#and maybe a low dose mood stabilizer

[jazzums]

anxiety is the worst feeling

[valiumgf]

ok so! coping with schizophrenia/schizoaffective on low dose/no antipsychotics (I do use mood stabilizers still) info under the cut

1. process your emotions as they come!! (you've gotta figure out how you process best, journalling, visual art, talking things over with someone you trust, exercise, nature walks, yoga, writing poetry, whatever works best for you!) by as they come I mean: literally ASAP!! don't let it have time to marinate and get lost in your subconscious without properly addressing it! something that helps this is really paying attention to where and how you feel emotions (example: I feel guilt and anxiety like a ball in my chest, when I notice I feel it I know I gotta talk to someone ASAP!)

2. OK you're recognizing something you hear/see might not be there think about what stressful events have occurred recently, how does it relate? is there a common trigger (feeling, memory, situation, even a passing thought that occurred before the experience!) try to write down the contributing factors and what the experience was if you have the time! (writing in your phones notes app can quickly work!) acknowledge the experience: i saw this, it made me feel this. next try to redirect your thinking to something else! (I'll explain what I mean by this in 3)

3. OK so the experience happened, but I don't know why? acknowledge it, acknowledge what things it made you feel! now think of something unrelated that doesnt evoke a strong emotional reaction from you, redirecting thinking allows me to not ruminate and not increase emotions related to the experience which just makes me personally spiral!

4. you have better insight!!! congrats and if u dont have better insight we will talk,abour redirecting less intense experiences!!! now you can treat the mild experiences you may still have akin to intrusive thoughts! once again, acknowledge, redirect! or, if you're able to, you might be able to just redirect and not use the mental energy to acknowledge them every time when you're confident!

5. if you struggle with going outside due to paranoia, try to focus more on your feet and listen to some music or talk on the phone! I know personally the less I focus on my surroundings on bad days the less my surroundings seem looming and threatening, also if you're afraid of other people and have the confidence: offering a smile when you pass by someone helps me feel less afraid of others and from all the bs I learned in DBT "wide smile open hands" DOES work, open body language and smiles do make me feel more at ease in public!

6. STIM!! my main one in public is closing my hands tight then opening them, sadly some stims are stigmatized but if you feel comfortable it does make it easier to be out of safe spaces!

7. delusions, this gets tricky! for me, it's not about "changing the belief" because let's be honest, it's basically impossible! what helps me, in, the beginning: was "ok so there's two possibilities, 1. your belief is factual, 2. it's not factual" you want to operate your decisions and actions under meeting in the middle, and not doing anything extreme! (example: "my neighbour's are always talking about me and it distresses me": ok! maybe say hi and ask them how they're doing next time you see them, maybe it could improve their view of you! and if not, you're building a little connection with someone you live near!) (example 2: I am being targeted: "I should maybe tell someone I'm feeling anxious (for whatever reason you feel comfortable sharing) and tell someone to keep in touch with me!" it does not confirm that you actually are being targeted but sets up a safety net which can help with the pain of being persecuted without feeling believed) also recommend looking into double bookkeeping!!

[niftynightmare]

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Jim Phelps September 22, 2014 Hormones, Meds

High-Dose Thyroid Hormone As a Mood Stabilizer in Bipolar Disorder

This webpage describes the use of thyroid hormone as a treatment for rapid cycling bipolar disorder. If you did not arrive from my main page on Thyroid Hormone and Bipolar Disorder, you could start there for some basics about this hormone and why it is relevant for this illness.

To summarize the information below: several independent research groups have been studying this treatment approach. The results are not conclusive, primarily because we need several more studies to confirm the initial results. Only one so far is a “randomized trial” comparing results versus a placebo treatment. But the results so far are quite promising, and the risk levels appear to be very low, so this approach is worth at least knowing about. For patients who have tried many other approaches, this represents one more alternative. Because the risks appear to be so low, it might even be worth considering early in the usual progression through standard mood stabilizer medication options. More data on its effectiveness would be nice, of course.

This high-dose approach has been described by a research group which has done most of the investigations, in a review article which provides a nifty summary if you are trying to get references to your doctors. Because otherwise your job will be quite difficult in this respect, I have taken the liberty of giving you a direct link to this document, which follows my summary below. All errors in interpretation are my responsibility. (If anyone objects to my having made this paper available in this fashion, please let me know and I will remove the link.)

The Hardest Evidence: a randomized trial

The only randomized trial of this approach was published in early 2014.Stamm Bottom line: high-dose thyroid was better than placebo, but only in women, not in men. And (very satisfying, I’d been nursing this hunch for years) it worked better in women who started the trial with a high TSH. This is hard evidence, because of all the work it took to produce this study with no big money behind it. At the rate it took to get these data, we’ll not likely seen another study like this for quite a while.

Skip to the next section, Who Might Benefit, unless you really want the details of this study.

Here are their results, first for women and men together; then for women only, then men only. Note the remarkable placebo response among the men, wiping out any difference with thyroid. When men’s results are mixed with the women’s, the men’s placebo response limits the “statistical significance” of the results in the overall group (A).

HighDo1

HighDo2

HighDo3

There are plenty of quibbles possible here. First, the sample size is so small, maybe that’s why the results are not more strikingly significant. Imagine what these results might look like if the authors had been able to recruit hundreds of patients, as was done in the (industry-supported) study of quetiapine. Looks to me like the trend here is very strongly positive, just as quetiapine was; the lack of “statistical significance” can be attributed to the small sample size — as long as one presumes that a larger sample would have shown the same pattern of results.

The dosing: 100 mcg daily in week 1, 200 mcg/day in week 2, 300 mcg/day in week three to six. (Really). Patients were all on mood stabilizers, optimized by blood level; over half were also on antidepressants.

Negative effects: of the 31 subjects receiving thyroid, one had mild hyperthyroidism, one got a rash, and one became manic. None had ECG changes, increases in blood pressure, nor weight loss.

Conclusion: at least in women, this strategy has been shown to be superior to placebo in a randomized trial. Based on these new data, but also on some complex thyroid physiology, the authors are much less enthusiastic about the likelihood of response to this treatment in men.

Who might benefit?

Most of the open-trial data on this treatment approach has focused on patients with rapid cycling bipolar disorder. The Berlin randomized trial described above focused on bipolar depression. Treatment-resistant” depression, whether bipolar or unipolar (a very difficult distinction in this group of patients), may also respond to this approach.

What are the risks, and side effects?

Surprisingly, this approach is generally tolerated very well. You would think that people would become hyperthyroid, which would lead to the following symptoms:

heat intolerance (hot when others are comfortable, sweating when no one else is, wearing fewer clothes than others)

loose stool or diarrhea

irregular menses

tremor

feeling “wired” or agitated

increased resting pulse rate

But that does not seem to happen for patients who do well with this approach. Pulse rates to go up, generally about 10-20 beats per minute. Some minor symptoms from the above list were noted by some patients, but not to the point of requiring a treatment change. The researchers note that in patients who do not have bipolar disorder, high-dose thyroid would be expected to produce

substantial levels of these symptoms.

Heart risk

Becoming hyperthyroid on your own, because your thyroid gland is not working properly, has been associated with an increased frequency of an abnormal heart rhythm called “atrial fibrillation”. This is not lethal, but it is uncomfortable. Heart pumping capacity decreases by about half, and people feel quite strange. They often go to the emergency room, where generally this abnormal rhythm can be corrected.

But does taking thyroid hormone cause this same increased frequency of atrial fibrillation? in other words, does it make a difference, when the thyroid hormone comes into your body from the outside, instead of when you make it (due to a hyperthyroid state) from the inside? This is not known. All we can say at this point is that in following the patients who are using this high-dose thyroid approach, the researchers have not seen episodes of atrial fibrillation. Of course, at this point they may not have seen enough patients to catch the few cases which might arise from this treatment, so we cannot yet say that thyroid hormone from the outside is different in this respect.

Bone risk

To reiterate from my Basics page:

Risk #2, Bone: This only applies if you stay on high doses of thyroid treatment, presumably because you and your doctor have decided that the treatment is working really well. If you try the treatment and conclude in a month or two that it is not working, this risk is not an issue. A risk that has been associated with staying hyperthyroid due to an overactive thyroid gland is osteoporosis — loss of calcium in your bones, with a risk of fractures, especially when you get older.

