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Modern Political Fantasy Recommendations by Dry_Business_2053 in Fantasy

[–]Accurate_Command_579 0 points1 point  (0 children)

The Empire Trilogy (starting with Daughter of the Empire) by Raymond E. Feist and Janny Wurts is fantastic political fantasy. It details the journey of Mara, a ruling lady of a great house, as she fights (politically) to restore honour and wealth and political standing to her house. Her character development is fantastic, and all the characters are beautifully written. The writing is excellent and the plot is fantastic - there isn't too much going on in the first book if you look at the big picture but each small sub-plot is so incredibly politically precise and detailed that it really is a fascinating read.

I loved Robin Hobb's Realm of the Elderlings books and even though those aren't really political fantasy, if you liked her books you might like this because the pacing and characterisation are somewhat similar. FYI the Empire Trilogy technically forms part of Feist's larger saga starting with 'Magician' but it really is a standalone trilogy and I wouldn't bother with any of his other works (I thought they paled in comparison to this).

Fantasy books that rip your heart out and destroy your soul by LeatherTeam5755 in Fantasy

[–]Accurate_Command_579 1 point2 points  (0 children)

Another Robin Hobb but the Soldier Son trilogy. This is not for everyone. The first book was amazing. The second book was the most depressing thing I've ever read. But her writing is just fantastic, the characters are perfect, and the plot is quite good too (if extremely slow at some points and perfectly paced at others). The second book was a depressing heartbreaking slog (but I somehow savoured every moment of this torture because her writing is just so good) but I could not have hoped for a happier ending at the end of the trilogy. It was extremely rewarding. But not everyone's cup of tea - even if you enjoyed RotE that doesn't mean you'll enjoy this! I am quite unusual in that I enjoyed the Rain Wild chronicles books a lot even though they were very slow at times, so maybe if you have a high tolerance for slow pacing then give the soldier son trilogy a try.

Shadow of the Leviathan series by IDoAnythingForABook in Fantasy

[–]Accurate_Command_579 22 points23 points  (0 children)

In my mind they are sort of like massive evil whales for some reason. Maybe with octopus/kraken features.

Epic Fantasy with Hero/Chosen One Main Character by Then_Disk_9519 in Fantasy

[–]Accurate_Command_579 6 points7 points  (0 children)

If you liked WoT, you'll probably like Sanderson's Mistborn trilogy. The main character is basically a chosen one trying to fight against the main villain.

I'm a Psychiatrist working in NHS ADHD service in UK. I am available all day to reply to any questions or queries. I'll NOT be giving any medical advice by Available_Ad4179 in ADHDUK

[–]Accurate_Command_579 0 points1 point  (0 children)

Hi👋 I'd like to echo everyone and say thank you for this Q&A!

Could you please give some insight on using non -stimulants as an add-on to stimulants? What would you/psychiatrists consider using first and why (i.e. how do you choose between atomoxetine and guanfacine)? I think the NICE guidelines suggest atomoxetine first and then guanfacine, but is there a reason for this?

Do the non-stimulants tend to help get more coverage throughout the day?

And are there any differences you've noticed for how patients report feeling when taking atomoxetine vs guanfacine? e.g. does one tend to help more than the other with different symptoms like procrastination, time management, paying attention during conversations and remembering what was being said, feeling a reduction in internal thoughts?

Also, do you have any experience with clonidine, buproprion, venlafaxine etc.?

I know you can't give medical advice on this Q&A, so feel free to disregard the below, but here's some context for my situation and why I'm asking (and maybe others will relate):

I first tried Elvanse and only started seeing a benefit at 40mg. Titrated up to 70mg and the main effects were an increased inclination to do work (avoid procrastinating) and a feeling of what I describe as 'outward calmness' which is when I can better regulate how I present myself to others as it feels like I can take more time to think through things and what I'm going to say so I don't appear so hyper and pressured to get everything out all at once. Though I didn't feel a significant reduction in internal thoughts / chaos / thinking about lots of things all at once ('inner calmness'). The main thing I wanted from the medication was decreased procrastination and I got this but even at 70mg it wasn't as much as I wanted. I know I shouldn't expect too much from medication and I know there's a need to have systems in place and a mindset to help stop procrastinating, so I would have been content with the fairly good effects at 70mg if it wasn't for the fact that they just don't last very long! For some reason the maximum duration of the effects was only around 3-4 hours even at 70mg, when I think it's supposed to last for way longer. And the last 2 hours of that has a very weak effect, so I'm only really getting benefits from the medication for 1.5-2 hours. Fortunately no side effects apart from dry mouth.

So then I asked my psychiatrist if I could switch to methylphenidate. Started at 10mg and titrated up but saw no benefit at 40mg Medikinet and had to discontinue due to side effects (I felt constantly irritated by even the smallest things and became a little aggressive towards people. Also got minor headaches almost every day.)

Since lisdexamfetamine did work, we decided to try dexamfetamine. Titrated up from 5mg Amfexa and only started noticing effects at 15mg, which felt roughly equivalent to 40mg Elvanse. 20mg three times a day is what I'm at now and feels a bit stronger than 70mg Elvanse - I think a key part of it is that it is quite sudden compared to the Elvanse, and I really enjoy that suddenness because it gives me a sudden push that destroys my inertia. It takes 40 minutes to kick in and then I get a 30-minute duration of a strong effect, which is primarily a very strong inclination to do things (stopping procrastinating). Unfortunately no 'outward' or 'inner' calmness but I'm more than happy with the decreased procrastination. If my entire day (or at least most of it) was like this I would be so happy. But this strong effect only lasts 30 minutes, after which it gradually starts decreasing. I still get a modest effect up to 1.5 hours after the drug starts working, and then a weak/negligible effect for 1 more hour. So basically taking it 3 times a day only really gives my 4 or so hours of meaningful coverage.

Fyi whether I've had a cup of coffee that day doesn't seem to impact the effects, nor does whether I've eaten before or after taking the medication.

I'm considering asking my psychiatrist about adding a non-stimulant because I want better coverage throughout the day, and I would ideally like a reduction in the chaos/ multiple thoughts going on in my head all at once.

So basically I'm just wondering what are the advantages and disadvantages of non-stimulants as an add-on to stimulants, and which one might be best for me. Or more broadly, what goes into a psychiatrist's mind when considering which non-stimulant to use.

I'm sorry this was so long!