#antidepressants that work well with adderall

[absintheancandle]

okay good news i finally found a combination of medicine that seems to work ( + got into vrchat so i think that’s helping me with my problem with being lonely all the time which pretty much just made my depression Worse) so now im drawing more ! not as much as i’d like to but i’m making pretty good progress on the current backlogged commissions and actually drawing for myself again?!?!? my god

[littlemuppetmonsters]

I mostly dont care about retail/service workers being unprofessional or whatever but something about this pharmacy tech today having the gall and audacity to try and tell me what meds i should be taking with whilst not even taking her fuckin airpods out.........i felt some kind of rage ive never experienced before

[wickedhawtwexler]

speaking of adhd meds i'm very excited/nervous because my doctor and i are going to talk about switching to a non-stimulant adhd med (so i don't have to cry on the phone to my pharmacist every single month 🥲)

[copperbadge]

Hi Sam, could you please recommend any resources/websites to learn about ADHD medication? Until reading your post about second-line meds I thought Adderal was the only one

I can definitely talk about it a little! Always bearing in mind that I am not a doctor and this is not medical advice, etc. etc.

So, I've had many friends with ADHD in my life before I got my diagnosis and I picked up some stuff from them even before getting diagnosed; I also spoke with my prescribing psychiatrist about options when we met. If you think your psychiatrist might be resistant to discussing options, or you don't have one, doing your own research is good, but it's not really a substitute for a specialist in medication management. So it's also important to know what your needs are -- ie, "I want help with my executive function but I need something that's nonaddictive" or "I want something nonsedative" or "I don't think the treatment I'm on is working, what is available outside of this kind of medication?"

The problems you run into with researching medication for ADHD are threefold:

Most well-informed sources aren't actually geared towards non-doctor adults who just want to know what their options are -- they're usually either doctors who don't know how to talk about medication to non-doctors, or doctors (and parents) talking to parents about pediatric options.

A huge number of sites when you google are either AI-generated, covert ads for stimulant addiction rehab, or both.

Reliable sites with easy-to-understand information are not updated super often.

So you just kind of have to be really alert and read the "page" itself for context clues -- is it a science journal, is it an organization that helps people with ADHD, is it a doctor, is it a rehab clinic, is it a drug advertiser, is it a random site with a weird URL that's probably AI generated, etc.

So for example, ADDitude Magazine, which is kind of the pre-eminent clearinghouse for non-scholarly information on ADHD, is a great place to start, but when the research is clearly outlined it sometimes isn't up-to-date, and when it's up-to-date it's often a little impenetrable. They have an extensive library of podcast/webinars, and I started this particular research with this one, but his slides aren't super well-organized, he flips back and forth between chemical and brand name, and he doesn't always designate which is which. However, he does have a couple of slides that list off a bunch of medications, so I just put those into a spreadsheet, gleaned what I could from him, and then searched each medication. I did find a pretty good chart at WebMD that at least gives you the types and brand names fairly visibly. (Fwiw with the webinar, I definitely spent more time skimming the transcript than listening to him, auto transcription isn't GOOD but it is helpful in speeding through stuff like that.)

I think, functionally, there are four types of meds for ADHD, and the more popular ones often have several variations. Sometimes this is just for dosage purposes -- like, if you have trouble swallowing pills there are some meds that come in liquids or patches, so it's useful to learn the chemical name rather than the brand name, because then you can identify several "brands" that all use the same chemical and start to differentiate between them.

Top of the list you have your methylphenidate and your amphetamine, those are the two types of stimulant medications; the most well known brand names for these are Ritalin (methylphenidate) and Adderall (amphetamine).

Then there's the nonstimulant medications, SNRIs (Strattera, for example) and Alpha-2 Agonists (guanfacine and clonidine, brand names Kapvay and Intuniv; I'm looking at these for a second-line medication). There's some crossover between these and the next category:

Antidepressants are sometimes helpful with ADHD symptoms as well as being helpful for depression; I haven't looked at these much because for me they feel like the nuclear option, but it's Dopamine reuptake inhibitors like Wellbutrin and tricyclics like Tofranil. If you're researching these you don't need to look at like, every antidepressant ever, just look for ones that are specifically mentioned in context with ADHD.

Lastly there are what I call the Offlabels -- medications that we understand to have an impact on ADHD for some people, but which aren't generally prescribed very often, and sometimes aren't approved for use. I don't know much about these, either, because they tend to be for complex cases that don't respond to the usual scrips and are particularly difficult to research. The one I have in my notes is memantine (brand name Namenda) which is primarily a dementia medication that has shown to be particularly helpful for social cognition in people with combined Autism/ADHD.

So yeah -- hopefully that's a start for you, but as with everything online, don't take my word for it -- I'm also a lay person and may get stuff wrong, so this is just what I've found and kept in my notes. Your best bet truly is to find a psychiatrist specializing in ADHD medication management and discuss your options with them. Good luck!

[omniseurs-blog]

My YouTube comment reposted - mental illness, schizospec, psychosis, ADHD, distrust of doctors, rage/anger vent, loss of childhood, drug use

I was diagnosed with emotional behavioral disorder NOS and ADHD at 4, depression at 10, schizophrenia at 14, changed to schizoaffective bipolar and PTSD at 15. Here's my (and my family's) story.

Before any of my immediate family was born, my paternal great grandpa was... "Quirky", aka delusional and had hallucinations, and my great grandma refused to get him help, because it meant institutionalization or lobotomy. She never told her kids (my paternal grandpa) about it, they simply divorced when the kids were old enough to work. This is still all I will ever know about my great grandpa. My grandpa had his first psychotic break in his 20s or 30s (all I know is my grandma saying he's been insane for a long time, which is why she divorced him) and hid it well enough until his 50s where he was institutionalized and diagnosed "early onset dementia without Alzheimer's features" or something along those lines, he used to call my dad up all the time talking about the mafia and how my mother was poisoning him. My father had his first break in his 20s as well after the birth of my older brother and the death of his brother, but he didn't get treatment until his 30s well after my mother divorced him when I was 3. For a long time I didn't know a single thing about him besides what my mother told me, "he's abusive, he's evil, he's crazy, he's a terrible person" (my mother got diagnosed with BPD recently, so I don't even know if those were lies or not), but one thing she did teach us was that he was schizophrenic.

And then there's me. I was a shy kid, never trusted anybody, didn't play, didn't socialize, took a long time to start speaking, and... Held a very negative view of schizophrenia all the way until I was diagnosed. I was put on ADHD meds at 4, 20mg of adderall, the same age I was diagnosed. I began hallucinating full visible dead and bleeding people because of them and I had paranoia of being followed and watched. My mother did warn the psychiatrist that schizophrenia ran in the family, but my psychiatrist just raised the dose higher, this time 30mg of Ritalin, and put me on risperidone, 5mg... I hallucinated even worse, had crying fits from the delusions, but I was completely and utterly zombified. Why was I zombified on "such a low/starter dose"? Because I was a maybe 60lb F O U R (4) year old. Since the hallucinations and delusions didn't stop, and my mother insisting that I had schizophrenia, the doctor ensured my mother "children can't have schizophrenia" and diagnosed me emotional behavioral disorder NOS, switched me to Vyvanse at 25mg, and switched my risperidone to a common antidepressant I can't remember the name of (Prozac?). Of course, I was perfectly happy then, absolutely off the walls running around, wandering around, all that, so the SCHOOL system said they were going to call CPS because they didn't believe my parents were giving me my medications... Which meant they were the ones dishing out my medications to me and I missed the doses I was supposed to take before bed.

Thankfully, we ended up moving when I turned 10, and the new school never threatened CPS or demanded proof I'm taking my meds, so on my own account, I quit my own meds. I went unmedicated aside from taking a different antidepressant (genuinely can't begin to guess the name) around 12-13. I completely forgot I had any mental illness other than obviously having attention problems, fidgeting more than everyone else, severe anxiety that I thought was normal, and frequent nightmares and bedwetting, and a lack of awareness that I didn't fit in with others (mostly because I didn't have the urge to socialize with anyone). Then... the teenage years hit. My brother was experimenting with dr*gs, weed, LSD, computer duster, m*th, all of the dr*gs that were said to be bad in dare, and I did them too. We got past computer duster and weed, my brother got into worse drugs, new years swung around at 14 and they had some "high quality acid" that turned out to be NBOME, or fake bitter acid that makes even the most mentally stable freak out.

New years 2015, I was 14 years old, we took the fake acid, all 6 of us. People became manifestations of my mental illness, my brother was ADHD, his friends sister was depression, his best friend was anxiety, his best friends gf was PTSD... And his friend was schizophrenia. I was only diagnosed with ADHD, anxiety, and depression. The TV was talking to me, the music was about me, the universe was going to collapse if I made the wrong move. Sure, a bad trip is a bad trip, but the bad trip didn't end after 12, 24, 48 hours, a week, 2 weeks, a month, 5 months, a year, 2 years, 4 years. 4 years is what it took to START recovering, dozens of different combinations of meds, 20 hospitalizations, 4 different hospitals, 3 different states, countless amounts of doctors, and 3, going on 4, disability applications. From 10th to 12th grade, I missed an average of 100 days per year, had a 0.0gpa, and just barely graduated through GED while experiencing active psychosis

What could've been diagnosed at age 4, what I could've been properly medicated for, what didn't take a genius to figure out. 14 to roughly 18 were all a delusional mess, I'm 23 now. I still act like a 14 year old because... I'm still there. I should still be a kid.