But so far, In a 5-year follow-up of patients being treated with high doses of thyroid hormone for bipolar disorder, this was not a problem. Bone density decreased, because the average age in this study was 50, and we all are going down at that age (so to speak; it’s the voice of experience…). But there was no more bone loss than was seen in people of the same age and gender who were not being treated.Ricken

A massive review of high-dose thyroid treatment and bone density also concluded that the risk is either non-existent or at least lower than that of multiple other common treatments for bipolar disorder.Kelly For more see details of bone risk in thyroid treatment.

Agitation

Once in every 15 or 20 patients or so it seems that even low doses of thyroid hormone cause a feeling of agitation and muscle tension and anxiety. This goes away when the dose is lowered or the thyroid is stopped; it takes about 3-4 days to fade away. Very unpleasant. This is a short-term risk I now warn my patients about. I’ve seen it even when the patient’s TSH is quite high, meaning we’re not seeing this agitation because the thyroid dose is “too high”. For example, one patient has a TSH around 4 and cannot take even one quarter of a 25 mcg T4 pill without getting this agitation thing. I have several patients like that.

A case reportRao describes a patient who had agitation and depression at the same time, associated with being hyperthyroid (symptoms resolved when her own thyroid hormone production was lowered). So it seems that in addition to inducing hyperthyroid symptoms, high doses of thyroid hormone could induce a “mixed state”, or something like it. Unfortunately, mixed states are relatively common in people with rapid cycling, the very ones who might theoretically benefit from the high-dose thyroid strategy. Neverthelss one must keep in mind the possibility that if a person is on the high-dose approach and having “mixed state” symptoms, this could be from the thyroid dose.

Tests to do before starting

Several groups of patients would not be suitable for this treatment approach, and so must be sought before treatment begins. These include:

High thyroid levels (hyperthyroid)

Cardiac history (previous heart attack, severe high blood pressure, previous abnormal rhythms, low cardiac output (“heart failure”))

Pregnancy or breast-feeding

Already low bone density, or age greater than 70, or dementia

The researchers also recommend some procedures which may require modification for use in the real world, as opposed to a research setting. For example, they recommend a measure of bone density (an expensive test) before treatment begins, whereas I think it makes more sense to limit this to women who have other reasons for concern about bone density, or at least those who do so well on the treatment that it will be continued long-term. An electrocardiogram is recommended for patients with a history of heart rhythm problems, and a consultation with an endocrinologist/internist for patients with a history of thyroid abnormalities.

Doses used for starting

Which form: T3 or T4?

As you know (if you don’t, read my Thyroid Basics page), there are two forms of thyroid hormone, T3 (triiodothyronine, liothyronine/Cytomel) and T4 (levothyroxine). Both of them have been used in this “hypermetabolic” treatment of bipolar depression. The randomized trial referred to above used T4. You could assume that because this has been the form which has been more widely used in research (namely the UCLA group and their spin-offs), that is the form which should be considered for this approach in the hands of most average psychiatrists.

However, a remarkable pioneer, Dr. Tammas Kelly, in Colorado, has gathered a huge number of patients that he has treated with the other form, T3. He is carefully analyzed the results achieved with this approach, and published them a well respected psychiatric journal (Journal of Affective Disorders).Kelly He clearly has one of the largest patient samples ever studied with this approach.

While I have generally used T4, following the UCLA approach, Dr. Kelly is strongly in favor of T3. There has never been a direct comparison of the 2 approaches. T3 has some significant advantages. Indeed, a recent large federally funded study found T3 better than lithium for treatment-resistant major depression: same degree of benefit, with less side effects and need to discontinue on that basis.STAR*D

So, which one to use? at this point, it’s rather a toss-up. If you saw Dr. Kelly, he’d give you T3. If you saw me, I’d give you T4, because that’s the one I have more experience with.

T4 doses (the UCLA review description)

Starting Dose(mcg per day) Dose Increase(mcg/day)

Normal thyroid(TSH in the normal range) 100 100/week

“Subclinical” hypothyroidism”(TSH elevated) 25-50 Slow*

Overt hypothyroidism(TSH elevated, T4/T3 low) 25-50 Slow*

*reach euthyroid status in 6-8 weeks

Lab tests during follow-up

In this high-dose approach, think about what will happen to TSH. If you followed the story about TSH lab result interpretation (How is Thyroid Measured?, here), you will understand that high dose thyroid treatment drives TSH down to very low levels, zero or close to zero. When starting this treatment, everyone should be prepared to see the TSH go that low. This should not be a surprise, and it should be accepted as part of the plan.

What about the other lab tests, like the T4 level, or T3 level? In the article linked below, the researchers with the most experience using this approach recommend allowing an increase in T4 up to 150% of the starting T4 level. In a personal communication, one of the researchers talked in terms of “150% of the upper limit of normal“, which is obviously likely a little higher number. As for T3, if we had our good reliable measure of this one hormone, especially one that was cheap, this might be the best marker of all, as it is closer to what might be the important physiological endpoint. The researchers point out that if this one is not elevated, perhaps the patient is not really hyperthyroid?

To summarize this issue: there is no accepted laboratory marker indicating the upper limit of this process if the patient him or herself does not have signs or symptoms of hyperthyroidism. This is still being worked out in research. Obviously what matters is to prevent bad outcomes that might be associated with “too high a dose”. But how can we say what it is too high, except based on bad outcomes or on some understanding of the physiology? (as you’ll see below, not much of the relevant physiology is understood)

Think about it this way: if the patient does not have signs and symptoms of hyperthyroidism, but the laboratory studies are in the “hyperthyroid” range, who is correct — the lab results, or the patient? It is such a person really “hyperthyroid”? Is she or he really at increased risk of atrial fibrillation and decreased bone density?

Remember, these risks were originally recognized in patients who were “naturally hyperthyroid”: they were made hyperthyroid by their own gland, not by someone giving them thyroid hormone. We do not yet know if high-dose thyroid creates the same risks, presuming that the patient is not symptomatic. For now, I think we can summarize by saying that there is no consensus on how to judge how much thyroid hormone is too much. Going to 300 mcg, as used in the randomized trial in Berlin, seems a reasonable upper limit for now. In cases where many other approaches have been tried, going to 400 mcg or even a little higher seems justifiable. I personally will be using “T4 up to 150% of the upper limit of normal”.

If this seems radical, or daring, or even “Western cowboy style” medicine, think about the kinds of risks to which we expose patients when we use a medication that has just been approved by the FDA. How shall we define the upper limits of acceptable treatment? What are the risks of going to that level, or beyond? how much risk are we taking just getting to levels that manufacture has already deemed acceptable? When a medication is new, these are almost completely unknown — perhaps even more unknown than the risks of the thyroid approach discussed here.

How does this work?

Seems like a strange idea, using these high doses. Does anyone know how this ends up having a mood stabilizer effect? Basically, the answer is no. Remember, T3 is the active version of thyroid hormone. The researchers point out that when someone becomes spontaneously hyperthyroid, from their own thyroid gland overproduction, they have increased levels of T3 as well as T4. When T4 thyroid is given as a pill, from the outside, even at high doses, T3 levels are not abnormal. In this respect, the patient is not “hyperthyroid”, at least in the same sense as if TSH went to zero from his or her own thyroid production. Thyroid hormone control is extremely complicated. Using high doses of thyroid is simply bumping a system we don’t understand very well. Unfortunately, this is what similar to the situation we face using nearly any medication for bipolar disorder (although our understanding of the causes of bipolar disorder is improving rapidly).

How to Explain This to Your Doctors

Most primary care physicians and endocrinologists have never heard anything about this high-dose approach. But some physicians have been using thyroid hormone for patients with mood problems for years, without a clear rationale. In their opinion, it just seemed to work and not cause too much trouble. Because there was no research behind this approach, it was thought to be almost irresponsible, at least by some endocrinologists. Therefore, if you are considering high-dose thyroid, you are very likely to run into resistance to the idea from other doctors. You can send them to this webpage, if they will go, but for many doctors you might need to walk in with a review article from a source with very good credentials on this issue. Because you could not easily put your hand on this otherwise, and you are so likely to need it, I offer you a link below to a PDF you can print. (Again, if anyone objects to my having made this available, please let me know and I will take it down and post an explanation of the objection.)

