to the bottom of some or a lot of my issues, I hope. He has a whiteboard in his office and handouts and worksheets he gives me. He draws stuff out on the whiteboard and asks me to take a picture of it after the session. He started talking about Eric Berne's theory of the Parent, Adult, and the Child, somewhat like Freud's theory of the id, ego, and superego, but with more information. Things have apparently happened to me before the age of 8 (before the Adult starts developing) that have really fucked me up. I know of one thing that definitely contributed, but it's a bit too personal to mention here. I could PM you about it if you like. But basically, the Adult can be in control, maintaining composure and logical thinking, then something triggers the "hurt Child," and it takes over and irrational emotions surface and one reacts accordingly. He said my Child is "very hurt."

50 minutes ago, sming said:

Also because there's not as much money in depression as there is in cancer or obesity... And that religion "if only you could see..." trip. I don't get it that much because I no longer interact with a wide range of people but it's just the worst. The thing is, if "seeing" God worked, I'd bloody well do it! I WANT to see because then I'd feel better!!!

Oh gods... Yes. I mean, yes, we need cancer and obesity funding, but share some of that with depression and other CNS illnesses FFS! Exactly, I've had the God speech so many times it's ridiculous. I grew up Christian, but being gay and the church environment (piers and Sunday school teachers) being toxic turned me away from organized religion that I refuse to go to a church for worship. I'm agnostic, pretty much right in the middle, but I don't claim to "know" for sure who any god or gods is/are. I don't think it's for us to claim to "know." Higher beings/deities have to be so complex beings that our brains cannot comprehend them, IMHO.

54 minutes ago, sming said:

Jesus. It's powerful for you too as well then. I tried the oscillating dose and it... didn't help. Perhaps I need to do 5 days @2mg, 5 days @5mg, alternating or something like that. God knows. 

That is a severe weight gain. Christ. I'm 200lb but normally am 175lb and I hate it. I'm so sorry (for us both) dude 😞 

I might try a week of alternating because Abilify's half-life is roughly two weeks, so that might be an even oscillation pattern. But I have been on 30 mg, and holy fuck was that an experience...

Yeah, I have desperately tried the keto diet again and again and can't seem to tolerate it since I had my gallbladder taken out. I may have to find another diet to try. That and actually exercise... lol I think I said this, but I am by no means a "big-boned" person, I have a medium-small frame without much muscle at all, just with a whole bunch of extra fat on it. If I lost weight and got down to a healthy body fat %, I'd probably look like a stick. My mom keeps telling me my weight loss goals are excessive, but I know my body.

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20 hours ago, mikl_pls said:

Atypical depressive symptoms are I believe responsible for the sensitivity to losing/not doing well in games played with other people. I can play Smash Brothers with my best friend aforementioned but only as long as we're on teams, and even then, if I'm in a certain mood, if my KOs aren't comparable to his at the end of the match, I get pouty and self deprecating. It's one of my most hated traits by myself. I haven't read any books on those types of therapy, perhaps I should try it.

Isn't it also a feature of BPD? I seem to remember a guy with I think BPD who was hypersensitive like me. There's also this non-condition now : Do I Have Rejection Sensitive Dysphoria? which asks:

  • High sensitivity about the possibility of rejection
  • Overly high standards for yourself
  • Feeling easily triggered toward guilt or shame
  • Isolating yourself in a preemptive strike not to be rejected
  • Aggressive or rageful behavior toward those who have been perceived to have slighted you
  • Frequently feeling an uncomfortable physical reaction due to "not fitting in" or being misunderstood
  • Self-esteem that is entirely dependent on what others think, and rises and falls accordingly
  • Frequent and intense ruminating after an interaction about how you did or said something wrong

Sounds like me to a tee. The only person I can play "competitively" is my 9yo son, which is a beautiful thing but also tragic that he's literally my gateway into a passion I've loved my whole life (videogaming). If he doesn't fancy a game, I'm done. If he wants to play with his buddies, I'm done. Etc. etc.

20 hours ago, mikl_pls said:

My therapist I think is really going to get to the bottom of some or a lot of my issues, I hope.

One can hope @mikl_pls. I don't mean to pour cold water on shit but I've had a few therapists who were licking their lips when they started work with me only to end up throwing their hands up after a few months/years and teflon-ing me off to some other poor sod.