[youregonnabeokay-kid]

ADHD information for fanfic writers:

Diagnostic Process:

the diagnostic process is different in every country, but this is a basic overview

- an ADHD referral can come from any type of doctor, unlike referrals for other neurodivergences

- the wait list depends on where you live and how old you are. typically the younger you are, the shorter the wait

- ADHD has to be diagnosed by a psychiatrist or by a doctor who has taken a specialized course to be certified in diagnosing and handling ADHD

- most doctors will make you fill out a questionnaire about your mental health. these questionnaires involves sections about family history, personal history, and statements that you have to agree or disagree with

- a good psychiatrist won’t diagnose you with ADHD during your first visit. they will instead spend the first few visits getting to know you and the state of your mental health

- most people are assessed for depression when being assessed for ADHD. this is because depression can present itself in similar ways. if diagnosed with depression and open to medication, the psychiatrist will first prescribe antidepressants and see how those affect you before moving on with the ADHD assessment

Meds:

- most ADHD meds are taken in the morning since they normally wear off after 8-12 hours

- when meds wear off we go through what’s known as a “crash” or “medication rebound”

- ADHD crashes are pure hell which is why some people with ADHD choose to only take meds during the week or they do nothing on the weekend as a reset of sorts

- basically, when our meds wear off all of our symptoms come back at the same time and we get overstimulated to the point of exhaustion

- some people have smaller doses of their meds that they take at the beginning of the crash. this means they can prolong the crash by a couple hours

- for some people, the first time taking meds is hell. the change is very noticeable and abrupt. i wouldn’t stop talking because it was “too quiet” (it being my mind)

- your dosage is not based on body type or weight and just because you take a high dose in one drug doesn’t mean you take a high dose in all others (my ADHD meds are 10mg higher than the highest prescribed amount but my antipsychotics are .5mg lower than the lowest prescribed dose)

- vyvanse is most often prescribed to people with combo ADHD, ritalin to those with hyperactive ADHD (especially those with impulsivity issues), and adderall for inattentive (no, this is not something that is typically disclosed or well-known but if you’ve talked to enough people w/ ADHD you begin to see a pattern) other ADHD meds are available but less likely to be prescribed

- other meds are also taken into account when getting a prescription for ADHD. vyvanse is the most versatile and is usually the one prescribed if you’re on other medications

- ADHD meds are stimulants which means doctors will never give you refills (if they do, they could lose their license)

- since they’re stimulants, for the first year you have to go to the psychiatrist’s bi-weekly for the first few months, then monthly after that so they can see how you are doing

- ADHD meds are known for lowering sex drives and increasing hunger (sometimes the opposite may happen, as with most drugs, but these are most common)

- it takes about 1/2 hour to an hour for meds to kick in and many of us are able to tell the exact moment they start working

Other Substances:

- the neurons and chemicals in the body of an ADHD person are fucked. this means that many substances and medications have either no effect on us, or the opposite effect of what they are intended for

speaking from personal experience:

- caffeine makes me tired

- melatonin and other sleeping aids like dextromethorphan, which can be found in many cough syrups, make me hyper

- weed makes me feel lighter, but it never affects me more than that. i never get a “proper high” like other people (ie; i find no more joy or fascination in bright colours or moving objects than i usually do)

- while “sugar highs” in general are a myth, they’re real for people with ADHD! they stimulate our dopamine and opioid receptors which gives us a burst of energy

- additionally, people with ADHD are more likely to be addicted to illegal stimulants like cocaine because it calms them down (yup, you read that right. when someone with ADHD does cocaine their mind quiets and they mellow down instead of the usual hyper-active high that neurotypicals get)

Additional Information:

- we’re lacking some of the neurotransmitters in our brains so it takes us longer to process information, and we have “more” thoughts than neurotypicals since our additional thoughts aren’t processed out

- we get what’s called “executive dysfunction” or “ADHD paralysis” where we are physically unable to do things despite no real physical limitations (for non-ADHD folks: try putting your hand in fire. you’ll notice that you are either physically unable to or that your body somewhat restrains you from doing it. this is what executive dysfunction is like. for ADHD folks: do not try this since we’re also less likely to have self-preservation instincts)

- basically, i can sit for hours thinking about doing the dishes, screaming at myself in my head to just do them, but i’m still unable to

- we leave trails! we have so many thoughts going through our head that we forget them all the time, so when we get a thought like “i think the printer is low on paper, i should check” we abandon all tasks in favour of the new thought. however, the remains of those tasks stay where we left them, and thus, an ADHD trail is made

- we have both the worst and best memory of anyone you will ever meet. i might be able to tell you the exact outfit you wore on a specific day five years ago but i won’t remember what i ate for breakfast

- when we get bored, we get depressed. like, life is meaningless and i want to curl up in a ball and die depressed. sometimes we need someone to physically force us out of bed to get us out of our funk (and sometimes all it takes to get out of the funk is doing something fun which makes us feel ridiculous when we think about how depressed we were prior)

- since boredom is detrimental to us, we have to constantly be having fun which, in and of itself, is not fun. this is also why a lot of us end up doing shift work or working dangerous jobs

- we’re adrenaline junkies. this isn’t even a “most of us” situation, it’s all of us. the only difference is how we get that adrenaline. (some get it by jumping out of a plane, others get it by working on assignments in a time crunch)

- we’re social beings. even if we’re introverts, we thrive on social interactions. without them our dopamine plummets and we, once again, get depressed

- all silences are awkward to us. it doesn’t matter if you’re the person we’re most comfortable with in the world, silence is always awkward. or, more specifically, we feel like we need to fill it which is why we often ramble

obviously there’s far more to ADHD than just this and everything can change person by person but i hope this helps to gain a bit more of a general understanding on ADHD

[thoughtportal]

esquire.com

The Invisible Man

Patrick Fealey

50–63 minutes

A.D. 2024—The United States

Twenty-seven degrees in a Port-A-Jon, the seat freezing my ass. I’m in the dark with a little flashlight. Chemically treated feces and urine splash up onto my anus. The wind howls, shaking the plastic structure. My hands go numb.

3:00 a.m., parked in a public lot across the street from the town beach in Westerly, Rhode Island. Just woke up, sleep evasive. It’s my first week out here. I pour an iced coffee from my cooler. I’m walking around the front of the Toyota I’m now living in when a car pulls into the lot, comes toward me. I see only headlights illuminating my fatigue and the red plastic party cup in my hand. Must be a cop. Someone gets out and approaches. It is a cop, young. I’m not afraid, exactly, but I’m also not yet used to being homeless.

“How you doing?” he says.

“Good.”

“Just hanging out?”

“Yes.”

“Are you okay?”

“Yes.”

“Do you need anything?”

“No.”

“Okay. Just checking. Have a good night.”

In the morning, I awake with back pain. Sleeping in the driver’s seat will be an acquired skill.

Sun-bleached fences wrap the perimeter of the dunes, blown over by the unrelenting winds off the cold Atlantic. I park at the beach most days and have spent all but one night here. Lovely Lady Lily, the sweet and wild angel with fur, is with me. The entire backseat is hers and she is adjusting to the car well, because I’m here and we are close. Her daily routine has improved in some ways. When we lived in the house, she snoozed on the couch, walked in the yard, and got to the beach, her favorite place, a couple times a week. Now she runs on the beach several times a day, hunting the tide line for shellfish. She crunches down crabs and tears the meat out of quahogs. And if there’s a fish? She found a single minnow on a beach two miles long.

The author was a reporter and arts critic for outlets including The Boston Globe and Reuters. Today he fills notebooks with novels, poetry, and stories. His guitar is sometimes a desk. (He props it upside down on his lap.)

My morning routine is taking gabapentin (an anti-seizure medication that also alleviates psychic and neuropathic pain and brightens my perception), lamotrigine (another anti-seizure medicine, but for me it helps my mental energy and cuts through fog, because gabapentin creates fog), fluoxetine (Prozac, an antidepressant), and Adderall (for focus and energy, because after the manic depression struck in 1997, my brain was a flat tire), walking the beach with Lily, getting coffee at the Mobil station up the road, and writing on an HP laptop I got two months ago that has already had one power-input jack fail. It sits on an upside-down acoustic guitar resting on my lap, a 12V/120V converter plugged into the lighter with the car running. I play the guitar first thing every morning, songs I’ve written. The rest of the day, I flip it over and it’s my desk.

When we’re on the beach early, we usually see John. Lily used to jump on his legs, and he didn’t like it. He’s about seventy and has the bearing and haircut of a military person. He walks the beach looking for sea glass.

I’m parked in the public lot across from the beach, sitting in the front passenger seat, working on a novel. An SUV police cruiser pulls in front of me, parks close, at an angle, as if to block me from a would-be escape. This officer is a young blond woman in a bulletproof vest with a pistol strapped to her abdomen. She says, “We received some calls. People are concerned.”

“Yes?”

“They see you out here and are concerned.”

She doesn’t say who these “concerned” people are, but the only ones who can see me are the owners of large beachfront houses. Maybe they’re looking out their $3 million windows and seeing the consequences of their avarice.

“What are your plans for the day?” she says.

The author in his car.

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She’s trying to get me to move along, but the lot is open to the public from dawn to dusk. I have every right to be here.

“Write,” I say.

“What do you write?”

“Literary fiction. I was a reporter.”

“Anywhere I know?”

“The Boston Globe.”

Her eyes open wide and she tosses her head back in recognition. She realizes I’m not dissolute and not a threat. She asks for my license and calls it in. Dispatch lets her know I have no criminal record or outstanding warrants.

“Do you need anything?” she says.

“Do you know if the homeless shelter will let me take a shower?”

She asks dispatch to call the shelter. Dispatch comes back. She says, “Yes.”

“Good,” I say. “Thanks.”

“You can’t stay here at night,” she says. “You can stay at Walmart, in the back parking lot.”

“Okay.”

She gives me her card. She leaves. I stay. I have every right to be here.

I go to Walmart that night and will sleep there every night. But the police will continue to come as if I’m some kind of one-man crime wave. Before I’m chased out of Westerly, I will meet, stand my ground, and lose ground to a dozen different officers, often at night, banging on my window and waking me just to ask, “Are you all right?” The question begins to sound like a pretense.

The officers are civil, but every encounter causes me apprehension and stress. I’m innocent of any wrongdoing, but the interaction between a citizen and law enforcement is unbalanced by nature. They are part of an apparatus that can take away a person’s freedom. I know it, and they certainly know it. When you’re homeless, you are even more vulnerable. You have no place to go, no kitchen table to sit at while you drink your beer, invisible to them. You’re always on their turf. It’s unnerving.

The author in Rhode Island.

I rented a beach house in Westerly for a year and a half. It had a chalet roof, high ceilings. Nice. I was most often alone, my then-girlfriend working in New York. Lily and my girlfriend’s dachshund were entertaining company, chasing each other around the house at top speed or snoozing on the couch while I wrote all day—freelance art criticism, newspaper articles, and novels. I ate takeout, mostly.

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Early on, I write an email to Westerly police chief Paul Gingerella to introduce myself. I inform him I am a writer and recently became homeless. I tell him I feel his officers are trying to unlawfully disperse me. I ask him to treat me as “who I am and not as what people fear I am.”

He writes back, invites me to come to his office or call to discuss the ordinances his officers are enforcing. I had also mentioned drug deals going down in the Walmart parking lot. When he took office, he stated that a priority was fighting fentanyl.

I don’t call or visit.

A sunny afternoon. I’m in the passenger seat, writing. The 2013 Corolla has been reliable since I bought it in 2019. It holds all that I need for daily life and makes for a decent workplace.

A police officer approaches the car on the driver’s side. Very short, he looks overwhelmed by his bulletproof vest and all that’s attached to it. Cops these days don’t look like they’re here for domestic law-enforcement duties. They’re equipped for martial law.

The cop asks me what I’m doing.

“Writing.”

“We got a complaint.”

“The chief knows I’m here.”

“Who’s that?” he says, a quiz.

“Gingerella.”

His face eases somewhat, but his smirk is fixed.

He’s looking at my hand. I’m rubbing my thumb and forefinger together. The involuntary motion is tardive dyskinesia, a side effect of the bipolar medication.

He says, “Do you have Parkinson’s?”

“No.”

“Do you have any health problems?”

By now I’m guessing they have investigated me enough to know I receive Social Security Disability Insurance (SSDI). That’s probably where this question is coming from. As far as I know, the Social Security Administration doesn’t make public one’s ailments. I say no, to avoid the potential discrimination that people with mental-health challenges face, but add that “I do have chronic renal insufficiency,” to satisfy his suspicion that something’s not right.

He doesn’t understand.

“Kidney disease.”