The Article You Will Need to Take to Your Doctors

(updated 11/2014)

Want to know more? Try Dr. Kelly’s 2018 book, The Art and Science of Thyroid Supplementation for the Treatment of Bipolar Depression.

Related posts:

Antidepressants in Bipolar II: What the Experts Do

Do Benzos Treat Depression?

Olanzapine vs. Asenapine

How to Microdose Medications

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About this site

[mydaymythoughtsandme]

Self improvement

I have decided to take control of my health this year. I have an appointment coming up in a few days and it'll mark exactly 2 years from my (thankfully) failed attempt. With that said though it has been two years with the same medicine at the same dosage for each. (One I actually only take every other day now because of the side effects I was experiencing and because I was put on the lowest dose for all of my meds [and the pills are tiny tiny) that was the best thing they said for me to do and I no longer got the negative side effects) So with the medicine all being the same for so long I thinking of asking for adjustments (maybe higher dosage amounts for one or two of them, I'm not entirely sure). But I have felt a bit plateud in my mood and stability levels. I'm not in a super bad place again by any means and I am greatful for that, but I do feel like when I do have my lows they get kinda bad lately (although I do have some external stressors that are different that before) and I haven't had too much of the highs, just a lot of bleh and okay enough.

I don't want to just be okay enough I want to do better and be better and be in a truly good place that I can stay in. I know life will never be perfect and it'll never be 100% but I know it can be better and more consistent. And so much of that falls on me as a person and the effort I put into improving and I understand that. So I will be asking for possible adjustments to my medicine and about getting back into therapy as well. It's expensive but after everything that has happened I don't think I can afford not to. They were supposed to call me a few weeks after the last time I went in about a new therapist coming into the office but that never happened so if I don't get practically connected with said therapist right then and there I will be searching through my insurance and starting again that way. Insurance really helps me feel like I can improve myself a lot. One big issue I'm still having is my excessive sleepiness. I am ALWAYS tired. I can sleep for well over 12 hours and it's still not enough sometimes (I know that over sleeping is a thing that can make you more tired but it doesn't matter how much I sleep be it 2hrs 15hrs or somewhere in between I am always tired. I already spoke to both of my doctors about this and they both want blood tests so hopefully we'll see progress there soon.

I think the sleepiness is caused by a lot of factors. One being I can't breathe correctly when I sleep. I'm also a restless sleeper so that would explain why I feel wiped out after a long solid sleep so often. I also have been having issues with falling asleep lately but I think it's stress from the life issues caused by the sleepiness and my stomach.

The big thing is my stomach hurts all the time to the point that I'm actually open to the possibility of having a chronic illness or the like. Obviously I don't know anything for sure but I'm just to the point where I wouldn't be overly surprised if that turned out to be the case.

I think that covers at least the basics for the main points so I will cut it off here and possibly add more detail later. I need to try to ignore my stomach for sleep

[flowergrownbeyondthestone]

I feel a bit silly. For at least a week I’ve been drowning in misery and my hormone tears and absolute lack of motivation and energy, haven’t even touched my guitar and spent a fair part of my weekend on the sofa. I already started to question my whole existence wondering if it’s going to get better at some point and finally the misery has pushed me to make the decision of taking a whole pill of my antidepressant instead of a bit below half. Result? I actually had energy yesterday at work and that’s despite sleeping absolutely horrible yet again. My mood has stabilized a lot as well despite the hormone rollercoaster. It seems like it’s not written in the stars for me to be medication free and enjoy a pleasant toilet time (if you know you know. I unfortunately do know). Luckily one pill is still a relatively low dose so it shouldn’t change that much, but I’m a bit frustrated at all the time and effort I’ve been putting to try to get off of it while clearly it does help more than I assumed. Maybe there are some better alternatives out there, but currently I don’t really have access to them and this is the best (somewhat) safe bet I have. If I have to grow gray and old and die still on antidepressants, so be it. I am definitely very grateful for how much the medication has helped me, especially initially when my anxiety was so bad whenever I left the house and tried to do… anything. I don’t think I’d be where I am now without it. On the other hand I truly wish psychiatrists spent more time trying to find accurate and optimal solutions instead of just upping the dose whenever I came and said I struggled with something. I have a lot of complaints about how the whole system works but that’s a topic for another time I guess. Right now I’m just happy to be where I am, I missed having motivation to do things and just not feeling on the edge and crying at the thought of crying. Now my brain just feels a bit more hyperactive but that’s not particularly new either. And tomorrow is already my personal Friday, yay!

[theysellbands]

well it’s 5 am and I finally finished my first paper. I work in 5 hours and I’m scared to go to sleep because I’m pretty likely to sleep through my alarms at this point. RIP my ability to do anything tomorrow or like. exist. or shut up even once lmao, but at least i think i did a pretty good job even though i wanted to fucking murder the author of one of the readings i had to analyze. but yeah i’m about to get less than 3 hours of sleep oops

[void-galaxy-shenanigans]

Infodump/Long Post: Caffeine, Sugar, Dopamine, & ADHD

Hi. I’m Nico. I don’t usually infodump on here but Aiden did before & fellow neurodivergent people seemed to enjoy seeing nd centered content, & people gave him a lot of attention, so…

Here goes I guess. I hope y’all like it.

It’s gonna be a bit long but I found it fascinating so—

So first important thing is, this is based on research studies I found & theories I know, as well as my own observations, & may not be absolutely perfect because of that. But for the purpose of sharing information I’m going to tell you the theories & findings & build from there. Just bear in mind these aren’t set in stone & knowledge could change in the future - this is based on recent/current findings & understanding.

((& I don't want any arguing about the theories, the existence of ADHD, the addictive nature of caffeine/sugar (that's not the central topic here), or the way I formatted this in replies/reblogs please))

——

So many of you may know that ADHDers are affected differently by caffeine (coffee) than non-ADHDers (& neurotypicals). It’s actually been so consistent that I can tell if someone is ADHD or not based on their reaction to coffee - even before they’re diagnosed. It’s generally accepted that stimulants affect ADHDers differently. Coffee/caffeine usually puts ADHDers to sleep, or makes them drowsy, or makes them very focused, & it’s sometimes baffling as an ADHDer that some people can drink coffee to feel energized & jittery (it feels like a lie sometimes). That’s not to say that people who aren’t put to sleep by caffeine can’t have ADHD, but it’s very common to be put to sleep/calmed down by coffee.

Based on my personal experience with coffee, I’ve had a 20 ounce black coffee put me to sleep for four hours. I also, just yesterday, had a 20oz sugared latte & ended up hyperfocusing on this (topic of infodump), rewriting an intro template we made around a year ago, & writing stories (a special interest of mine) for around 6-8 hours total.

Now I think I might know why.

So I suspected the other day that maybe it had something to do with dopamine, & I did some research on how caffeine affects the brain. But because I also know sugared coffee (e.g. syrup-flavoured lattes, which is what I prefer) seem to have a different affect (especially depending on how much sugar you use), I looked into how sugar affects the brain too.

——

This is gonna use a few technical terms so I’ll explain them first for anyone who doesn’t know—

Adrenaline/Epinephrine: “A hormone your body can release (especially when you’re under stress) that increases blood circulation rate (quickens heart beat, strengthens force of heart’s contractions), breathing speed, & carbohydrate metabolism, & prepares your muscles to be used. It’s part of the human ‘fight or flight’ response to fear, panic, or perceived threat. An adrenaline rush can feel like anxiousness, nervousness, or pure excitement as your body & mind prepare for an event.”

Adrenaline Simplified - It gives you heightened energy, excitement, strength, & alertness, & a lot of it will make you jittery, anxious, or panicky.