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21 hours ago, mikl_pls said:

Things have apparently happened to me before the age of 8 (before the Adult starts developing) that have really fucked me up. I know of one thing that definitely contributed, but it's a bit too personal to mention here. I could PM you about it if you like. But basically, the Adult can be in control, maintaining composure and logical thinking, then something triggers the "hurt Child," and it takes over and irrational emotions surface and one reacts accordingly. He said my Child is "very hurt."

Well, if you ever "unlock" these things (like some PDoc's and T's think you can, and then you are just light-years better), then I'll be fucking jealous as fuck! 

I've had numerous T's and PDoc's ask very awkward questions (e.g. were you touched etc.) about my youth and I honestly can't think of anything untowards at all. I've wracked my brains many times 😞 

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21 hours ago, mikl_pls said:

I might try a week of alternating because Abilify's half-life is roughly two weeks, so that might be an even oscillation pattern. But I have been on 30 mg, and holy fuck was that an experience...

That's not a bad idea. Yeah it's def "roughly" two weeks since it has several active metabolites IIRC. I might try that as well once my meds go back to their pre-op levels (as right now I'm doing much better due to the large doses of Oxy...). 

21 hours ago, mikl_pls said:

Yeah, I have desperately tried the keto diet again and again and can't seem to tolerate it since I had my gallbladder taken out. I may have to find another diet to try.

I thought the keto diet had been mostly debunked as effectively just being a low-calorie diet? 

21 hours ago, mikl_pls said:

That and actually exercise... lol

I'm way, way too depressed to exercise. I barely have enough energy to make a cup of tea most of the time, let alone go for a run or something proactive.

21 hours ago, mikl_pls said:

I think I said this, but I am by no means a "big-boned" person, I have a medium-small frame without much muscle at all, just with a whole bunch of extra fat on it. If I lost weight and got down to a healthy body fat %, I'd probably look like a stick. My mom keeps telling me my weight loss goals are excessive, but I know my body.

Huh. Sounds like the meds really are doing a number on you 😕  I'm fairly athletic under the extra med lbs. You can see it now and again if I hold my breathe in, lol.

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7 hours ago, sming said:

Isn't it also a feature of BPD? I seem to remember a guy with I think BPD who was hypersensitive like me. There's also this non-condition now : Do I Have Rejection Sensitive Dysphoria? which asks:

  • High sensitivity about the possibility of rejection
  • Overly high standards for yourself
  • Feeling easily triggered toward guilt or shame
  • Isolating yourself in a preemptive strike not to be rejected
  • Aggressive or rageful behavior toward those who have been perceived to have slighted you
  • Frequently feeling an uncomfortable physical reaction due to "not fitting in" or being misunderstood
  • Self-esteem that is entirely dependent on what others think, and rises and falls accordingly
  • Frequent and intense ruminating after an interaction about how you did or said something wrong

Sounds like me to a tee. The only person I can play "competitively" is my 9yo son, which is a beautiful thing but also tragic that he's literally my gateway into a passion I've loved my whole life (videogaming). If he doesn't fancy a game, I'm done. If he wants to play with his buddies, I'm done. Etc. etc.

Oh my, that sounds like me to a tee too. Perhaps rejection sensitive dysphoria is both a symptom of BPD and atypical depression?

7 hours ago, sming said:

One can hope @mikl_pls. I don't mean to pour cold water on shit but I've had a few therapists who were licking their lips when they started work with me only to end up throwing their hands up after a few months/years and teflon-ing me off to some other poor sod.

Well, we'll see. Hopefully that won't be the case. I did feel like I got stuck with my last therapist and she would start saying "you're fine, you don't need anymore sessions right now. Come back when you need me," all the while with me thinking "but... but... I'm nowhere near ready to be discharged by you..."

7 hours ago, sming said:

Well, if you ever "unlock" these things (like some PDoc's and T's think you can, and then you are just light-years better), then I'll be fucking jealous as fuck! 

I've had numerous T's and PDoc's ask very awkward questions (e.g. were you touched etc.) about my youth and I honestly can't think of anything untowards at all. I've wracked my brains many times 😞

My first tdoc asked me if I had been molested and I blurted out "I don't know" as a response before i could think about it. Turns out, a repressed memory of being molested came up a few months later after thinking about it and having really weird, fucked up dreams in my early 20's. It was a friend of my oldest brother's while he was in the Air Force. It was pretty brutal, I won't get into details. I was 5 years old at the time. It's why I have to have absolute trust with someone if we engage in any sexual activity. I would go so far as to refer to myself as demi-homosexual, which makes things complicated for dating, as most gay guys want it on the first date. She did guide me through the PTSD that ensued from remembering that memory, and helped me immensely with processing that. I just can't handle certain things, like seeing portrayals of rape on television or games, or especially rape jokes. They trigger me so hard that I have to take a benzo (can't do that anymore), take something to relieve anxiety, and do mini-meditations to break myself from having a meltdown.