“How do you get your money?”

“Assistance.”

“Call us if you need anything.”

Statistics vary by source, but last year there were a record-high 650,100 homeless people in the United States, many of them suffering mental illness and substance-abuse issues. Of course, most citizens suffering mental illness and substance-abuse issues are not homeless.

One of the primary causes of homelessness, obviously, is a lack of affordable housing. Wages have not kept up with escalating real estate values and rents, especially in major cities.

Lily is a rescue dog Fealey adopted in 2020, and they have not been apart since, constant companions. She was found tied to a fence in the summer heat, homeless.

The number of homeless people has grown significantly over the past couple decades. An advocacy group in New York says that the rate there is the highest it’s been since the Great Depression. Across the country, most homeless people are male and almost half of us are white. Rates are much higher among non-white populations, with Pacific Islanders, Indigenous people, and Blacks all experiencing homelessness in disproportionate numbers. Twenty-two out of every ten thousand veterans are homeless.

In 1997, I was a twenty-nine-year-old award-winning art critic and journalist when I was stricken by a violent and disabling onset of manic depression. Bipolar I, rapid-cycling/mixed state, the most severe form of the genetic disorder and often fatal (by suicide). My psychiatrist actually said to me, “You are the worst manic depressive I have ever seen.” Together, we developed a unique cocktail of eight medications that enables me to function and has kept me alive for twenty-seven years.

The condition is a torturous gift, one imparting vision, and manic depressives historically succeed in all fields of human activity, from medicine to art. Theodore Roethke described these blessed sufferers as possessing “nobility of soul.”

The medications that save my life can be blanching. I am often tired. My kidneys are functioning at 30 percent, resulting in malaise and fatigue. It’s difficult to make it through the day without rest. Working in the high-stress, fast-paced world of newspapers was no longer possible. Before the crash, I had a lot of energy, was working on a novel and short stories while reporting for two newspapers and Reuters. (I attended the University of Rhode Island undergrad and Humboldt State University for journalism school.) I acquired the ability to remember every word spoken during an interview. Light hurt my eyes and my hearing became acute. I was jamming with a jazz band and saw the notes as animated apparitions flying before my eyes. Total breakdown struck me overnight. I went to bed feeling good and in the morning was paralyzed in darkness, staring at the white walls. Wallpaper was painful to look at. When I lit a match, it flashed as big as a blowtorch, and I could hear it burning and hissing.

I called my editors at Reuters and The Boston Globe and The Narragansett Times, where I had been the art critic, and told them, at the very least, I needed a break. I haven’t returned.

I tried to work in other settings, but I couldn’t master the computer at a retail job and was fired by a house-painting company for painting too slowly. I worked as a laborer on a vineyard, but I could work only two days a week and the longest I lasted was six hours. On one of those days in the sun, I collapsed to the ground unconscious.

I receive $960 a month from SSDI. I should have $32 a day, but my needs, and a few wants, are debiting my account. Gas is costing $10 to $15 a day, food is $5 to $8 a day, coffee $7, beer $9, ice $45 a month, nicotine patches $86 a month, and jugs of spring water $80 a month. Other incidentals like toilet paper add up. Living as minimally as I know how, I’m not making it. I’m losing weight I don’t have to lose. I quit smoking and went on the patch to save money. Alcohol is the buffer a sensitive soul needs to withstand the crimes of a race—the human race—that has proved itself ungrateful and homicidal.

The toughest parts of homelessness have been surviving the poverty and the marginalization, discrimination, and hostility from the non-homeless population. It’s usually subtle, this hostility. People pull in to visit the lighthouse or the beach or wherever I am, see me, and immediately park somewhere else. All day long.

They are so afraid. I know I look disheveled, but I don’t believe there’s anything wrong with me intellectually or spiritually. I know I could look better, but I just don’t see what the big deal is.

I live on Jif-and-Smucker’s-strawberry-jam sandwiches. At first, I ate bologna-and-cheese sandwiches, but the ice in the cooler melts within a day, and the bologna floated around in the water, turning pale and slippery.

I keep the food in the trunk, with my clothes. I make the sandwiches there, on top of a suitcase. I spread the peanut butter on sliced Italian bread thickly, thicker than frosting on a cake. I use so much jam, some falls out. I make it a meal.

In the Westerly town-beach lot, late afternoon, the air is getting cold. I’m standing at the trunk, bread on the suitcase, a jar of peanut butter in my hand, when a red SUV pulls in beside me. A woman climbs out, in her forties, long black hair. She sees me with the peanut butter. Most people look worried and afraid when they see me eating out of my trunk.

Fealey’s $960 a month in Social Security Disability Insurance goes primarily to food and gas—he can never park in one place for long before the police tell him to drive someplace else, plus he runs the car to power his laptop and for heat. And it goes to beer.

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“Do you want the other half of my meatball sub?” she says. “Nothing beats PB&J, but you might want something different. I just went out with a friend. It’s still hot.”

I’m surprised by her kindness. “Yes,” I say.

She retrieves a carton from the car.

“Thank you,” I say.

She walks for the beach. Does she know I’m homeless? Maybe she’s seen me here before. She will be the only person in six months to offer help.

I sit in the driver’s seat and eat. I chew carefully. Four teeth hurt too much to chew solid food. The sub comes with potato chips. I try to eat them but can’t take the pain. I’ve lost nearly half my teeth since I became disabled twenty-seven years ago. I can’t afford dental care. When a problem has arisen, such as when I needed a root canal, I’ve had the tooth pulled at a clinic that charges patients on a sliding scale. One of my essential medications, gabapentin, has been linked to tooth loss.

Shortly before I became homeless—a period of mounting worry in which my appearance suffered—a tooth on the upper right began to hurt. It was excruciating to touch with a toothbrush. Then an agonizing pain developed in my lower-left jaw. The jaw swelled. Two teeth toward the front began to ache. I couldn’t eat anything. I couldn’t touch the teeth. I developed a fever. I shook, lost control of my body. I made an emergency appointment at the clinic. I resigned myself to the idea I would lose the two teeth. An assistant took X-rays of the two lower-left teeth, the most painful place, where my jaw was swollen. At my request, she X-rayed the tooth on the upper right.

The dentist came in and sat behind me. He said nothing. I couldn’t see him. Was he going to examine me?

He finally wheeled over on his chair. He was holding the familiar sharp, metal hook. He didn’t ask what the problem was. I told him about the two teeth on the lower left. He said nothing. He didn’t make eye contact. He approached with the tool. I opened my mouth. He looked, touched one lower-left tooth very quickly and lightly. He didn’t test for a cavity. He didn’t check any other teeth.

“You have tartar buildup, but I don’t see anything,” he said.

“The pain is severe,” I said.

“I don’t know why.”

He wheeled away and turned, his back to me again, and looked at a computer. He said, “The X-ray doesn’t show anything.”

“No cavities?” I said.

“No cavities. No abscess. Look.”

I turned to see. The X-ray showed one white tooth in an ocean of black. It was an upper tooth. He barely touched it, withdrew the metal hook, and didn’t say anything. I was too deranged by excruciating pain to ask him to do more before he began to conclude the examination.

Finally, I said, “Do you see the swelling on my face?”

“No,” he said.

I raised my voice and said, “You don’t?”

“Maybe a little.”

My left jaw was twice the size of my right.

I realized the problem: He believed I was drug-seeking. He must have seen this all the time. He made his judgment immediately. He wanted the vagabond out of there. I got a cursory examination and denial of suffering. He was not going to offer pain medication.

I said, “I was a newspaper reporter. The reason I’m poor is I was stricken by severe manic depression. My teeth are bad because I can’t afford dental.”

He turned to his computer. He typed and looked for a while. Clicked the mouse. What was he doing? It occurred to me that he may have been Googling me. Was I telling the truth? Was I a reporter? He was on the computer for two minutes, reading in silence.

He wheeled his stool back to my side and looked me in the eye. Now respectful, he said, “I don’t see anything, but I can give you antibiotics.”

Gas is costing Fealey $10 to $15 a day, food is $5 to $8 a day, coffee $7, beer $9, ice $45 a month, nicotine patches $86 a month, and jugs of spring water $80 a month.

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I picked up the antibiotics at CVS. He also prescribed ibuprofen. The pain overwhelmed consciousness. I saw dancing white lights. The maximum daily dose of ibuprofen didn’t alleviate the pain. I alternated it with the maximum daily dose of Tylenol. I could tolerate the pain for the first two hours after each dose. Then it surged. I couldn’t sleep through the night.

By the third day of antibiotics, my chin had ballooned. I pressed it. It was hard. A stream of pus shot out horizontally and hit the rearview mirror. My jaw was infected. Soon after, I saw my internist and shared the story of my dental experience. He said it was an abscess.

My jaw recovered, but the two lower teeth remain too sensitive to chew on. I have not been brushing my teeth out here. I could brush some of them, but it’s difficult to avoid the ones that hurt. I rinse my mouth with antiseptic mouthwash several times a day and before going to sleep.

Three months later, I awake in the car to a sudden pain in the tooth farthest back on the upper left. I look in the mirror. It’s split in half. The pain is severe. The inside half is loose. I can’t chew on the left side. I now have three upper teeth and two lower teeth I can’t chew on.

Eating is torture.

The American flag flies over Walmart. When I was young, I was proud of and found comfort in the flag. I felt fortunate to have been born in the United States of America, where every life mattered. I still believe this.

Many men and women fought and died for what the flag represents, freedom and democracy. My father was rocketed and shot at in Southeast Asia and came home a bomb waiting to explode. His nervous system was shattered. He could go from laughing to rage instantaneously. He wasn’t like this before the war.

As the police instructed, I sleep in the car in the Walmart parking lot. I park where they said to, in back of the building near where people pick up orders and the semis come in to unload. Inside I shop for food, including the occasional tuna fish and deli chicken for Lily, and nicotine patches. I use the restroom.

I begin parking at Walmart in November. The masses flood the lot to shop for the holidays. People drive fast in the lot, as aggressively as they do on the roads, whipping in and out of empty spaces while pedestrians walk in the low fluorescent glow. They make me nervous. People are economically squeezed, the stress of everyday survival and the fear of uncertain futures turning into hostility. Most Americans live paycheck to paycheck, and many have no emergency savings—they are one crisis from homelessness. A job loss or an unexpected illness and they are where I am. They are on edge, driving bigger and faster and louder cars—a society speeding along as it disintegrates.

The store plays bland, agitating covers of classic Christmas songs, which are piped out to the parking lot.

It snows, a light covering, and turns cold, in the low 20s. The ground freezes solid.

I recline the driver’s seat every night and sleep on my back under a fleece blanket. I have a pillow. I begin to awaken cold and shivering, coughing. I start the car and turn on the heat. As the season progresses, I have to run the car every night and even during the day at the beach. Gas consumption surpasses what I budgeted for.

My girlfriend, Lane, gives me everything she can, sharing in the struggle.