Serotonin: A neurotransmitter compound which constricts the blood vessels and acts as a neurotransmitter. It’s responsible for influencing/stabilizing mood, feelings of well-being & happiness, cognition, reward, learning, memory, & numerous physiological processes (nausea & vasoconstriction (narrowing (constriction) of blood vessels by small muscles in their walls to slow blood flow)).

Serotonin Simplified - reduces depression, regulates anxiety, heals wounds, stimulates nausea, maintains bone health, helps with sleeping, eating, & digesting, & regulates happiness, well-being, & mood stability; it’s a soother & a happy chemical. A lot of it will make you extremely energetic & jittery.

Dopamine: “A neurotransmitter compound. When dopamine is released in large amounts, it creates feelings of pleasure (happiness, achievement) & reward, which motivates you to repeat specific behaviours; low levels of dopamine are linked to reduced motivation & decreased enthusiasm for things that would excite most people. It controls mental & emotional responses but also motor (physical) reactions. Known for being the “happy hormone”; responsible for the experience of happiness. The anticipation of most types of rewards typically increases the level of dopamine in the brain (anticipatory pleasure), & then you get a larger dose later when you get the reward.”

Dopamine Simplified - It’s your happiness/pleasure response to achievements, rewards, praise, etc. It functions as both motivation & reward, & when it’s functioning properly it’s what keeps you focused on tasks until they’re done.

Residual Dopamine: Dopamine that’s “floating” around in your brain, ready to be deployed as needed to motivate you & help you get through less fun tasks.

Temporary Dopamine: Dopamine that you get as a reward from things like beating a level in a video game, winning the lottery, etc. (accomplishments); is released after an accomplishment or event is over.

Note that typically, these chemicals (dopamine, serotonin, & adrenaline) are supposed to be balanced, & they’re supposed to be generally not very difficult to get. In mentally ill or some neurodivergent brains, however, these chemicals are imbalanced.

——

Now that the technical stuff is out of the way -

Caffeine lowers your serotonin levels, majorly increases dopamine, & releases adrenaline.

Sugar raises all three - serotonin, dopamine, AND adrenaline.

So sugared coffee will raise serotonin, dopamine, & adrenaline levels.

So how does that make them affect ADHDers differently?

——

This part is based on something called Low Arousal Theory (& no that’s not sexual).

Basically, the theory states that what makes an ADHDer appear inattentive or hyperactive has to do with dopamine in the brain - both how much we have & how easy it is to get it.

ADHDers, according to this theory, have lower residual dopamine. This causes an imbalance between dopamine and other neurotransmitter compounds/hormones.

Because of this, then, ADHDers have to rely on temporary hits of dopamine, both to focus & to boost their mood. There are often less ways we can get enough dopamine, since our brain doesn’t pre-produce enough & we thus need more dopamine total to be able to focus. So we end up hyperfocusing on anything that automatically gives large doses of dopamine - which usually ends up being things like TV shows (binge watching), video games (blackout hyperfocus where you play for hours & lose time), & social media (like, scroll, comment, scroll, lots of feedback/reward).

——

(Note in this case sugared coffee can mean coffee with sugar cubes/physical sugar added, coffee with sugary creamer added, coffee with milk added coffee with sugar syrup added, coffee with flavoured sugar syrup added, & coffee with any combination of those added (because those will all add at least a little sugar); & black coffee means coffee/espresso with not even milk added)

So if black coffee raises your dopamine levels, that means, for non-ADHDers, that it makes them energized, jittery, anxious, motivated and alert. Sugared coffee has a more significant/amplified, but similar, affect & this often shows up as shakiness & inattentiveness.

Non-ADHDers will get an artificial imbalance & a whole lot of dopamine, adrenaline, &/or serotonin. Since they already have enough dopamine naturally, this spike causes hyperactive/inattentiveness.

For ADHDers, however, their dopamine levels are low, so black coffee will cause an artificial imbalance but will leave the ADHDer with enough dopamine (higher levels of dopamine) to be motivated to do tasks & focus, & this usually causes focused drowsiness in small doses. Large doses (usually 20+ ounces of black coffee) will put the ADHD brain to sleep.

Sugared coffee though, for an ADHD brain, will cause an artificial balance with higher levels of dopamine, so this usually creates either blackout hyperfocus (medium dose of sugar + medium (16-20oz) coffee), calm focus (large coffee (20-32oz) + some sugar), or amplified hyperactivity (small coffee (8-16oz) + a lot of sugar or large coffee (20-32oz) + a lot of sugar; jittery, jumpiness, running around).

((Note the oz are an estimate & will vary depending on your personal tolerance for caffeine & sugar))

Essentially, sugared coffee could have a similar affect to prescription meds for ADHDers who don’t trust meds, get bad side effects from meds, or aren’t allowed meds? (I wouldn’t necessarily recommend it or say anyone should ditch their meds to try it, especially since coffee can be addictive, but I found it fascinating either way (since it explained (potentially) why black coffee could put me & other ADHDers to sleep).)

It also means being put to sleep by coffee, or suddenly able to Do The Thing™ because of coffee, is ADHD culture. (/lighthearted)

~Nico

[tailless-whale]

I just started topamax yesterday and I am so excited!!!

I was diagnosed with idiopathic intracranial hypertension last year and it has been a struggle finding a drug to treat it that my body can tolerate. After two tries at acetazolamide, months of furosemide and two weeks of methazolamide (plus 3 days of bactrim) I figured out that sulfa drugs make me psychotic!! Yay! In retrospect, that explains the hallucinations I had on low dose lasix that I brushed off for months.

I tried going without meds, but after 3 days my ears were ringing, my head was spinning, eyes were throbbing, head was pounding, and neck was stiff and achy.

My Neuro suggested topamax, but seemed hesitant because of the side effects (honestly, nothing can be worse than acetazolamide!). She was like "This is used to reduce intracranial pressure, but is also used for migraine, weight loss and mood stabilizer."

"That's great Irina! Sounds perfect for me! I have high intracranial pressure, migraines, I'm fat, and I'm bipolar! It sounds perfect for me!"

I took my first dose Tuesday night and I already feel it working. My high pressure headache is gone, my face and fingers are tingly (gotta take potassium for that), and my appetite is nearly non-existent 😁 of course I know to eat, I learned that when I started concerta as a teenager, but maybe now I can lose some weight and make my IIH go away. Here's to hoping I finally found my drug 🤞🍀

[giorno-plays-piano]

Rx Queen

Pairing: criminal!Bucky Barnes x Reader 

Warnings: obsession, stalking, non-con, breeding, minor depiction of violence.

Words: 2567. 

Summary: James Buchanan Barnes was the most difficult patient you had ever treated as a criminal psychiatrist. His release from prison doesn’t make things easier for you. 

_____________________________________ 

You turned off the phone and threw it on a chair, clenching your teeth. Whatever Dr. Strange wanted you to do, you wouldn’t stay another day in this goddamn place, waiting to be abducted or even murdered. It was too much. Today you found the new bottle of your favourite perfume on your nightstand. It wasn’t there before you went to bed last night. In fact, you could hardly remember the last time you bought yourself a perfume.

It all started two months ago when James Buchanan Barnes, the patient you had been working with during those seven long years, was finally released from State prison after serving 15 years of life sentence. The Soldier, as prisoners called him, once gone mad and murdered his commander. Bucky – that’s how he asked you to call him during your first seance – had PTSD, antisocial personality disorder, and severe depression. You could say he became better after all those years of treatment, including insane doses of antidepressants and mood stabilizers, but it was not enough to set him free. He was dangerous, psychotic even, yet devilishly clever: he knew how to portray a man who had reconsidered his life choices and deeply regretted taking someone’s life. 

You knew he had never truly cared. Patients like him did not have capacity for remorse.

You started treating him once you became a criminal psychiatrist; Bucky was among your very first patients. Now when you thought of it, you could hardly believe Dr. Strange just transferred a patient like him to you, a young girl with too little experience to handle an unpredictable psychopath hiding behind a façade of a victim. Of course, you made many mistakes, starting from telling Bucky about your own past and some mental issues. That time you believed you can gain trust of your patients by being more open about yourself. You were a complete idiot.

