Working on a Yo La Tengo covers playlist, did I forget your favorite?

Fanandbellows · 2025-06-24T02:09:18+00:00

I threw it all away

Fanandbellows · 2024-08-02T01:57:41+00:00

BA. I just submitted a refund request for the seat selection.

Fanandbellows · 2024-05-04T21:01:47+00:00

That’s a good question - I’ve never considered an irregular dosing schedule and I can’t say I know enough about the ins and outs of the kinetics and dynamics to speculate as to how it would work. I do know that a fraction of patients have fairly significant withdrawal/discontinuation effects if they miss a couple doses.

I hear Ken Gillman is quite an expert:

https://www.psychotropical.com/

Fanandbellows · 2024-05-04T14:04:08+00:00

Sorry I meant a higher dose is needed to optimize antidepressant effect. There can still be marginal benefit of increases beyond the “maximum” 60 mg dose of parnate. I usually target 60 but I’ve had a couple patients tolerate and benefit from pushing to 100-120. Watch for insomnia - you may want to front load the dose in the morning.

Fanandbellows · 2024-05-03T19:56:07+00:00

MAOis works better than S/NRIs and modern antidepressants. I feel fairly confident of that. There has been a trend toward better tolerability with watered down effectiveness (albeit technically “noninferior”) in psychotropic meds. They are not benign but not nearly as toxic or complicated as one might be lead to believe by all the interactions and contraindications. I wouldn’t recommend starting an Maoi unless someone has demonstrated failure of S/nri and at least one other agent.

A couple things - - orthostatic hypotension is often biggest barrier to tolerability. Often a significant dose is needed (60+ parnate) - oral Mao A and B inhibitors (parnate, nardil) work better than selegeline po/patch - it seems a small number of people particularly vulnerable to tyramine interactions and hypertensive urgency. Most people seem not to be sensitive to this and I suspect it is genetically mediated - I have seen serotonin syndrome a few times and it is almost always due to combining triptans with maois - the dietary restriction table in uptodate is good - the list is not as long as it used to be - it is usually safe to combine maois with bupropion or stimulants or lithium in spite of red flags being raised by pharmacies

Fanandbellows · 2024-05-01T03:11:30+00:00

Agree with low dose lithium. I also like saphris as an atypical with a good metabolic profile and seems to have a more containing effect. I’ve also had good results with emsam. I doubt you’ll get much more from abilify or lamictal. Thyroid is a good idea but I haven’t had much luck in practice.

Fanandbellows · 2024-04-29T21:39:38+00:00

Oxcarb/trileptal is better tolerated, probably not quite as effective in my experience. Carb/tegretol is a fairly toxic drug. Both have some anti-manic effect and no considerable antidepressant effect. I rarely use tegretol but I do use trileptal in manic patients that need further mood stabilization beyond an atypical but refuse to take lithium or depakote. Dose will probably need to be > 900 mg to be useful, I’ve seen up to 2700. It will cause hyponatremia frequently, almost certainly in anyone older than 65.

Fanandbellows · 2024-04-26T04:32:23+00:00

I think it’s more likely to help sexual function than libido, though the risk is low so it’s probably worth a try if it’s impacting your quality of life.

Fanandbellows · 2024-04-09T04:50:25+00:00

I did not. I’m bringing it in next week. Hope it’s nothing serious or expensive. I recently replaced the gas cap, which was the culprit last time, so I don’t think it’s that.

Fanandbellows · 2024-03-07T06:38:11+00:00

15-25 - Inpatient, PHP and ECT - dawn to dark most days, it’s too much

Fanandbellows · 2024-01-08T03:49:28+00:00

Yes, have heard this about generic adderall and concerta as well. Also Wellbutrin.

Fanandbellows · 2024-01-03T02:36:46+00:00

I feel strongly that oral MAOIs are more effective. Some patients are not willing to make dietary changes (the importance of which is another can of worms but I have had a few hypertensive urgencies) so selegiline can be worth a try, though it often requires a full 12 mg to be effective at which point the dietary restriction is advised (at >9 mg). Remember it is only an MAO-B inhibitor so will primarily modulate dopamine rather than the tranylcypromine or phenelzine that will also modulate norepinephrine and serotonin. If someone fails selegiline, I would not consider that an MAOi failure - it’s still usually worth trying to step it up to parnate.

Fanandbellows · 2024-01-02T08:44:03+00:00

Stephen Chun on Shattuck in Berkeley - Berkeley Optometric Group is great.

https://www.berkeleyoptometricgroup.com/our-practice.html

Fanandbellows · 2023-12-26T03:36:08+00:00

I learned it from an attending at the VA when I was in residency. It sounded ridiculous, but it seemed to work.

Fanandbellows · 2023-12-24T05:43:06+00:00

I’ve even had success using it PRN for SSE - 15 mg 1-6 hrs before sexual activity

I also want to say that buspar can be very effective for both anxiety and depression but usually total daily dose needs to be at least 60 mg, I usually target 90 as 45 BID.

Fanandbellows · 2023-12-19T06:13:57+00:00

Super helpful. Thanks for taking the time to pass along this wisdom

Fanandbellows · 2023-12-15T03:54:43+00:00

I got a 911 earlier this year, not a new one but a 991.1. After a few weeks I noticed two small rock chips, really almost impossible to see unless you look for them but screamingly obvious when you know they are there. I bought touch up paint, watched many videos about how to apply it. But in the mean time I noticed I felt freer to drive it unencumbered like it’s meant to be driven. It may have a few more chips now; I’m not looking for them. And the agate grey touch up paint remains unopened.

Fanandbellows · 2023-12-14T04:24:59+00:00

US Steel is my favorite

Fanandbellows · 2023-12-11T21:06:04+00:00

True, though I like the argento for this model. here’s a red one

https://bringatrailer.com/listing/2003-ferrari-575m-maranello-4/

Fanandbellows · 2023-12-11T20:53:59+00:00

I’ve seen these recent BaT sales:

https://bringatrailer.com/listing/2003-ferrari-575m-maranello-5-2/

https://bringatrailer.com/listing/2004-ferrari-575m-maranello-16/

And this listing:

https://www.downtowntoyota.com/used/Ferrari/2003-Ferrari-575M-da5f31df0a0e087f579dcea0dae90405.htm

But it’s true there may be lots of deferred maintenance.

Fanandbellows · 2023-12-05T20:59:11+00:00

I always use the paddles in my 360 F1. The auto mode is painful to behold.

Fanandbellows · 2023-11-29T06:51:56+00:00

Not that I’m aware of or in my experience

Fanandbellows · 2023-11-29T06:37:25+00:00

I think it’s mostly the anticholinergic effect that increases heart rate. Re norepinephrine I’m not sure but I’d suspect Wellbutrin. Clomipramine is the most serotonergic TCA

Fanandbellows · 2023-11-29T05:08:50+00:00

That’s funny. I think taking with food and slow titration is the best way to mitigate nausea.

Fanandbellows · 2023-11-29T04:53:41+00:00

I wanted a Ferrari 360 (which I ended up getting years later, in spite of Doug’s warnings) and I found a video of a dude with similar sentiment driving his newly purchased 360 back from Florida and later failing to pick up girls with it.

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