She is the front-desk supervisor at a four-star boutique hotel by the beach in Narragansett. A night there can cost hundreds of dollars, even $1,000 with all the add-ons. She lives with her parents. She can’t afford a place of her own. Her monthly earnings are equal to the rent on a one-bedroom apartment. She is forty-nine and has been in the service industry for thirty years. Her hotel is highly ranked by some of the travel magazines and she regularly receives notes of appreciation from guests. She earns five dollars above minimum wage, the same as the dishwashers in the hotel’s failing restaurant.

I became homeless on October 16, 2023.

My devotion to literary work combined with the disabling manic depression sent me to the periphery for much of the past two decades—twenty rooms in eighteen cities coast to coast, banging out novels on a 1939 Smith Corona and fighting off insane rabble, wallowing in a stupidity they were unaware of.

I managed to avoid the street for twenty-six years after my diagnosis. The idea of homelessness was terrifying. When I faced it in 2019, I thought of which warm states I could go to and live in my car, and I had visions of which bridge I would jump off. I saw myself at the railing, looking down at the water, climbing over. Homelessness looked worse than death.

Fealey’s life is laid out in front of him, all the time. A bag of dog food, the PB&Js.

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Then? A miracle. I met a wealthy entrepreneur while working on his vineyard and he liked my writing and he helped me. He said he would help me find a literary agent. I bought the Toyota and I could rent an apartment. I adopted Lily. She is my first dog. We have been together every moment since Lane and I signed the papers three and a half years ago. Lily was found tied to a fence in the August Texas heat, skeletal, with mange, flies buzzing her. Since then, she has gained twenty-eight pounds and become a most engaging, agile, and sensitive creature.

In 2023 the man ended his support “for financial reasons.” He didn’t help me find an agent.

We walk on the beach, Lily trotting ahead, nose down, looking for seafood. She chases seagulls, breaks into a sprint. The birds are wary, see how fast she is, and take flight. Running at speed, she once caught a seagull as it was taking off. She let it go but broke its wing.

Lily and I wrestle daily. She leaps in the air, going after my arm. I let her seize it in her sharp teeth and push her away with enough force to throw her off balance. She charges back, leaps for my arm. I withdraw it and she misses and falls back to the ground. She jumps in the air and grabs it. She restrains herself and doesn’t hurt me too much but has torn the sleeves of two leather jackets and a hoodie, and drawn blood. She’s smiling and I’m laughing as we battle ourselves breathless.

I drive over to the Warm Center, a shelter in Westerly. Inside, it is dark. A few resident men sit in chairs in the small front room watching TV. I ask about the shower and one tells me it’s in back. I walk through the room where they sleep. About a dozen scattered mattresses without headboards fill the small, dark room, close to each other. The beds are unmade. These people have no light and no privacy. An obese man in a wheelchair says hello. I say hi.

In the bathroom, one shower of two is functioning. A man comes into the bathroom. He seems determined about something, yet is sheepish. He doesn’t use the bathroom. He stands, glancing at me as I undress.

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I shower. I stand under water as hot as I can tolerate. Heat hits my body, nirvana. Water has never been so comforting. I emerge calm, but energized.

He types on an HP laptop plugged into a converter in his Toyota’s lighter with the car running.

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I dry off with the towel I brought and change into clean clothes, which I typically either take to a laundromat or Lane washes at her parents’ house. Passing through the sleeping room, a man sitting on a bed says, “Believe me, I will fuck you up.” I walk out barefoot into the cold and put my dirty clothes in a plastic bag in the trunk. I find socks.

“Can you give me a ride?” a man says from across the street.

“No.”

I first called the Warm Center a few days before I became homeless. My goal was financial assistance to help pay for food and gas. The first woman I talked to referred me to another woman. I talked to her briefly and she said she couldn’t help me until I talked to an intake coordinator. I called him and asked about the assistance for food and gas. He didn’t reply to that request but mentioned the seasonal shelter. He said he couldn’t get me in until I talked to the state. I called the state’s central intake—they put homeless people into a database. The man, who said he was pessimistic, suggested a shelter in the city. I declined.

I called back the coordinator at the Warm Center.

“I can probably get you into the seasonal shelter,” he said.

“I have a dog,” I said.

“Male or female?”

“Female.”

“How old is she?”

“Three and a half. She’s sweet and loves people.”

“That won’t be a problem. I’ll call you when the seasonal shelter opens.”

“My cheap phone has never allowed me access to my voicemail.”

“Can you receive texts?”

“I won’t see them. You can email me.”

He said skeptically, “You’re living in your vehicle?”

“Yes.”

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He never emailed me and, to my knowledge, didn’t call.

That is okay.

The despair in the shelter is contagious, and it wouldn’t be ideal for Lily. In the car, we have autonomy and privacy. In the car, no one is gawking at my junk or wanting to fuck me up.

We sleep in the Walmart parking lot for two months. During this time, police intervene half a dozen times, always in the middle of the night, when I’m asleep.

They bang on the driver’s-side window, awakening us, and shine bright lights in my face, just to ask, “Are you okay?”

I was okay before you woke me up.

The police are the ones who told me to go the Walmart parking lot. I park where they instructed. They know I’m here and see me in the same spot every day and night. Chief Gingerella knows who I am, that I have no criminal record, am a professional and productively engaged, am not a threat and keep to myself. When I’m asleep, I’m not visible, and my car is parked among other cars. They know which car is mine and come, and come, and come, systematically robbing me of peace and a sense of well-being.

In the early-morning hours on Christmas, I am jarred out of sleep by banging on glass. I sit up and lower the window. A police officer beams a light in my face and into the car. He is a young blond in a watch cap and a ski mask. The air is bitter cold and I see his breath as he says someone called the police. He implies the caller feared I had committed suicide. The alleged caller saw the car running, and it is Christmas, which I know is a popular day to kill yourself. I assure him I want to stay alive.

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“The car is running so I can stay warm,” I say.

He says, “Okay.”

Then he says, “Can I have your phone number? I always ask. I’m not going to use it or anything.”

Half asleep and dazed, I give him my number. In the morning, I think about it. Why did he ask for my phone number? I didn’t have to give it to him. There is only one reason I can think of that he would want my phone number, which is so that the police could install some kind of stalkerware on my phone, to track me.

I look again at the flag above Walmart, a store packed with imported goods that has made its owners among the richest people on earth. People squeezed from both ends come to Walmart, where prices are lower. Their money goes into the pockets of the Waltons. But the more the Waltons take, the less people will have to spend until, eventually, they have nothing at all.

Fealey has always been a reader and a writer.

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Late morning, parked in my spot, I am writing. A man and woman approach the car on the driver’s side. They look in at me, don’t come too close. They wear blue uniforms with badges sewn onto their chests. I roll down the window. They look afraid.

Walmart security.

“You have to move,” the man says. “We’ve let you stay here for a while.”

“The police told me I could be here,” I say.

“The police don’t own this property. I do.”

I give him a look.

“Okay, Walmart does,” he says.

“Okay,” I say. “Do you know of any other places?”

“You can try the old Benny’s parking lot. Nobody’s there.”

The police chased me out of the beach parking lot. Now Walmart. I’m running out of places to sleep, and to be.

The definition of homeless is we have no home, no place to go. If “I think, therefore I am” is true, we are people who are. We are, and we stand on this ground. If you deny us ground, you are denying us our “I am.” Isn’t that negation of our existence? We are here and we are you and we are yours.

Many of you could be where we are—on the street—but for some simple and not uncommon twist of fate. This is part of your rejection, this fear that it could be you. You deny that reality because it is too horrific to contemplate, therefore you must deny us. And the moneyed reject us because they know they create us, that we are a consequence of their impulse to accumulate more than they need, rooted in a fear of life and the death that comes with it. Nothing good comes of fear, only destruction, and America has become a society of fear, much of that fear cultivated to divide and control.

A few months into homelessness, my feet begin hurting and the bottoms and sides turn red. It’s a deep pain and I don’t know what it is, but it hurts too much to walk normally. Maybe it’s circulation. The pain awakens me in the morning. I buy Neosporin and coat the affected areas every night. Neosporin cures a lot of things! After a week, the redness and pain subside. I stop the Neosporin. A month later, the pain returns. I’ll have to see my internist, who I already owe for unpaid co-pays. I also owe money to the psychiatrist who saved my life and I receive letters at Lane’s parents’ house, where I get my mail, from his office manager. I’ve known my doctor since 1997. If I lose him, I will be in a bad spot, because he is the only one who understands how my unorthodox medication regimen works.

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I move on.

I drive eighteen miles north on Route 1 to South Kingstown. This part of the state is where I grew up and went to college. My parents moved us here from New York City in 1968. It’s pricey now and I struggled to be here when I was supported, but it’s home

My childhood must have looked normal from the outside. I grew up on an island off Newport, a nice place to grow up. Ocean, beach, fishing, woods. Good for an adventurous kid. My mother was a nurse and my father was an engineer and an inventor. He could be abusive. He was abused by his mother when he was a child. I think he resented how my sister and I changed his life, and while he was mechanically brilliant—one of his inventions was advertised during the Super Bowl—he only had empathy for frogs and lizards.

My parents never gave us money, not even when we were kids. The unspoken rule was “Don’t ask.” I began cutting lawns and working on boats very young. Today my mother, and my sister and her family, live in northern Rhode Island. My sister drives a Lexus SUV and owns a house, but she has her own set of challenges. She and I have just begun to see each other for the occasional lunch after years of distance. I don’t want to ask her for anything.

The first night in South Kingstown, we sleep in the town-beach parking lot. It’s an isolated area of Matunuck, a quiet hamlet on the sea. The gravel lot is enveloped in tall hedges and trees. There are no houses in sight, and in all the years I have come here, I have never seen police in the lot.

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It is very dark.

Nobody else is here and the night passes calmly. In the morning, Lily and I spend time on the beach. The day is uneventful, a relief.

That night, I park in the same lot, but farther in, out of sight of anyone who might pull in.

9:00 p.m. I’m writing when a bright light shines from behind and on the left side of my car. I turn and see the searchlight on a police cruiser. An officer walks toward my car. Closing in, he puts his hand on his gun.

I roll down the window. He looks in.

“You can’t be here,” he says.

“Okay,” I say. “I will leave.”

“Can I have your phone number?” he says.

“No.”

“It’s just in case if we need to call you.”

“Why would you need to call me? I know it’s legal for you to install tracker software.”

“Okay.”

A second officer appears, leaning toward the window. He’s big and has a shaved head.

He says, “We can cite you for parking here at night. The ordinance allows parking dawn to dusk. You’ll have to go to court and pay a fine. Or you can give us your phone number. That’s a small price to pay, a fair trade.”

Statistics vary by source, but last year there were a record-high 650,100 homeless people in the United States.

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When I was a kid, police officers were our friends. When I was a reporter, they were men who surfed and played in bands when they were younger. They were not out to ruin your day, or your life. They enforced the law with a sound sense of context.

We have never seen police in this lot. Many people stay after dark, in no hurry to leave. Two weeks ago, I was here until 2:00 a.m. talking to Lane. Common sense and courtesy says that if police found people parking after dark, they would simply ask them to leave.