Now there was not much to do once his time in prison was up. You didn’t have true evidence to make him stay. A part of you wasn’t even sure you wanted it – when a riot had started in the prison three years ago, it was Bucky who shielded you with his own body from Brock Rumlow, a serial killer and your second most dangerous patient. Bucky was the only reason you were still alive.

But he was also the reason why you were leaving in haste, packing only necessities. 

It all started quite innocently with him sending you flowers and thanking for everything you had done for him. It didn’t alert you that he knew what your favourite flowers were. You thought it was just a coincidence since bouquets like these were sold in any flower shop in the city.

Then you stumbled upon him in a café where you often had your breakfast on weekends. It could alert you, but Bucky was sitting with a charming red-haired woman, her manicured hand resting on his thigh. She didn’t quite strike you as his sister, especially since you knew he had no relatives left after his violent father died in a car accident. Seeing such a beautiful woman with him just two weeks after Bucky was released from a prison was surprising, but you knew how seductively charming Barnes could be. Besides, he looked really good in his biker jacket, his tight black jeans showing his strong muscular legs.

In the end, you just talked to both of them a little and gave your advice on which dishes to choose. You walked away, praying you were wrong about Bucky and hoping he could settle peacefully like some of your former patients. Actually, even though many of them were imprisoned again, others were able to return to normal life. Some even had families now – from time to time you received thank-you notes with nice photos and many heartwarming words. It was probably one of the few things that made you keep your job.

It was over now. You were not going to stay in a place Bucky break into multiple times. Maybe you were not sure before, but the bottle of perfume was an obvious sign. It also meant that when a week ago you woke up and smell a man’s scent on your sheets you were not delirious. Bucky was there. He was laying beside you on your fucking bed.

How did it happen? Why didn’t you see his obsession growing with each day? You were his psychiatrist; you knew him better than anyone. How could he hide his infatuation with you for so long? Of course, you knew he had some feelings for you, but it was never that bad. You thought he would forget about you once he would be released. In the end, now you were not the only woman he saw around.

You kept stumbling upon his beefy figure more and more often. You realized Bucky was stalking you when after a month of his release you saw him watching your house from the forest. He was hiding behind the trees and bushes. It was a miracle you managed to see him at all – after 15 years he was still the Soldier, his skills remaining keen.

You tried talking to Dr. Strange. It wasn’t your first time being followed by your former patient, and police had always assisted you. But Barnes wasn’t like any of those stupid psychos who left tons of evidence behind them. Police had nothing to work with.

Well, you weren’t going to sit there and wait for Barnes to come and get you. You had no idea what was going on in his unstable mind, and you weren’t ready to take risks. You had already booked a flight to Austria tonight.

It was scary, thinking about wandering around a city you had never been, in a foreign country where you had neither relatives nor friends. But Barnes would have a hard time following you there, and that’s what mattered.

You threw a pack of salted cashew in the bag and returned to the bedroom to grab your phone from the chair. It wasn’t there. Although you dropped it just five minutes ago, your phone simply wasn’t there.

You were so fucked.

Next minute you were in the kitchen grabbing a knife, but a strong muscular arm knocked it out of your hand, and you felt Bucky’s musky scent. He stood behind your back, caging you with his bulky arms. You froze and held your breath. You knew you better obeyed the man instead of provoking him to become violent.

“And where were you going, honey?” His husky voice was enough to make you tremble. “It’s not nice to leave without saying goodbye, is it?”

“Please, Bucky.” You did your best to hide how frightened you were. “Stop.”

“No, honey.”

He leaned closer to you and buried his nose in your hair, inhaling its smell. His rough hands were already caressing your body through the clothes.

“You’re free to start a new life. You can find a good woman, have a family if you’d like.” Panic was rising in your chest. 

“That’s exactly what I’m doing.”

“No, Bucky, it’s not.” You said in a calm voice. “It will only get you back behind the bars. Don’t throw away your life, please.”

“What life?” He growled, turning you around harshly, and you almost fell on his chest, his arms holding you still. “I have no life. I should have never left my cell, you know this better than anyone else. I’m rotten. Damaged goods. I will never have the life I’ve always wanted. Do you know I have nightmares every fucking night again?”

“It’s because you don’t take your pills.” You carefully put your hands against Bucky’s chest. He tried manipulating you, you knew that. “When was the last time you had thioridazine?”

“Stay with me, and I’ll take whatever pills you want me to.” He grinned suddenly, cupping your face. 

Bucky’s strong athletic body emanated heat, and you were already sweating from both his closeness to you and an extreme agitation. Why did it take you so long to leave? You should have done it the first thing in the morning, just grab your documents and money and run to the car. Maybe then you had a chance. Unless Bucky had already been hiding inside your house…

“Why do you want to make a wrong choice again?” You felt his heart beating loudly with your palm against his chest. “You are given a chance to start over. If you want me to consult you still, I can figure something out. I can continue helping you, but you need to find your way. Don’t you think it’s good to meet new people, have friends, find a job, date a girl?”

“Who wants to deal with a psychopath like me?” He let out a chuckle, his expression darkening. “No one can handle me, doc. No one but you. Do you know I wanted to commit suicide before you showed up seven years ago? If not you, they’d already buried me.”

Before you opened your mouth to protest, he turned you around again and gently nudged you towards your bedroom. You broke out in cold sweat. If Bucky was able to outpower Rumlow, that beast of a man, he would have no problems forcing you to do whatever he pleased. It took three strong prison guards to bring someone like Bucky down. You were helpless.

“No one out there is good enough.” His breath was tickling your ear. “You’re the only one, can’t you see? Maybe I’m rotten to the core, but you still helped me. You made me better.”

You stopped in front of your bed, the white cotton sheets and blue blanket crumpled. You stormed off early in the morning once you saw a bottle of perfume on the nightstand and didn’t care to make your bed.

You needed to keep calm. As far as you could see, Bucky didn’t plan to murder you, not when you would accept him, that is. He obviously had a nice plan how to make you stay with him without police knowing, but as long as he kept you alive you still had a chance. You needed to play along.

“On the bed.” He let out a low growl, and you felt the bulge in his pants pressing against your ass.

Shivering, you took off your slippers and sat on the bed facing him. His erection was obvious; Bucky was breathing heavily, his pupils dilated. The next second he was pulling his black t-shirt over his head, and you saw his shredded body littered with scars. You saw one particularly long one on the side close to his waistline: this was the one Rumlow gave him when Bucky was protecting you during the riot. The man let out a quiet laugh when he saw your eyes focused on a nasty pink line.

“Why are you frightened, honey? I know you want a family too. You good-for-nothing ex wasn’t able to give it to you, but I can.” His hands landed on your bared shoulders, and you flinched a little. “Let’s get married, and I swear I’ll do whatever you tell me to.”

“Bucky, relationships don’t work like this.” You whispered, withholding a cry when his hand pushed you down on the bed. 

“Don’t they?” The man smiled and cocked his head to the side, removing his black leather belt. “You do something for me, I do something for you. That’s what I learnt in prison.”

You dragged yourself back as quickly as you could, but your back was pressed into the wall once Bucky put his knee on your bed. There was nowhere to run.

“Don’t be scared, honey.” His sweet voice broke the silence, and he crawled to you, slowly caging you with his bodyweight. “Let’s make a deal. You marry me, you bear my child, and I will return to prison. I don’t care if they’ll give me twice more pills or make me a lethal injection as far as you take care of my kid. You’ll love my kid, won’t you? You’ll take care of them. You’ll make them a better person than I am.”

The more he spoke, the more feverishly he touched you, his left hand pinning your palms above your head. He traced his arm along your breast, ripping your shirt with so much force that its green buttons ended on the floor. You realized your cheeks were wet with tears when Bucky kissed you on the forehead and wiped your face with his other hand.

He wanted to have kids with you. Why? Why you? Why did he consider you a perfect mother? Why did he consider returning to prison? Why was he ready to trade his goddamn life for a chance of having a child? Why couldn’t he have a child with someone else and just keep living?

Oh, of course he couldn’t. Bucky loathed himself. It wasn’t uncommon for the patients with Cluster B personality disorders, and it was probably true he wanted to end his life since you saw his self-destructing behavior. In the end, even his effort to save your life back than in the prison might be some kind of a suicide attempt. 

