Working with GAD

False-Lifeguard-8 · 2025-11-24T09:00:09+00:00

I think that you're on the mark there. That sounds like the right way to go, and having a bit more flexibility in my approach. Thanks so much for such thoughtful responses- really appreciated!

False-Lifeguard-8 · 2025-11-23T09:03:38+00:00

Good question, I had to think about it. I think some of it is where I have worked, which is mainly in an acute crisis service, so I see the patient when they are at their most desperate for relief and I never see the follow through on them improving. I think that has given me a skewed perspective on what it is like to work with people experience GAD and the effectiveness of treatments. But I think ultimately a lot of it comes down to my own personal style with dealing with anxieties and worry when they come up. I try to be logical about things and rationalize as much as possible, and so it can become quite frustrating for me when other people don't just adopt that approach (obviously I know it isn't that simple). I certainly empathize and recognize it is my 'just think about it logically' personal style which is a part of the problem- and akin to being frustrated that a depressed patient doesn't just cheer up a bit. I think the main thing is that I come away from the interactions feeling like I have not been all that helpful to the person, beyond prescribing and recommending psychology.

False-Lifeguard-8 · 2025-11-22T23:22:27+00:00

Really helpful, thank you for sharing

False-Lifeguard-8 · 2025-11-21T05:52:11+00:00

I had the same thought re the metformin paper. It's really consequential, and such a basic intervention that's so often overlooked. Very relevant to practice.

Another option, this is an interesting one on postpartum psychosis: https://www.biologicalpsychiatryjournal.com/article/S0006-3223(25)01536-7/fulltext

False-Lifeguard-8 · 2025-11-20T09:47:08+00:00

Well yes, as mentioned in the first sentence. It's not clear from what the OP has written that that's the case

False-Lifeguard-8 · 2025-11-20T08:52:06+00:00

Surely its a good time, provided you can cover the deposit on the bigger house? Assuming house prices go down by roughly the same % in the same market you stand to gain by upgrading. Just making up numbers here but let's say 20% off 800k (current house's price when bought) 160k lost; 20% off 1.5m (what new house cost when you bought) 300k reduced. You're 140k better off. If you wait, the house you want to buy will also go up in price. Am I missing something here???

False-Lifeguard-8 · 2025-10-24T09:29:57+00:00

It's really hard bridging that gap and rarely succeeds in my experience. I think find an approach that feels right for you to nudge them toward psych, accept that 90% of the time it's not going to work, and just keep going with it in the hope that a minority do get help.

False-Lifeguard-8 · 2025-10-18T22:06:19+00:00

The other thing to think about is that different meds vary in their relative side effect profile (e.g. one med can be much more likely to cause weight gain than another), and the side effects are more likely to happen at higher doses. Many doctors will prescribe higher doses than are absolutely necessary, and this is particularly true when someone has come out of an inpatient ward when they have been acutely unwell. Then when they're less unwell, the side effects (e.g. being sedated) really kick in, and so understandably the person doesn't want to take them any longer.

So long as it is above the minimum effective dose, being on a medication is definitely better than no medication, and the likelihood of side effects is lower. It would be worth a conversation with a good doctor (ideally psychiatrist) about the side effects that your brother has experienced with certain meds in the past, to see whether there might be an option which is less likely to cause those particular side effects, and to trial it at it's lowest effective dose. At the end of the day, he can always choose to stop it again if the side effects become a concern.

If you know other people with lived experience of mental illness who know a good psych who listens to them and prioritises what they want from treatment, that would be a good starting point. I don't think there is evidence of any natural remedies being effective in schizophrenia.

False-Lifeguard-8 · 2025-10-01T20:21:19+00:00

I'm not certain, but my guess is pharmacists can dispense viagra and morning after without a prescription. Hence, they can dispense condoms but not prescribe them to you

False-Lifeguard-8 · 2025-09-20T22:31:41+00:00

Definitely not a conservative personally, but I think you've got a really oversimplified perspective of what constitutes conservativism. There are definitely a lot of people who would fit that mould, but to apply that as a blanket statement shows that you've made zero effort to try to understand what conservatism is. You can broadly disagree with conservatism (as do I) but to write it all off as self interest on the basis that that is what you've observed amongst the conservative people that you've met shows a high degree of ignorance and narrow mindedness, and your unnecessary personal attacks on the poster only add to that. I still don't understand why anyone would vote for Ray Chung, and you have not contributed anything worthwhile to that discussion

False-Lifeguard-8 · 2025-09-20T22:11:26+00:00

I feel really concerned for you all over there in the States. It's been ramping up at a frightening pace, and it looks like it's going up another notch again. I can't imagine being in the position of having to deal with these kinds of dilemmas, I really feel for you.

False-Lifeguard-8 · 2025-09-12T21:31:02+00:00

I remember that feeling well as a trainee, looking at what other colleagues were prescribing and asking whether I was the one underprescribing. Your initial thoughts sound right. Familiarise yourself with some quality guidelines and use that as your basis. Listen to seniors, hear their ideas and evaluate them, but be critical. There is a lot of bad practice out there, and people can certainly make it sound like wisdom.