I look at the cop with the shaved head. He actually believes he’s right. How do people get this far apart? We are arguably of the same class and live in the same town. He has no idea my empathy is with him.

I believe they will cite me. I can’t afford to go to court and pay a fine. I give them my phone number.

How did they know I was here?

Lane sometimes gets us a room for a night or two at a chain hotel on Route 1. The last time we did this, I arrived first with Lily on a leash. The looks on the faces of the women behind the desk reminded me I was rough around the edges. I needed a shave and shower. My hair was disheveled. I had been wearing the same clothes for days, living in a car. Every day, dirt and sweat made my clothes baggier. I was wearing a blue hoodie that needed to be washed.

A few nights later, I sleep at the park-and-ride on the highway. At night, coyotes howl in the nearby woods. Semis roar past. Raccoons emerge from the darkness to rifle through the garbage. Lily growls. In the morning, I go to the Mobil across the highway, get coffee, and use the restroom. Finding bathrooms is a never-ending quest.

The park-and-ride can be a despairing place. It sits next to a stoplight, and cars accelerate at unnecessary rates when the light turns green, blasting aggression out dual exhaust pipes. I witnessed an opiate overdose, a man sprawled on his back unresponsive who was saved by two doses of Narcan. The ground is littered with trash, beer cans and cups, discarded food, and full garbage bags that have been dumped. It pains me to walk a dignified dog here.

The woods adjacent to the park-and-ride are nice. There are paths back there that Lily likes to walk, sniffing out the rabbits and deer, raccoons and coyotes. Sometimes she tracks down a rabbit and it bolts. Once I went back there to relieve myself and was startled by a flock of turkeys that I surprised. They yelled at me and stood their ground, a giant tom staring with his beautiful tail feathers fanned open.

In the morning, the panhandlers arrive in a green dual-cab pickup. It has a Connecticut license plate. They work during the day, standing on a median, showing cardboard signs to drivers stopped at the traffic light on the road that connects to the highway.

“Homeless. Anything helps. Thank you.”

Their clothes are worn and dirty, and so are their faces. They do not smile. Their speech is profane. They walk between stopped cars staring at people with menacing eyes, as if they’re trying to scare them out of their money. They must have some success, because they always come back.

Sometimes they spend the night and sleep sitting upright in their truck, which runs poorly and is loud. The driver is the leader of the operation. He’s an older man with long blondish-white hair who never looks anyone in the eye. He never panhandles. He rarely gets out of the truck. They defer to him. Lane and I joke that they are the panhandler mafia.

One morning, I’m at the park-and-ride and writing. The sun is bright and it’s a warm day for February. I hang my black rain jacket in the window to block the sun from shining on the computer screen. I hear a loud voice outside the window. I turn and see a cop.

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“Roll down the window,” he says authoritatively and impatiently. He’s a muscular guy.

I throw a hat over the beer by my side. I roll down the window.

“What are you doing?” he says.

“Writing a novel.”

He’s thrown.

I say, “My name is Patrick Fealey. I’ve lived here fifty years. I was a reporter for The Narragansett Times. I am homeless.”

“You’re staying here?”

“Yes.”

“It’s my job to know who’s here and what’s going on. Can I have your license?”

I give it to him. I wait, hoping he won’t tell me to leave. This spot has been all right and I don’t know where I’d go.

The cop returns with another cop. He hands me my license.

“Are you on assistance?” says the second cop, a young balding blond with a pleasant face.

“I just applied for Medicaid.”

“Have you tried the Welcome House?”

“I take showers there.”

“Have you tried Tri-County?”

“No. What is it?”

“They can help you with food and other things.”

These officers are trying to help. They don’t tell me to leave.

The 2013 Corolla has been reliable since Fealey bought it in 2019.

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I call Tri-County to ask what assistance is available for the homeless. After navigating its extensive employee roster, I am able to leave a voicemail message. A woman calls back and says she can’t help, but will give my name to a woman who can. She calls soon after, speaks to me in an indifferent, lecturing voice. She rattles off the programs I don’t qualify for because I don’t have a dwelling before finally saying I can get food at its pantry. She mentions canned goods and other foods I can’t prepare. That’s it. I don’t go because driving there would use more gas than it’s worth.

It’s becoming clear how little help there is for the homeless. Here’s how things look from my car: Assistance doesn’t reach low enough. The social-services net is wide and catches many, but not the person living on the street. I asked the Warm Center, which specifically addresses homelessness, for ten dollars a day to help pay for the gasoline that keeps us alive and they responded with a hard silence.

We are all alone out here.

Back at the park-and-ride in South Kingstown. One night, a panhandler climbs out of the back of the truck. He zips up his fly. A woman comes out behind him. A prostitute? In the morning, she hangs around for a while.

She returns three days later.

She’s a faded beauty. Some wrinkles, a distraught expression, a great body in blue jeans. I recognize her. From where? When? I think about her. About noon, it comes to me. She lived across the hall from me in a Newport boarding house in the early 2000s. She was intelligent and soft-spoken, kept to herself, was a good neighbor until she met a woman. The two embarked on a romantic relationship. The woman moved in. Taller and weightier, the woman was an extrovert who tried to assert dominance in conversation.

Fealey can’t imagine moving away from the local beaches.

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They fought. Bad fights. One night, I heard a body slammed into the wall. Screaming, running, the body slammed into the wall again. I opened my door. There was blood on the floor outside their door. The fight went on. One was beating the hell out of the other. I called police. The police arrived and broke it up. They were evicted.

Years later, I was at a soup kitchen when a woman accosted me. It was the bigger woman.

Now my old neighbor is in this park-and-ride with the panhandlers. How did she hook up with them? Where does she live? Does she recognize me? But she is not the same. She sits in the truck all day, nodding. When she comes out, her head is down and she moves slowly. She has a habit.

It’s Monday, February 19. I have $20 to make it to the end of the month. It’s a leap year, too. An oil change, paid for in cash, wiped me out. Lane said she can help on Thursday, when she gets paid.

The minimum I need for a day is $20. I pay for coffee and food with my supplemental nutrition card—food stamps. I receive $160 a month. It was more when I wasn’t homeless and was paying rent. Lily has plenty of Blue chicken-and-rice dog food and we have a gallon of spring water. I have enough peanut butter and jam. But gas and beer are everyday expenses. I’ve needed to run the engine for heat. The $20 will go toward gas. But the gas will not last until Thursday. I will run the car as little as possible. I will go to sleep without heat, under the blanket. We will not be driving anywhere. No beach for the next two days. I will go without beer. I will withdraw, experience agitation and depression, sweat and shake.

Time for a PB&J.

I finally meet with the housing coordinator at the Warm Center. She is an older woman, her long gray hair braided on one side. She speaks softly and slowly but is alert and present. She signs me up with a state program for emergency housing. Receiving this help depends upon the availability of housing vouchers, and at the moment there are none. I heard there were no hotel vouchers for the entire winter when I called the state a couple months earlier. There are more than two thousand homeless people in this small state, a number that has more than doubled since 2020.

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She and I discuss the affordable housing I will be applying for. She asks what areas of the state interest me. I mention towns, all in southern Rhode Island. She asks if I’m willing to live in Providence. She advises I apply to as many places as possible throughout the state to enhance my chances. I don’t tell her I will not do this, will not live in an urban setting, will not walk down some streets. I’ve been attacked on the street, and I am wary. It’s a visceral response, a survival mechanism, not an idea. I never felt it before. Also, Lily and I have a life here in southern Rhode Island and the beach is integral to it.

There are more than two thousand homeless people in Rhode Island, a number that has more than doubled since 2020.

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She gives me a booklet listing the housing by city and town, with phone numbers. My job is to call and request applications. She tells me I will be waiting years, though I might be able to get into one place in Westerly in just over a year. She says the Warm Center “might” be able to help me with the first month’s rent and deposit, which would be $640.

I say, “If there is any financial assistance available for food and gas through Warm Center, I’m in a tough spot and could use the help.”

She doesn’t look up and says nothing.

There is not.

I leave the Warm Center with little more than the booklet listing the housing, something I could have gotten from the state. I’ll be calling the housing places, asking for applications, filling them out, mailing them back, and waiting years to hear back.

And can I truly afford to live in affordable housing? Based on my past experience, rent is about one third of your income. My SSDI is $960. Paying $320 a month in rent, I would be left with $640 to live on. I would have to get a job, maybe at a gas station, a job I might be able to handle. Out of every $100 I made at this job, the housing authority might take $33. If I’m paid minimum wage, $14 an hour, I might only keep about $9. To make up for the original $320 subtracted from my $960, I’d have to work about thirty-six hours. Nine hours a week doesn’t sound like much, but I know that I would struggle to perform the job well enough to retain employment. And then I’d have no more money than I have now, and I’m not making it. I’d have to work more hours for what amounts to $9 an hour. But I can’t work many more hours without jeopardizing my SSDI. How many other people are in this position, too ill and poor to afford affordable housing?

And too poor to be homeless?

It’s May 8 and pouring rain at the park-and-ride. I’m writing and the raincoat I put in the window to block the sun earlier is soaked and dripping into the car, onto my arm and mouse pad.

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I’m hit by a lower-bowel emergency.

I grab the toilet paper and hurry into the woods where the turkeys and coyotes live. I find a spot under an overhanging shrub, as out of the rain as I can get, pull down my corduroys, and go. Squatting, waiting, the primitivism comes over me with the rain. I’m saturated by the absurdity of this twenty-first-century moment.

What comes to mind?

Luciano Pavarotti.

Foxwoods, 1994. At the sublime power of his performance, my eyes welled with tears of joy. God makes his presence known in some men, and I was in wonder at the mystery of him. I saw and heard him sing from twenty feet away. The more I studied him in those moments and the more I read about him, I sensed something troubled him, that he lived in conflict between the public image his handlers chose, the happy family man who enjoyed pasta, and who he truly was. He was caught in a commercial whitewash that didn’t allow for the man. I wrote this. The general manager of the Metropolitan Opera sent the piece I wrote for the Southern Rhode Island Newspapers to Pavarotti himself, who wrote to me to say, “Great job” in Italian.

In the woods I think of the red velvet and gold in the Met in New York when I later attended Puccini’s Turandot and witnessed its moving aria “Nessun Dorma.”

I never sleep. But I am not alone.

Lane has a gallery opening in Newport tomorrow night. The Spring Bull Gallery is well established yet open to the avant-garde and exhibits many styles. This exhibition is abstract art.

Lane will cut my hair at the beach. I will shower and shave at the Welcome House and put on my best clothes, beige corduroys and a white button-down dress shirt. Lane left the hotel job. It was making her sick and she was getting nowhere financially. She has no resources at the moment, but has taken a leap of faith, has the courage to do what she was born to do. I believe in her and her work, an advancement on the abstract expressionists, employing their spontaneous subconscious methods but often fulfilling Pablo Picasso’s insistence that a painting include an image we recognize from life, however deformed or abstracted.