And the reason he wanted you and no one else… Well, you were the one who had been taking care of him all these years. The only one to navigate him through his nightmares when everyone else gave up on him. He saw good in you. He wanted it for himself. He wanted to make sure his child would never be treated the way he was.

You cried out when Bucky suddenly forced his cock into you. It felt like he was ripping you apart – he was huge. Your eyes flooded with tears again, and he cooed at you softly, pressing his chapped lips to your burning face. You couldn’t even remember when was the last time you had sex since you broke up with your ex a year ago. Thankfully, Bucky gave you time to adjust. He kept whispering filth into your ears and stroking your naked thighs. When did he take off your jeans?..

He kissed the top of your head, playing with your hair, and moved his hips slightly. You hissed in pain, but then realized it was a bit better – the pleasure started building up slowly, and you squeezed your eyes shut. No, no, you were not disgusting, your body tried to cope the best way it could, nothing else, it was a perfectly normal reaction, you knew that. Then you felt Bucky licking up the shell of your ear and whined desperately.

“It’ll be ok.” He whispered and kissed your temple. “I’ll take you to a nice place, and we’ll be there all alone. Once I make sure you’re pregnant I’ll return to prison, I give you my word.”

You bit down on your lip to muffle the noise coming out of your mouth.

“If they keep me alive, I might become your patient again.” He sounded almost ecstatic, rutting deep into you. “I’ll do whatever you say. I’ll stuff my mouth with your pills. Please, just stay with me.”

Staring at the white ceiling, you bit your tongue so hard your mouth filled with blood. You’d survive this. You’d get him behind the bars again. 

You wouldn’t stay.

[my-wayward-son]

Soooo… Um. It’s bad.

BPII is a common comorbidity with autism, and the whole diagnosis of BPII was coined (separated from BPI) because the depression end is stronger and the manic end is more like super anxiety. I know this. I’ve known this for a long time.

I have chronic migraine disease and severe gastroparesis/adult FTT. I know this too.

My labs still haven’t recovered completely from the colectomy and subsequent stint on TPN; my H&H is chronically low and my ferritin is shit. Fatigue is is a problem. Like, majorly.

It never fails to catch me off guard, though, when things really take a turn for the worse, especially all at the same time. Lack of interest in things I usually enjoy keeps washing over me. Like, all the time.

Let me explain.

I haven’t seen the new Spider-Man trailer. I haven’t seen What If. I haven’t seen Shang Chi (though that’s also due to fear of the delta variant and crowded theaters). I need 4 (count that, 4) doses of sleep med to put me down for the night, and I still roll all over the bed and listen to Buzzfeed Unsolved I’ve already seen and get barely any REM. All I want to do is ballet, then I get frustrated that I can’t remember combinations easily, but that’s because of the (faulty) migraine and psych meds I’m currently on. I’ve been having sick stomach a la pre-colectomy if I take in anything but clear liquids by mouth. I haven’t combed my hair or put in my hearing aids in about a week.

The list goes on, but I don’t want to bore you. Or sound too complainey. I feel pathetic and like I’m being an attention whore by putting it all out there, but, as DD has told me, at least I have words. A couple of weeks ago I felt so low that I could barely express what was wrong. Now I’ve been to a couple doctors appointments, switched a few meds, and have enough presence of mind to know that everything is seriously fucked up.

The SSRI I’m on is absolutely not agreeing with me, and my sleep med is obviously not doing its job. My psychiatrist is working on coming up with a new med cocktail, though we’ve only been able to talk via email so far.

I’ve pretty much eschewed my migraine steroid pack because it’s keeping me from being able to think, but the headache is… impressive. If my mental health/drive were in order, maybe I’d call the pain functional, but right now it’s edging back up toward status. I take pain meds ranging from ibuprofen to RX injectables at random intervals when I feel especially bad. Intensity ranges from dull throb to skull-splitting, going to vomit.

I know most meds have headaches as a side effect, which sucks fucking rocks because that makes it impossible to tell how much I actually hurt and what’s amplified by my new meds. Not all of them are bad (we think), so it’s kind of a waiting game to see if my body “gets used” to the formulation.

I have neurology in two days, so I guess we’ll be able to discuss the headaches then, however it’ll be hard to ensure any med changes are appropriate when my psychiatrist is still working on a new batch for mood stabilization. I’m nervous and frustrated in advance.

There are so many things I want/need to do, like catching up on short fics in my inbox and doing this month’s Artsnacks challenge. I’m basically living day-to-day right now, and I’m lucky if I get all my daily household and self-care tasks done. I keep wanting to do fun activities with the kids, too, but time gets away from me. It winds up taking 10 years to fold the laundry, and all the sudden it’s time to get ready for bed, and I did nothing all day.

I hope to all gods above and below that everything will be worked out before Inktober/Whumptober, because I really want to commit to completion for both. We’re going on vacation for the first week of October, and I plan to focus my non-beach time on art and writing work. I’m all planned out (was able to do that before the depression hit so badly), but I’m currently doubting my abilities. I also plan to slide back into working on Keeping Safe, so I can take it back on for NaNo. That’s something that will take some commitment and discipline. I want so badly for it to work out. I’ll be disappointed if it doesn’t, and I know it’ll be a hit to my self-confidence. A few years ago I wrote a whole 70k book in just 28 days, and now I’m struggling to pop out shorts…

Anyway. I’ll stop talking now. I hope this doesn’t read as overly dramatic or like I’m begging for sympathy. I’m not. I’m trying to be real and maybe explain why my presence has been spotty lately. All I want is for things to get better.

[addictedtostorytelling]

i forget what episode, but in an early season Nick & Warrick are bothering Greg in his lab and make a joke/crack at his expense that mentions Greg's medication? Harmless fun, or could Greg potentially need/be on meds (ADHD maybe?)? its only mentioned once so it caught me off guard as to how much weight the audience should put into one line

hi, anon!

in my view, while the line itself is a throwaway (in the sense that i don't believe that warrick is speaking knowledgeably about greg taking medication), the fact that it is doesn't preclude the possibility that greg might be on medication nonetheless.

the episode in question is 03x10 "high and low."

in the scene you mention, nick and warrick are hanging out in the dna lab, getting in greg's way, bickering with each other, and generally being obnoxious; fed up with their knucklehead antics, greg tries to push them out the door—literally, in nick's case, as greg unseats him off a chair he's sitting on to force him to move his feet.

both nick and warrick are surprised by greg's brusqueness.

as a parting jab, just before greg hustles him into the hall, warrick quips, "have you taken your medication today?"

greg doesn't answer, and the scene ends there.

now.

because of the tone and context of this exchange, i'm 100% certain that warrick isn't asking his question in a genuine way—i.e., this is not a case where warrick knows that greg is neurodivergent or mentally ill and takes medicine to stabilize his moods and/or control his behaviors and so is asking him about it in a "hey, buddy, are you okay? did you maybe miss a dose?" concerned kind of way.

rather, this is warrick making fun of greg.

essentially, he's insinuating that greg's attitude is getting out of hand, so he needs to "take a chill pill" to settle down.

it's an "are you crazy, sanders?" type of dig.

honestly, it's just the kind of mean-spirited crack that warrick wouldn't make if he knew that greg did take medication of that sort—because then it would be too low a blow; too much of a "punching down" deal—so to me the fact that he does make it tells us that he has no reason to believe that greg is actually on medication.

of course, just because warrick most likely doesn't have any knowledge of greg being on medication doesn't necessarily mean that greg isn't.

this case may be one where warrick says something jokingly (and in ignorance) that actually ends up having more truth to it than he realizes.

greg very well could have adhd—and i know that a lot of fans, particularly including those who have adhd themselves, headcanon that he does.

certainly, if he did, it might explain some of his tendency to flit from activity to activity, his chronic boredom in the lab, his excellent multitasking abilities, etc.

of course, since greg has no diagnosis that we're told of in show canon, we never actually see him taking any medication, and the topic of him even potentially doing so is never revisited again at any point throughout the series, it's really up to the individual viewer to decide if they think he does have adhd (or any other neurodivergence or mental illness) and take medication or not.

if one does think he's on medication or even that he used to be*, then this scene takes on new significance, as what warrick means as an offhanded joke probably ends up hitting a bit close to home for greg, potentially hurting his feelings.