7 hours ago, sming said:

I thought the keto diet had been mostly debunked as effectively just being a low-calorie diet?

The caloric intake on the keto diet is entirely up to you, however much of a deficit or surplus you need. The keto diet relies on taking in very few carbohydrates. When one starts the diet, they typically will either ween off carbs or just go cold-turkey straight to 20 g carbs/day. (It's 5% calories from carbs, 25% calories from protein, and 70% calories from fat.) It relies also on high fat and moderate protein consumption. If you intake too much protein, it can throw you out of ketosis because it metabolizes half and half into ketones and glucose, the glucose being the part that would throw one out of ketosis. As one becomes accustomed to the diet, they can increase carb consumption up to 50 g/day, some people can even pull off 100 g/day, as long is it doesn't exceed 10% calories from carbs.

It is often prescribed for people with intractable epilepsy, often children, and it usually helps quite a lot, although they're not exactly sure why. There is a substance that is produced in the brain (can't remember the name of it) that is believed to be an AMPA glutamatergic receptor antagonist.

7 hours ago, sming said:

I'm way, way too depressed to exercise. I barely have enough energy to make a cup of tea most of the time, let alone go for a run or something proactive.

Oh god, me too. I'm also very gym shy, can't go without a friend because of how self conscious I feel if I manage to go. I go back and forth to the bed and my computer all day. That's about all I do. I'm useless to my family, or so I think. They tell me otherwise, but I "know" better.

7 hours ago, sming said:

Huh. Sounds like the meds really are doing a number on you 😕  I'm fairly athletic under the extra med lbs. You can see it now and again if I hold my breathe in, lol.

Yeah, I've had a few meds really do horrible things to my metabolism and weight, the biggest offenders being Rexulti (20 lb), Parnate (50 lb, paradoxically, being an amphetamine derivative), and Anafranil (30 lb). I've never been athletic, but if there was one thing I could do, it was run when I was a kid. I could run forever. Then I started getting older and stopped being able to run as much, especially because of my asthma which got worse when I was a teenager, and the growing pains and shin splints I had kept me from any sustained physical activity. I used to actually be relatively skinny as a teenager, but due to probably body dysmorphia, thought I was fat, but never did anything about it. In 9th grade, I was put on Lexapro which made me crazy but that's another story, and I gained 30 lb in the first 6 months I was on it, then 20 more lb until I quit it for a total of 50 lb. I went from 185 lb to 235 lb in just a year from a supposedly weight-neutral medicine. I gain weight easily but to lose it it's a bureaucratic act of congress for my body to process weight loss. I have to really convince my body I'm taking in a caloric deficit and burning more than I'm taking in.

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      I generally feel good during the week but am miserable on the weekends. I generally lay in bed all day feeling depressed, binge eat, try and sleep as much as possible. I don't know if this is something that can be fixed with medication or if it is purely behavioral. My therapist suggests making plans for the weekend ahead of time and trying to make my weekends structured.
      I finally got around to sending the doc a message on the patient portal asking about the GeneSight results. He responded that the report showed all my meds were good for me except Prozac. The test recommends Lexapro or Zoloft instead. He did not say anything about changing the Prozac.
      For three days I have been trying to make an appointment to see the doctor. If I call I'm on hold for 10 minutes before leaving a message. I've also tried requesting an appointment with the patient portal. Nothing. So, I'm thinking about just messaging the doc (since I know he responds) and mention the problems I'm having on the weekends as well as concerns I have about staying on Prozac. I want to know if I should switch, or if I should just stay where I'm at since I'm basically doing good except no motivation and very depressed on the weekends.
      What do you all think I should do? Ask the doctor online about switching, keep trying to make an appointment, or just try and add structure to the weekends and see if I can get by without a med change?
      Current meds (all generic):
      Wellburtrin XL: 450mg
      Prozac: 20mg
      Seroquel: 200mg
      trazodone: 400mg
      hydroxyzine: 25mg 3x daily P.R.N.
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