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And here is the weird dichotomy in our lives: A few nights after the triumphant opening, Lane downloads the DoorDash app and we set out to make some money. We work from 6:00 p.m. to 9:30 p.m., through dinnertime. We receive no cash tips. Everyone makes their tip on the app when they place their order. They don’t have to face us. Tips are one dollar to two dollars. Three fourths of the people ask for their food to be left by the front door. We make twenty-seven dollars. DoorDash made billions in the first six months of this year.

Our last drop is at a house near the beach. Some college kids are having a party. Their cars in the driveway are new, nice, and expensive—a Jeep, an Audi, reflecting how college tuitions have risen beyond the means of those like myself at that age. Lane is carrying an order to the door; a kid comes out and dismissively grabs the bag of Mexican food from her. It is a trigger for me. Darkness moves in. Lane and I are more than twice his age, have lived accomplished lives, and to an inexperienced kid whose parents are buying that food, we are invisible.

In the morning, I have a message from my sister. I had asked her if I could borrow money to fix the car. I wasn’t optimistic. She said money was tight, but she would see what she could do and she would ask my mother for help.

Suicidal ideations break through. I see myself on the bridge. I’m afraid. Sometimes suicide looks like the best idea. But this time, it’s not good. It’s no inspiring cure but a pathetic out. My senses are acute. I recoil at the sounds of drivers flooring the gas at the light. The aggression translated through machines kicks me into a tailspin. What the hell is wrong with these people? They’re cornered and desperate. They may not be conscious of it, but they feel it. I take extra Depakote, a mood stabilizer that will hit my brain like a sun-shower, and lie motionless in the dark. Will misdirected anger ever stop? They take it out on themselves, on each other, when the problem is the predators and the politicians who enabled them to suck most of the wealth out of the common economy.

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Later that night, Lane comes to the park-and-ride after work. I rarely go to her house. Her father and I don’t get along.

Lane is exhausted.

I’m in Mobil when I see a page-one story on the homeless in The Providence Journal.

I pick it up and read.

A small group of homeless people have been living in tents on vacant public property. Residents in the nearby neighborhood have been complaining. They must be “concerned.” The article says that the mayor’s policy is to “break up every encampment that forms.” One of the homeless interviewed said she doesn’t know where she will go.

I awake in the dark. Check the clock. 3:18 a.m.

A car drives up on the road adjacent to the park-and-ride lot. A man gets out the passenger side. A hitchhiker? He isn’t a commuter or student. He stands on the grass between the road and the lot, the lights on the highway silhouetting a man with a shaved head holding a small bag dangling by a cord. The bag is cinched at the top and just big enough to hold a pair of pants and a shirt.

I think, Vagabond. A transient on the move.

I find my cigarettes and light one. I look out the window and the man is gone. Maybe he has walked up the road and is concealed by the trees in the middle of the lot.

I have to take a leak. I get out of the car, walk around the front, and head for the woods. I usually piss somewhere in the lot, like a lot of people, but the last time I did, at 2:00 a.m., an unmarked police SUV blasted into the lot and did a hard brake beside me just after I put my gear in my pants.

I am just about to the woods when Lily lets out a loud bark like I’ve never heard: “Woof-YEHHP!!” I am a little annoyed at what I think is her separation anxiety, so I turn and say, “Lily!” And coming straight at me, ten feet away, is the man with the shaved head. He has been behind me, silently walking toward me at a pace faster than I am walking. That chill people talk about, when the hair on the back of your neck stands up—it is real for me in that moment.

He sees me see him.

I cut for the car. He passes close on my right, agile and strong looking, and says, “Hey,” like it was just another sunny day in the city.

I say, “Hi,” like all is well. He is white, about thirty, five-foot-eight, wearing jeans, neat and clean.

I look back to see him turn right toward the watchtower.

I get in the car and lock the doors. “Good girl,” I tell Lily. “Good girl.”

The significance of what has just happened reveals itself. No one walks that close to someone in a large area and in the dark without making a sound. And how did he get so close so fast? He was not present when I got out of my car. If he was behind the trees, he had to hustle to get that close. A chilling realization: He was not holding the bag as he had been, hanging down by the cord. He was holding it at his midriff, the free cord in his hand. He was going to strangle me from behind with the cord. He didn’t want a fight. He wanted to get rid of me in a sneak attack and take my stuff.

A dog left to die in a vacant lot a thousand miles from here, the companion who’s been by my side for four years, has just saved my life.

This content is imported from OpenWeb. You may be able to find the same content in another format, or you may be able to find more information, at their web site.

[circumlocutive]

My Adderall is hitting and I just wanna shit this text post out before I start work.

I don't think there's a practical point to this kind of navel gazing at this stage in my life, and really it's more of a symptom of an issue in psychiatry with labeling phenotypic categories that don't have much correlation to biochemical mechanisms. But. I do still wonder about whether my avolition and related executive dysfunction/motivation crisis is " better " characterized as a CPTSD thing than an ADHD thing. And whether that should play a role in my expectations for functioning.

Like functionally I'm still going to treat my symptoms the same either way (it doesn't respond to CBT, DBT, or a few diff antidepressants, but does respond adequately [if inconsistently] to stimulants), so from a pragmatic angle fussing over which label is better is not useful to me. It's mostly identity wanking - unless the labels can implicate something actionable, all they really seem to do is saddle you with their sociocultural baggage.

I'd say I have evidence suggesting a genetic predisposition to ADHD traits (which I generally conceptualize based on handling in the broader psych literature as an innate/biological/"nature" [as in nature vs nurture] based thing, like the impairments are there whether or not the environment is good or bad though of course environment influences the final result). My dad is very ADHD and was long before he was a combat veteran if you listen to stories from his family, my dad was adopted bc he had a teen mom so highly likely she had something up too, and my brother is so textbook autism (and autism and ADHD genes run around skipping hand in hand) (stimulant side note these are not definitive scientific correlations I'm making here, autism looking presentation could be related to my brother being abused too and having far less social support, could be related to my mother's psychotic lineage [autism and schizo/bipolar/psychotic spec genes also run around skipping hand in hand], could be a lot of shit).

On the other hand, it is so obvious I have CPTSD (which I conceptualize as a nurture based, acquired dysfunction that does also alter your "nature" in the sense it affects your genetic expression. But while trauma will change your innate biochemical settings, I see the biggest distinction from ADHD in that cptsd wouldn't manifest without external initiation). In the narrative of my life, my current difficulty with motivation makes more sense as. Well. Something to do with living in constant fear for my life in my developmental period. How can I find anything as compelling or salient as preserving my life against a direct, explicit, and omnipresent threat. How am I supposed to give a fuck about tasks if no one is breaking plates over my head about them or depriving me of food and shelter. My whole risk reward system calibration is fuuuucked.

Realistically, I have issues with emotional regulation/motivation/self care because of the combination. I probably do have congenital neurological differences inherited from my parents, and then the extreme circumstances of my youth made for maladaptive neurological conditioning (think in the firing/electrical circuitry) + hormonal release + epigenetic changes + downstream effects that further stunted my prefrontal cortex and amygdala and striatum and whatever structures associated with emotion and reward. Some of the conditioning may be reversible with therapy/safe life experiences but the baseline performance won't be adjusted without biochemical intervention. Maybe that should play a role in setting my expectations for my performance and "improvement" over time.

Idk I have more feelings about labels and the ways they change our perception of the bio phenomena underlying "mental illness" and the self, but I need to do work instead of wasting hours getting the words out and refining them

[the-cookie-of-doom]

I'm taking Mental Health Nursing this semester, and it's going to be fun. I have been struggling to get treatment for my depression bc

1. I spent a long time not wanting to get on antidepressants 2. got on antidepressants and then felt worse 3. got on Adderall which helped some things but still didn't fix the depression (shocker) and 4. now that I'm ready to get back on antidepressants, can't, bc they react very very badly with Adderall

I really need an actual psychiatrist (y'know, the people who specifically specialize in psych drugs? and their interactions?) which is impossible to find out here, to the point my school director almost committed me to the ER last fall just so I could get seen by someone in patient. I told her thank you very much but they will not let me leave, ma'am. and I have tests on Tuesday.

A family practice NP, not my usual, tried to put me on Wellbutrin when I went for my Adderall refill. Wellbutrin does very bad things with Adderall. Like. You are specifically not supposed to combine them. Which she would have known if that was her specialty, which it isn't. Ironically I was also there asking for a psych referral to avoid this exact thing. (She kept pushing the drug on me despite repeated refusals, then wrote the prescription anyway, and now I keep getting notifications to pick it up even though I told them I didn't want it/wouldn't take it. like 3 weeks ago.)

Lucky for me, being a nursing student and having a special interest in pharmacology/medications, I knew better than to just take what was given. I'm in a place where I have the knowledge to self-advocate. I may not know what I do need, but I definitely recognize the things that will hurt me.

But now!! With Mental Health!! Which has a ton of focus on drugs!! I'm starting to make some progress. It's helping me learn what to look for/ask for and I'm v excited, bc now it feels like I'm closer to being able to get the help I need.

I found an antidepressant that was developed specifically to treat ADHD and !! It's exciting!! Bc it should also help treat the depression, too. And if it does work well enough for the ADHD I wouldn't have to keep taking the Adderall, but I'm reluctant to get off it bc it was so hard to get that prescription in the first place. I would rather be depressed but still able to study, then get on another med that doesn't help at all.

Anyway. Healthcare is fascinating and drugs are cool <3

[stardustinmyhands]

8/19/24

I talk to my psychiatrist today in less than 2 hours. I’m nervous I don’t know why. I trust him (I trust 3 of my doctors very much). Maybe cause I have to admit I’m not doing well, when I’ve been doing well for so long. Now this.

Today I’m cleaning in my house. My apartment complex is spraying for bugs in our kitchen and bathroom, so we have to clear out all our drawers and cabinets. Thats my job today. I made a list of things I have to do.

I only have 4 things left. One is my appointment with Dr. B at 2.

My normal dose of adderall a day is 50 mg through out the day. (20 mg, and two 15 mg). Today I’m taking three 20 mg cause of all I have to do. I’m not telling my dr of course. It will be our little secret. (Haha). I’m also pretty uncomfortable today (pain wise). Adderall also helps me forget that, or not feel it. 

I guess I’m also nervous cause I don’t know what my doctor will say, or if he will change my meds or just increase them. I take 600 mg of trileptal twice a day and abilify 15 mg at night time (among many other things, but those are my behavioral medicines). I also can’t take antidepressants, because they make me suicidal. So they are basically “black listed” in my chart.

I also will have to be honest I’m having intrusive thoughts of cutting, but I’m not acting on them. I’m not anywhere near suicidal.

I also haven’t talked to my friends (except one I met at work, I talk to her daily. But I feel she understands me and won’t judge me) in like almost 2 months.

My friend is throwing a birthday party later this month for herself. I don’t wanna go, but it will be important if I do go. So I’m trying my best to go. Her divorce was finalized a few months ago, it was a toxic marriage. And she’s going to school to become a nurse. She’s also doing a lot other good things to improve herself. I’m proud of her. I do feel bad about not talking to my friends, but I just can’t do it.

I’m also gaining weight.

I’ve lost a lot of interest in stuff to the point my wife is telling me I need to go back to art therapy. All I do is word searches, write in my journal, and watch tv. And over eat.