* if greg did have adhd, he would have most likely been among the first wave of gen xers who got diagnosed with the disorder under its new name (changed from hyperkinetic impulse disorder to attention deficit disorder with hyperactivity, as per the dsm-iii) during the early 1980s. most probably, he would have been prescribed ritalin, which was the most common drug used to treat the disorder at that time, when he was in grade school. since back then, and even up through the 90s, adhd was considered solely a childhood condition, he, like many other adhd people his age, may have been taken off of his medication around the time that he went to high school, or at least by the time he went to college. it is therefore possible that even if he does have adhd, he is not actively taking medication for it in 2002, when the episode in question takes place, even if he could still potentially benefit from taking it.

of course, it's also 100% possible to read this scene as warrick making a jab that has no basis in truth, if one believes that greg isn't actually on medication and never has been.

it just depends on one's druthers.

anyway.

thanks for the question! please feel welcome to send another any time.

[myhealthmag]

15 EASY WAYS TO BE HEALTHIER

More and more research is showing that the key to lifelong good health is what experts call “lifestyle medicine” — making simple changes in diet, exercise, and stress management. To help you turn that knowledge into results, we’ve put together this manageable list of health and wellness suggestions.

We asked three experts — a naturopathic physician, a dietitian, and a personal trainer — to tell us the top five simple-but-significant lifestyle-medicine changes they recommend.

Besides giving you three different takes on how to pick your health battles, this list gives you choices you can make without being whisked off to a reality-show fat farm — or buying a second freezer for those calorie-controlled, pre-portioned frozen meals.

1. THINK POSITIVE AND FOCUS ON GRATITUDE

Research shows a healthy positive attitude helps build a healthier immune system and boosts overall health. Your body believes what you think, so focus on the positive.

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2. EAT YOUR VEGETABLES

Shoot for five servings of vegetables a day — raw, steamed, or stir-fried. A diet high in vegetables is associated with a reduced risk of developing cancers of the lung, colon, breast, cervix, esophagus, stomach, bladder, pancreas, and ovaries. And many of the most powerful phytonutrients are the ones with the boldest colors — such as broccoli, cabbage, carrots, tomatoes, grapes, and leafy greens.

3. SET A “5-MEAL IDEAL”

What, when, and how much you eat can keep both your metabolism and your energy levels steadily elevated, so you’ll have more all-day energy. A "5 meal ideal" will help you manage your weight, keep your cool, maintain your focus, and avoid cravings.

4. EXERCISE DAILY

Did you know that daily exercise can reduce all of the biomarkers of aging? This includes improving eyesight, normalizing blood pressure, improving lean muscle, lowering cholesterol, and improving bone density. If you want to live well and live longer, you must exercise! Studies show that even ten minutes of exercise makes a difference — so do something! Crank the stereo and dance in your living room.

Sign up for swing dancing or ballroom dancing lessons. Walk to the park with your kids or a neighbor you’d like to catch up with. Jump rope or play hopscotch. Spin a hula hoop. Play water volleyball. Bike to work. Jump on a trampoline. Go for a hike.

5. GET A GOOD NIGHT'S SLEEP

If you have trouble sleeping, try relaxation techniques such as meditation and yoga. Or eat a small bedtime snack of foods shown to help shift the body and mind into sleep mode: whole grain cereal with milk, oatmeal, cherries, or chamomile tea. Darken your room more and turn your clock away from you. Write down worries or stressful thoughts to get them out of your head and onto the page. This will help you put them into perspective so you can quit worrying about them.

1. CHECK YOUR FOOD ’TUDE

What we eat and how we feel are linked in very complex ways. A healthy approach to eating is centered on savoring flavor, eating to satisfaction, and increasing energy, rather than focusing on weight. Check your balance of low-calorie foods, nutrient-dense foods (providing many nutrients per calorie), and foods that are calorie dense but nutrient poor.

Most Americans need to eat more fresh whole foods (in contrast to processed, highly refined foods). Try to add more whole grains, fresh fruits and vegetables, and legumes into your meals. Pair these carbohydrate-rich foods with a healthy fat or lean protein to extend satisfaction.

2. EAT LIKE A KID

If adding more fruits and vegetables sounds ominous, look to “finger food” versions that preschool kids love — carrot and celery sticks, cherry tomatoes, broccoli florets, grapes, berries, and dried fruits. All are nutritional powerhouses packed with antioxidants.

3. BE A PICKY EATER

Limit saturated fats and trans fats, and aim to eat more foods rich in anti-inflammatory omega-3 fatty acids to cut your risk of cardiovascular disease and maybe even improve depressed moods. The equivalent of just one gram of EPA/DHA (eicosapentaenoic acid/docosahexaenoic acid) daily is recommended. Eating cold-water oily fish (wild salmon, herring, sardines, trout) two to three times per week will provide both EPA and DHA.

Adding up to two tablespoons of ground flaxseed and eating meat, milk, and cheese from grass-fed animals will provide you with a healthy dose of omega-3s.

4. USE FOODS OVER SUPPLEMENTS

Supplements are not a substitute for a good diet. Although many health experts recommend taking a multivitamin and mineral supplement that provides 100 to 200 percent of your recommended daily value, each and every supplement should be carefully evaluated for purity and safety. Specific supplements have been associated with toxicity, reactions with medications, competition with other nutrients, and even increased risk of diseases such as cancer, heart disease, and diabetes.

5. GET SATISFACTION

Both eating and physical activity are fun, sensory experiences! In both, aim for pleasure — not pain. Pay attention to the nutritional value of the foods you choose to eat, as well as your sense of satisfaction, relaxation, tension, exhilaration, and fatigue when you sit down to eat. Check in with yourself as you eat, rekindling your recognition of hunger, fullness, and satisfaction when considering when and how much to eat.

1. GIVE YOURSELF A BREAK

“I spend countless hours doing cardio and never seem to lose that last ten pounds!” is a common complaint I hear from clients. Give yourself permission to shorten your workout. Believe it or not, overtraining could be the problem. Your body can plateau if not given adequate rest to restore itself, ultimately leading to a decline in performance. Fatigue, moodiness, lack of enthusiasm, depression, and increased cortisol (the “stress” hormone) are some hallmarks of overtraining syndrome.

Creating a periodization program — breaking up your routine into various training modes — can help prevent overtraining by building rest phases into your regimen. For example, you might weight train on Monday and Wednesday, cycle on Tuesday and Thursday, run on Friday and rest on Saturday and Sunday. You can also help balance your program by simply incorporating more variety.

2. THINK SMALL

Often the biggest deterrent to improving health is feeling overwhelmed by all the available advice and research. Try to focus first on one small, seemingly inconsequential, unhealthy habit and turn it into a healthy, positive habit. If you’re in the habit of eating as soon as you get home at night, instead, keep walking shoes in the garage or entryway and take a quick spin around the block before going inside.

If you have a can of soda at lunchtime every day, have a glass of water two days a week instead. Starting with small, painless changes helps establish the mentality that healthy change is not necessarily painful change. It’s easy to build from here by adding more healthy substitutions.

3. KEEP GOOD COMPANY

You can do all the right things — but if you have personal relationships with people who have unhealthy habits, it is often an uphill battle. The healthiest people are those who have relationships with other healthy people. Get your family or friends involved with you when you walk or plan healthier meals. Making healthy changes with a loved one can bring you closer together as well as motivate you.

4. MAKE A LIST…AND CHECK IT TWICE

Take a few minutes and write down all the reasons you can’t begin an exercise program. Then look at the basis of each reason. For instance, if you wrote, “No time” as one of your reasons, then perhaps that’s based on a belief that an exercise program takes a lot of time.

Starting with even five minutes a day will have a positive effect because you will have created a healthy habit where one didn’t exist before, and that’s a powerful mental adjustment. A closer look at your list will expose those false beliefs hiding behind each excuse.