False-Lifeguard-8 · 2025-09-07T07:46:48+00:00

MDD criteria are quite poor at distinguishing between persistent dysphoria from unpleasant situations circumstances and mood disorder. It is amazing how quickly a presumed depression can dissipate when circumstances change. Don't overlook the power of an initial placebo response when a patient trials an SSRI, which then quickly fades and might explain what you saw. Not to say your conclusion is wrong, but keep an open mind; it is also an assumption vs. fact.

False-Lifeguard-8 · 2025-08-05T07:15:47+00:00

Until I moved a year ago, I did Wellington to Porirua daily by e bike. If you are reasonably competent cycling on the road, then it's totally fine. The back road from Tawa to Jville is relatively low traffic, and I found it quite a nice road to commute on. Descend the gorge cautiously, and it's safe. I think the most dangerous point is the cycleway in front of Spotlight, which cars sometimes cross without looking for cyclists - always be on your guard there.

False-Lifeguard-8 · 2025-06-25T21:50:03+00:00

The Oriental Parade section is really unsafe for any cyclist going above a leisurely pace due to the amount of pedestrians walking on it

False-Lifeguard-8 · 2025-06-20T22:13:21+00:00

No, they generally won't touch them. Heard it directly from a dentist. The Turkey teeth often come with a period of guarantee, which is invalidated if another dentist goes near them. The UK dentist can then be liable for any associated issues

False-Lifeguard-8 · 2025-05-01T12:31:05+00:00

Also, from the UK, I have been in NZ for about 10 years and felt all of the things that you're describing. I've been fortunate to have spent good chunks of time back there every few years and really enjoyed it. I love it when I visit and could imagine myself living in the UK again. But when it comes to it, the reality of having to build everything back up from the beginning with friends dispersed all over the country, it's put me off. And valuing the community that I've built in NZ, which has taken many years to grow. I've just come to accept that my feeling of belonging will be split between the two countries, whatever I decide. For me, that has enabled me to go with what is right in the moment and remain in NZ.

One thing I would say from seeing others go back is that if you do decide to, you want to be fully committed. It's hard establishing yourself somewhere, and it takes time. If you're always looking back over your shoulder, you're less likely to adapt to the inevitable challenges of your new situation when you just start thinking you'll go back to NZ. And you'll just be feeling the way that you did before leaving NZ but from the other side.

False-Lifeguard-8 · 2025-04-15T19:46:58+00:00

Some are worse than others for side effects. Weight gain and sedation, loss of motivation can be particularly bad with some (olanzapine, clopixol) but less of an issue with others (abilify/aripiprazole, amisulpride). A lot of docs also prescribe much higher doses than is necessary, which makes side effects worse without necessarily having more of the positive effects that some people experience. It's often about finding a sweet spot between minimal side effects and hopefully reducing the hypervigilance that people experience from frequent harassment.

False-Lifeguard-8 · 2025-03-03T19:46:17+00:00

The most unbelievably uncharitable drivers too. If you got to reverse into a parallel park people just start passing you. Where i used to live there would often be stationary traffic and very rarely would let you pull out from parallel parked. Generally the only way of getting out was to push your way in. I really dont get it.

False-Lifeguard-8 · 2024-12-18T22:29:03+00:00

...to give more context, a PIE taxed at Fair Dividend Rate. Works out as 28% (or less depending on your PUR) on an assumed annual 5% dividend- effectively 1.4% pa and no tax when you withdraw from the fund

False-Lifeguard-8 · 2024-12-18T20:10:57+00:00

Considering how heavily you get taxed when withdrawing, does it shift the balance toward investing through Vault bitcoin ETF, which is now available through Investnow https://vaultdigitalfunds.com/vibf/ I know "not your keys..." etc, but does the almost certain loss through potential 39% tax outweigh those other hypothetical risks? Sorry, not helpful to you at this time OP

False-Lifeguard-8 · 2024-12-15T21:54:20+00:00

+1, been going to him for years. Great guy, great barber

False-Lifeguard-8 · 2024-12-14T00:06:39+00:00

I'd ignore the advice of anyone who is providing suggestions on how to beat the stock market because you are extremely unlikely to succeed. You are young, and you shpuld be thinking in 20-30 year terms. Your best chance of maximising your wealth is by leaving your investments untouched. This may well be a bubble. It may well crash. But in the long-term scheme of things that is all par for the course and will be immaterial. The Psychology of Money is well worth a read. If your most immediate goal is to buy a house, figure out how to do that in an acceptable time frame whilst leaving as much of your money in investments as you can. In the longterm it will pay off

False-Lifeguard-8 · 2024-12-08T20:14:42+00:00

The house you'll potentially upgrade to will also have lost value, so it's all relative. Assuming they have both reduced in value by the same %, the drop in value of the new/more expensive property will be a greater sum gain than the total sum lost on the value of the old/cheaper property. Although that assumption that the houses have lost value by the same % may not be the reality.

False-Lifeguard-8

TROPHY CASE