This was triggered by a break up with my boyfriend. It was made worse when I stopped texting him (we were friends, at least I thought we were) and he hasn’t texted me in a week. It bothers me I can’t even get a minute of his time. And if I confronted him, he probably wouldn’t answer me. And that would bother me more. I loved him very much, and trusted him to not hurt me.

Today for the most part, I feel ok. As usual it changes by the hour. Like it has for the past three weeks.

I will update after my psychiatrist visit.

[zurajanaizurakoda]

Katsura Biologist Post

I haven't finished a fic in forever but I wrote 1k words about Katsura and his constitution and how him being a genius politician is actually really smart and well supported by the story. This contains major spoilers for season 4 of Gintama.

Another headcanon I don’t think is true but really like is the idea that Elizabeth has been slipping various antidepressants and other medicines to Katsura the whole time and the day she chose space Adderall he drinks his tea as usual, goes to his office as usual, locks his door and doesn’t come out for three days.  No one knows what to do, but hell, it’s Zarump, who knows what he’s thinking?  And three days later he leaves his office and he doesn’t look any different from when he went in, and he drops about a ream of paper on his secretary's desk and announces he’s taking the rest of the week off.  And she thumbs through it listlessly and there’s writing on every single page, front and back, with no corrections, and she asks him what it is, and he replies, “It’s a constitution.  I was thinking we needed one,” and then he walks off.  And she reads a little bit and it’s absolutely incomprehensible to her, so she calls someone who deals with legal jargon and he starts reading it and it’s absolute nonsense and he thinks, “Zarump-san is playing a joke,” and he decides he’d better read it so he doesn’t get in trouble but he’s not looking forward to it…

…and a few pages in it’s like a magic eye poster and it clicks-

It’s brilliant.  Everything works, the jargon makes it sound like incomprehensible bullshit but if you cut away the red tape then you get a perfectly balanced constitution.  It won’t insult the Amanto, but it retains autonomy for Japanese citizens.  What looks like a tough policy on criminals hides plans to offer services to marginalized and unhoused people.  It promotes equality.  It has long term plans to help ease the populace into the more radical changes.  It provides relief to citizens whose lives were upended by the battle of Edo.  It shouldn’t work, and if you took out a single paragraph it would fall to pieces, but it works.

He calls an emergency meeting and all the heads of state get together and they can’t explain it but it solves all the problems that people had been trying to foist onto others for months.  None of them can believe that idiot came up with this.  Of course they’re going to put it into action, but they have innumerable questions.  They call Zurump’s villa and gets a servant who announces that he’s not taking calls right now, and turns the camera to show Katsura in Elizabeth footie pajamas in the middle of the day, watching a Korean drama on the theater TV, eating popcorn and explaining to Elizabeth that the real killer is the porter in the first scene that didn’t even get a face reveal.  He’s right but his logic is 100% unhinged speculation.  Elizabeth is hanging on every word like it’s a religious manifesto.  The servant informs them that he’s not taking calls for the rest of the week, not because he’s avoiding them but because it’s over and it never occurred to him that there would be questions because it addressed the issues.  

And they just shake their heads and are glad he’s on their side.

Like I don’t think he’s a savant (I do strongly believe he’s autistic, but that’s another post) but I do believe he’s normally the smartest and the dumbest person in the room.  And  I think the constitution is baffling on purpose because he didn’t want anyone to mess with it (for instance, less accepting officials can’t just cut out the equality because it’s woven into the constitution) but it’s also oblique because he does not think like other people think. 

And I think the series does establish that, strange as he is, he’s a great leader and a strategist, and he’s also very good at getting people to underestimate him.  Especially in the episode Zura, Sakamoto says the war would be lost without Katsura’s guidance.  The soldiers agree and even refer to him as the leader of the Joui 4 but it never occurred to them that he was strong because he likes to give the impression he’s not important.  He was a total dumbass when he got taken by Prince Hata in the end arc, but he also shows shrewd strategizing when he wants Hata to declare war and then flee.  He doesn’t want unnecessary loss of life, even when it’s not his men, and he rightly choses plans that are more destructive in terms of property damage if they result in less loss of life. He wants to buy time, and of course, he has 100% faith that Gintoki will take care of the mess on earth if they can just give him the time.  He didn’t become Prime Minister for power, he became PM because there was a need for someone to do a lot of thankless work and be hated for it.  I think he’s in his best element when he’s handling jobs that would drive other people crazy, because it’s the only thing that can occupy his mind enough to get him to focus.

Anyway, I could keep going forever, but if I don’t stop I will go forever.  It seems like a lot of people think that Katsura is just a silly character and  trying to assign meaning to his actions ruins that, but I think they can both be true. He’s a brilliant war hero with  a traumatic past and crippling PTSD (I actually think he has CPTSD because of the homelessness, but that’s also another post)  and he’s also a goofy dumbass who manages to get through life despite having no self awareness.  He’s both.  Get you a guy that can do both.

Anyway, just my personal views and not to be taken as my argument that these things are canon.

[donnerpartyofone]

I am not handling anxiety well. I may be experiencing a protracted spike due to (my circumstances and) this new asthma medication I'm still experimenting with, which at the recommended dosage gave me a panic attack so bad it took me out for an entire day. Antidepressants and anxiety meds all make me sick or make my ears ring so bad it makes me want to [redacted]. I don't like being stoned during the day or socially or while working on anything (even creative things), and I wouldn't say it always makes me less anxious anyway. I took a course in transcendental meditation but I could never get to a point with it where it really affected me. I've found other kinds of meditation I like more, but they also don't do much for my general state, they're more fun and interesting to me than therapeutic. Regular exercise doesn't make a noticeable difference in my daily mood (besides which we're out of space, which is why we're moving). I most often just reach for a drink when I can't handle something (unless I'm having a major depressive episode, then I don't want food or drink or drugs or anything). Alcohol is the only thing that depresses my nervous system enough for me to get through certain things. This is pretty dysfunctional. Based on the frequency and intensity of my drinking no one would say I have a "problem", but I know I'm doing something maladaptive. If I had stayed at my old job I would surely have drunk myself to death. I have to spend today going over these really complicated document notes and comparing them to a couple of older drafts to prepare my statements (defenses) for a really difficult meeting tomorrow. I don't know how I'm going to get through the preparations or the meeting itself. I mean I'll do it, I have an often tyrannical sense of responsibility and I practically never just flake on things like this or do them half-assedly (which would scare me). Besides which the project has kinda been my life's work and I won't give up on it even if I absolutely feel like it. But I'm suffering under the worries of not knowing whether I can do the task successfully or whether I am Being Insane. I spent an hour and a half last night working on this email to my project partner, who is also a close friend, trying to explain what I'm anticipating with this, and also excusing the fact that I am possibly Being Insane. I got it as short and emotionally controlled as I could, and I'm sure he wouldn't be mad at me for such a thing, but I'm still worried that I can't really tell how acceptable my behavior is. Hilariously, I only convinced myself to write the email because my fucking horoscope told me not to be ashamed of making use of my relationships. In doing so I realized that in all my years of indulging, to varying degrees, in magical thinking, I never did anything specifically because my horoscope said it was a good idea. So, that's something. Maybe I'm not as far gone as I thought. Or maybe I'm only getting there NOW! Anyway I wish I had an Adderall. I am not a person who NEEDS Adderall, but I would really appreciate the intense focus and artificial confidence in completing tasks that it gave me when I tried it. If you're in my general area and you wanna give me an Adderall, I'll buy yuz a beer, or something. Fair warning though, I am possibly Being Insane!

[kalamity-jayne]

And stimulants aren't the only option either! I've tried various stimulant meds over the years, mainly ritalin and adderall. I was on Adderall for a while (titrated up to a fairly high dose) and it worked for a several years but after awhile it felt counter productive and made me sort of manic (probably on account of the high dosage). Now instead of stimulants I'm trying a route of antidepressant and alpha blockers (only been on it a few weeks, too early to tell how well it's working), but there's also drugs like Strattera that isn't a stimulant and folks describe that one as clearing the brain fog (I can't take that one cause it doesn't play nice with my other meds). There's also newer stimulant ADHD meds that work via different mechanisms than the more traditional adhd meds, such as Vyvanse. So talk to your doctor, they can work with you to figure out what will work for you!

bro im gonna CRY i didnt know this 🥺

[imformation]

Understanding Psychiatric Medication Management: A Guide for Portland Residents

Psychiatric medication management is a critical component of mental health care that can significantly impact an individual's quality of life. For residents of Portland, understanding the ins and outs of psychiatric medication management Portland is essential for navigating the path to better mental health. This comprehensive guide explores the fundamentals of psychiatric medication management, including its purpose, common medications, the role of psychiatrists, and practical tips for optimizing your treatment.

What is Psychiatric Medication Management Portland?

Psychiatric medication management involves the use of medications to treat mental health disorders, such as depression, anxiety, bipolar disorder, and schizophrenia. It aims to alleviate symptoms, stabilize mood, and improve overall functioning. Effective medication management is a collaborative process between the patient and their psychiatrist, focusing on finding the right medication and dosage while minimizing side effects.

1. The Purpose of Psychiatric Medication Management

The primary goals of psychiatric medication management Portland are to:

Reduce Symptoms: Medications are designed to target specific symptoms associated with mental health conditions, such as mood swings, anxiety, or psychosis.

Improve Functioning: By alleviating symptoms, medications help individuals function better in their daily lives, improving relationships, work performance, and overall well-being.

Enhance Quality of Life: Effective medication management can lead to a significant improvement in the quality of life by reducing distress and promoting stability.

Common Psychiatric Medications

Psychiatric medications are categorized based on their effects and the conditions they treat. Here are some common types of psychiatric medications:

1. Antidepressants Purpose: Used to treat depression, anxiety disorders, and certain other mood disorders.

Types:

Selective Serotonin Reuptake Inhibitors (SSRIs): Examples include fluoxetine (Prozac) and sertraline (Zoloft). SSRIs work by increasing levels of serotonin in the brain. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Examples include venlafaxine (Effexor) and duloxetine (Cymbalta). SNRIs increase both serotonin and norepinephrine levels. Tricyclic Antidepressants (TCAs): Examples include amitriptyline and nortriptyline (Pamelor). TCAs affect several neurotransmitters in the brain.

2. Antianxiety Medications Purpose: Used to manage symptoms of anxiety disorders.

Types:

Benzodiazepines: Examples include diazepam (Valium) and lorazepam (Ativan). Benzodiazepines work by depressing the central nervous system, providing quick relief from anxiety. Buspirone: An anxiolytic that helps alleviate anxiety without the sedative effects of benzodiazepines. 3. Mood Stabilizers Purpose: Used to treat mood disorders such as bipolar disorder.

Types:

Lithium: Helps stabilize mood swings and reduce the risk of manic and depressive episodes. Anticonvulsants: Examples include valproate (Depakote) and lamotrigine (Lamictal). These are used to stabilize mood and manage bipolar disorder. 4. Antipsychotics Purpose: Used to manage symptoms of psychotic disorders such as schizophrenia and schizoaffective disorder.