5. SIGN UP FOR AN EVENT

Let’s face it, exercising just for the sake of exercising or losing weight can get boring. Spice things up by signing up for an event like a run/walk race or a cycling ride where you can be part of a team.

Doing so gives your workouts a new purpose, and it’s fun to be around others who are exercising just like you — not to mention that most events benefit nonprofit organizations, which doubles your feel-good high.

[torque-witch]

I gotta vent fam long post warning plus medical stuff

My body is doing some wacky shit like

First of all I’m on low dose anti depressants for ibs. Why? Idk it’s an off label use my Crohn’s doc prescribed and it stopped my persistent agonizing cramps after coming off prednisone

But now I have absolutely no passion or feelings except existential dread with a side of oh well

(It’s been like ...10 months on this med)

And idk it’s lately just been off. Everything is off. My hands are burning off so there’s just about no relief of pain ever. Intermittent cramping. Nausea. My social anxiety about eating is back. Like literally went out for tacos and took one bite and felt so sick I took it all home and was fine eating at home. Constant stomach ache. New excitement was getting a fever during sex. Next day was hot flashes and horrible nausea indicating I had to poop lol. Headache every morning.

Like I recognize my mood is the IBS pills. Being on humira is an invitation for my immune system to wreak havoc on my skin. Crohn’s has always given me burst fevers here and there in relation to my poop cycle. It’s all fucking normal and that’s what absolutely shatters me. On top of that this time every year Humira pharmacy can’t decide if the assistance plan will cover or if I owe 500$ a month to stay alive.

Like either I try to survive off of mood pills to stabilize my gut and benzos to compensate for error because it’s affordable and deal with my immune system or try to utilize the most affordable biologic or die or maybe because I’ve been on birth control pills for years without a period my mood is just completely lost to the void with the addition of mood pills idk man

It’s time to inject myself again and I’ve been getting worse at doing it on time because I’m not functional after work. I can’t manage all this fam. I can’t. But I’m finally making financial progress and it’s actually killing me.

There’s no way to improve this situation. I gotta keep being emotionless and ignore all of these problems until there’s a different support system for my living situation. I have to support myself. I have to pay down my debts.

I also have to poop.

Thanks for coming to my ted talk

[shield-sheafson]

When I'm done lowering my risperidone and lamotrigine my mood stabilizer/antipsychotic numbness might fade and I'll be more easily moved and write more passionately

And I know reducing meds for something like that is maybe not the best reason but even though I'm not sad I don't enjoy podcasts or video games and I can't write poetry and my emotionally intense scenes are half-hearted and mediocre

And I know if I lose it again I'll have to go back up and give up feeling again and I'm scared but I'm going to bet on the off-chance that things can be better

Anyway low dose make me grumpy

[anotherdayforchaosfay]

So...prescription refills ran out for my mood stabilizer (klonipin) last week. Been waiting all week for the doctor to approve of new refills. I’m completely out of this medication now. Hubby is more concerned than I am because the last time I went several days without it (because the doctor took her sweet fucking time) I was a wreck. It’s been seven years, and maybe the counseling I’ve been getting has helped keep me from losing my shit, but that medicine is absolutely necessary. My brain is wonky and wired very differently than an ordinary person’s brain. I have epilepsy, PTSD, ADHD, and severe general anxiety disorder. That medication is absolutely necessary for me to be stable. I’m on the lowest dose, 0.5 mg a day, and the last time I went days without it I was back to where I was before I even started the medicine.

Am I concerned? Yes. Very much so. It wouldn’t be so concerning if Hubby wasn’t forced to go back to work. Yeah, they’re opening up the restaurants here. I live in Oregon, in one of the most conservative areas (Trump-Humper country), and no one here has been social distancing, folks aren’t wearing masks or gloves. No one in that kitchen is happy about having to go back, but the boss is fucking thrilled. Anyone who is happy about opening their business and forcing employees to return while this pandemic is fucking active is a monster. Restaurants aren’t necessary!

Anyway, he told his coworkers that as soon as I get notification the meds are ready for pickup, he’s hauling ass outta there. If I get really unstable while he’s at work or before he leaves for his shift, he’s gonna use his sick-pay (which is boss refused to give anyone while the place was closed) to stay home and keep me safe. The meds do have an effect on my seizures, and with my seizure threshold so low I’m very much at risk of having complications.

We got me some THC drops and edibles, I have loads of CBD, and they work wonders, but being goofy 24/7 isn’t good for me. Plus, Medicare doesn’t cover the cost, making it more expensive.

I have plans to keep busy and focused, and will likely be writing fanfiction or reading. That and working on the quilt occupying my sewing room. The next several days are gonna be rain, cooler weather, and my sewing room won’t become an oven by 3pm.

[prudencepaccard]

I need a quick shrink opinion because I am having Problems with my current one (I scheduled a second opinion appointment but it’s not till October 12 and my medication questions are too urgent to wait till then)

@slatestarscratchpad and it won’t let me @ @gruntledandhinged for some reason

so I have OCD, for which I take (in principle) fluvoxamine, and also had some kind of an episode (manic? hypomanic?) in May which had aftershocks into June and possibly July; my psychiatrist took me off SSRIs lest I have another one of those episodes. (I wasn’t on fluvoxamine at the time, because Reasons, so SSRI use did not directly contribute to the episode, but she thinks it would heighten my risk or having another one.) I have been on a low dose of risperidone (recently increased from 0.5 mg to 1 mg) in the meantime and nothing else. This was supposed to be a short-term thing but every time we talk about putting me on something else there’s some reason why I shouldn’t do it yet.

In the meantime my OCD has been really bad (currently, as of this writing, R E A L L Y B A D) and I have also been very depressed for the past week. I need to get into therapy but there’s going to be a bit of a wait there (old therapist is no longer available, have to go through the process of switching to someone else) and in the meantime I think I would really benefit from SSRIs but my psychiatrist is just really firm that it’s a terrible idea, even though I’m on risperidone at the same time.

She keeps talking about puttiing me on lithium, with or without SSRIs at the same time (the former being a prequisite for the latter) but the last two times, prior to my appointment yesterday, that I saw her, she said she needed to do more research about it/think about it more. Her verdict yesterday was that my compliance record is too spotty (see above re: the fact that I was not on SSRIs at the time I had the ‘sode, although my psychiatrist thinks that was probably for the best) for her to safely put me on lithium (for...toxicity reasons?) which means I also can’t be on SSRIs. For like two seconds she entertained the notion of switching me to Abilify since messing up the dosage wouldn’t be as dangerous and the side effects are not as bad (for an atypical antipsychotic) as risperidone but then for reasons that are unclear to me she opted to just send me home with a risperidone prescription, but this time telling me to take 1 mg instead of .5. The idea was that when I’m in therapy I’ll be in a better position to comply with treatment med-wise so only then will she consider putting me on lithium?? Or something like that. Being (rightly) gung-ho about therapy is also her way of actually giving a shit about my OCD since she sure as hell isn’t putting me on any meds for it right now (even Abilify would probably have been better. The risperidone does NOTHING for it, at least not at this dose, but I don’t WANT to go on a higher dose.)

The risperidone kind of maybe helps my mood a little in some vague way sometimes, especially if I’m anxious rather than depressed, but I’d rather be on something else--either SSRIs or a better (?) mood stabilizer or both (I am aware the psychiatrist would rather I frame this is “a better mood stabilizer, with or without SSRIs”). The mood stabilizer thing will just have to wait but I actually have a supply of fluvoxamine I could start on (speedrun titration schedule would be starting at 50 mg and doubling every five days until I get to 200 mg, easygoing one would be starting at 50 mg and increasing by another 50 once a week).

I guess what I’m asking is, what are your thoughts on me going on fluvoxamine against my psychiatrist’s wishes while I wait for a second opinion, while continuing to take the risperidone? How does that compare with lithium + SSRIs? And is she right to refuse to put me on lithium right now? Also where does Abilify fit into all this?

Am I wrong to want to throw meds at this problem at all? Do I need to just stick it out till my next therapy appointment? NB: I have one on Tuesday but it’s not a regular ongoing thing since the guy I have it with isn’t really available, so who knows when the next one will be.