Types:

Atypical Antipsychotics: Examples include risperidone (Risperdal) and olanzapine (Zyprexa). These medications are used to manage symptoms such as hallucinations and delusions. Typical Antipsychotics: Examples include haloperidol (Haldol). These are used to manage severe symptoms but may have more side effects compared to atypical antipsychotics. 5. Stimulants Purpose: Used to treat attention-deficit/hyperactivity disorder (ADHD) and certain other conditions.

Types:

Methylphenidate: Examples include Ritalin and Concerta. These increase dopamine and norepinephrine levels in the brain. Amphetamines: Examples include Adderall and Vyvanse. These are used to enhance focus and reduce hyperactivity. The Role of a Psychiatrist A psychiatrist plays a crucial role in psychiatric medication management Portland. They are medical doctors who specialize in diagnosing and treating mental health disorders. Their responsibilities include:

1. Conducting Evaluations Assessment: Psychiatrists conduct thorough evaluations to diagnose mental health conditions and determine the most appropriate treatment plan. Diagnosis: They use clinical interviews, psychological assessments, and sometimes laboratory tests to diagnose conditions and prescribe medications.

2. Prescribing and Managing Medications Medication Selection: Based on the diagnosis and individual needs, psychiatrists prescribe medications that target specific symptoms. Dosage Adjustments: They monitor the effectiveness of medications and adjust dosages as needed to achieve optimal results. Managing Side Effects: Psychiatrists address any side effects that arise and make necessary changes to the treatment plan to minimize discomfort.

3. Providing Ongoing Care Regular Follow-Ups: Psychiatrists schedule regular follow-up appointments to track progress, assess treatment efficacy, and make adjustments as needed. Collaborative Care: They often work with other healthcare providers, such as therapists and primary care doctors, to ensure comprehensive care. Tips for Effective Medication Management

To make the most of your psychiatric medication management, consider these practical tips:

1. Be Open and Honest

Communicate Concerns: Share any concerns or changes in symptoms with your psychiatrist. Open communication helps in tailoring the treatment plan to your needs. Discuss Side Effects: Report any side effects you experience. Your psychiatrist can adjust the medication or suggest alternatives to alleviate these effects.

2. Follow the Prescribed Regimen Adhere to the Schedule: Take your medications exactly as prescribed, at the right times and dosages. Consistency is key to achieving the best results. Do Not Alter Doses: Avoid changing your medication dose or frequency without consulting your psychiatrist. This can affect the effectiveness and safety of the treatment.

3. Keep Track of Your Progress Maintain a Journal: Keep a journal to track your symptoms, side effects, and any changes in your mental health. This information is valuable for your psychiatrist to make informed decisions. Review Regularly: Regularly review your progress with your psychiatrist and discuss any concerns or observations.

4. Educate Yourself Learn About Your Medications: Understanding how your medications work and their potential side effects can help you manage your treatment more effectively. Stay Informed: Keep up to date with the latest information on psychiatric medications and mental health research.

5. Seek Support Involve Family and Friends: Engage your support system in your treatment process. They can provide encouragement and help you stay on track with your medication regimen. Join Support Groups: Consider joining support groups for individuals with similar conditions. These groups can offer additional insights and coping strategies.

Navigating Medication Adjustments Medication adjustments are a normal part of psychiatric care. They may be necessary due to changes in symptoms, side effects, or other factors. Here’s how to navigate medication adjustments effectively:

1. Understand the Need for Adjustment Discuss Reasons: Talk to your psychiatrist about why an adjustment is needed. Understanding the rationale behind changes helps in managing expectations and adhering to the new plan. 2. Monitor and Report Changes Track Effects: Keep a close eye on how the adjustment affects your symptoms and side effects. Provide detailed feedback to your psychiatrist during follow-up appointments. Be Patient: Adjustments may take time to show results. Be patient and continue to follow your psychiatrist’s instructions. 3. Adjust Gradually Follow Instructions: Implement changes gradually as directed by your psychiatrist. Sudden changes can cause instability or new side effects. Stay Informed: Understand the potential impact of the adjustments and be proactive in addressing any concerns with your psychiatrist. Scheduling Your Appointment for Psychiatric Medication Management Portland If you’re looking to start or adjust your psychiatric medication management, Portland offers several excellent resources. NeuStart Psychiatry is a leading provider in the area, known for its comprehensive and patient-centered approach to psychiatric care.

Contact Information for NeuStart Psychiatry:

Phone: (503) 379-1902 Email: assist@neustartpsychiatry.com Website: Visit NeuStart Psychiatry Office Address: 308 NW 11th St., Suite 201, Portland, OR 97209 Fax: (503) 334-1617 Conclusion Understanding psychiatric medication management Portland is essential for effective mental health treatment. For Portland residents, a range of top-tier services is available to provide personalized, evidence-based care. By working closely with your psychiatrist, adhering to prescribed regimens, and actively participating in your treatment plan, you can optimize your medication management and achieve better mental health outcomes.

For more information or to schedule your site visit with NeuStart Psychiatry, reach out today and take the first step towards enhanced mental health care.

[gaysexunfortunately]

something confessional 01.rtf

It’s been. I don’t know. Like two months sinc e I stopped taking wellbtrin. At one point this spring I just noticed my pill minder had like a 4 day backlog and I still felt fine as opposed to every other time I forgot my meds two days in a row and immediately wanted to kill myself. So I said fuck it and stopped taking wellbutrin. I made a deal with myself that I wouldn’t tell anyone for two weeks because I have a tendency to tell a bunch of people when I first start a project and then enver fllow through and it makes me feel like total shit and a fucking retard for ever saying anything. 

So like 5 days in I told Shannon that I had gone off the pills after consulting my psychiatrist and I couched it in that lie so she woulndt worry about me like she always does and I fucking hate it more than anything else when people WORRY about me. sinc e she thought I did it like a normal person would she was supportive which was nice and after that I don’t think I really said anything about it to anyone else for a while.

eventually I told my therapist who I don’t really like but I still keep seeing because I think people would be concerned if i stopped seeing her that I had gone off the m unsupervised or maybe I told the same lie because I just repeat the fucking lies I tell otherwise I know I’ll slip up and reveal the truth that’s behind all these small facades and diversins I maintain i n my everyday life for some fuckng reason so now she knows and the last person who doesn’t whwo “should” know is my actual psychiatrist who is some kind of hog from fenway health who prescribes me adderall which is the only drug other than estrogen I’m still taking.

I fucking hated taking the wellbutrin. and the hydroxyzine. and the folic acid. and my multivitamin. so many fucking pills just to make me function normal instead of lying in my bed all day thinking of creative ways I could paint my brains on a wall as a copiing mechanism for never being able to live up to the expectations I set for myself which is a problem costar predicted I had when I signed up for it recently. but I’d miss two doses in a row, or even one day’s dose, and 48 horus later I’d be horizontal, eyes fixed upwards, thinking about how it is not worth it at all to live a life where i have to take like six pills a day and inject shit into my thigh muscles once a week just to remain barely fucntional in the long run (adderall doesn’t count because it makes me feel like a god) and how I was going to have to do this routine for the rest of my life and every time i missed one pill I was going to have a day of feeling like this for the resto f my life.

im so fucking sick of seeing my therapist. i feel like ive done most of the work myself to get anything out of therapy which is probably to be expected because other people cant fix you but I feel like she hasnt even offered any ideas she just kind of mm-hmms me and sometimes tells me i forgot to zelle a copay and once every three months or so she brings up the time she was late to an appointment in 2019 and I tweeted “my therapist is 15 minutes late which is already making me feel a lot bnetter about myself” and I really wish she shouldn’t but much like flat out not going to therapy any more I don’t know how to tell her I don’t want to hear about that any more.

and im on cypionate so therapy days are injection days which keep my internal clock pretty steady all things considered.

I don’t think you’re supposted to stop taking 300mg of wellbutrin cold turkey because your seasonal affective wore off but it’s worked out well for me so far. im alot more tired lately and find myself sleeping a lot but that’s sort of eased up in the last couple months but I find myself constantly fighting the urge to sort of slip back into the depressed sorry state I was in from before I started taking antidepressants. I had a really good day yesterday where I saw like four different friends over the course of the day and I felt really good and today I felt like shit and now I’m in bed drinking johnny walker and writing this. 

I think I maintain a facade of white lies to keep everyone around me from asking if I’m ok. I hate it when people ask if I’m ok. I feel guilty if I express how I really feel and they get concerned for me so I just tell them I’m fine and I”m plugging along doing what a normal human being should be doing like filing job applications and practicing bass guitar but ost of my free time I”m jsut fucking sitting in my room killing time because I”m scared of trying something and failing. And I was cool with that feeling on wellbutrin because I didn’t really get depressed about ityou know. But now I’m off it and I am fucking terrified. maube it’s because I stopped taking the anti anxiety pills too but I have been holding back the urge to cry and fantazise aboutall the cool ways I could kill myself like I used to from like 2010-2022.

I’ve never cried in therapy or in front of anyone really. I don’t like to show that weakness because when I did in childhood my parents would blame it on each other look what you did, you made him cry so I just tell my therapist “I want to get my money’s worth haha” like I’ll tear up or stay quiet for a while but I’ve never really broken down and sobbed infront of anyone. when my boyfriend would stay for the night in like 2019 and I had to cry I’d go to the bathroom and weep into a folded towel so I wouldnt make any or too much noise. 

I really don’t want to start taking antidepressants again. it’s like a compressor and it flattens out all the highs as well as the lows. I’ve had some good moments in the time since I stopped taking them and I think now that Im not smoking a ton of weed any more I actually have perspective on when things are good and bad and how much time has passed between those points. but I think I’m going to cointinue to make not a lot of noise. I don’t want anyone to ask me if I’m ok. 

[sadboihowrs]

I've been unmedicated for my ADHD for over 10 years, because the medications they were putting me on as a teenager either werent working or were harmful. I don't remember what the first one was called but it didn't work. Then we tried Vyvanse, which worked, but was causing me to experience violent mood swings. And last we tried Adderall, which worked extremely well ADHD-wise, but made me not want to eat, resulting in me losing about 50 pounds(24 kilos) in only 6 months. I had to be hospitalized for malnutrition, and after that I have never tried any other meds for ADHD. People definitely think that I'm weird sometimes, but I'm fairly high functioning and I don't need to worry about struggling to literally stay alive while being made "normal".

I do still need antidepressants though, so I'm not anti all medications, I just wanted to give my personal experience for needing neurodivergent medication.

I love seeing those posts where people are like “if you have headmates or whatever you should be on meds because that’s not okay” posts. Like neurotypicals just think that there’s some magical pill out there that will ‘cure’ anything they don’t consider ‘normal.’ Meanwhile, in the land of reality, my shrink thinks it’s pretty healthy that I’m finally getting to know my headmates, and has no intention of putting me on magic pills, because as long as I’m not hurting myself or anyone else, who cares what neurotypicals think is ‘normal?’ Actually, let’s be real: who cares what neurotypicals think at all?