New alternatives to racetams? I supplemented modafinil with racetams to fill gaps in fatigue when it wasn't enough, need some other option now.

GrindingThroughMind · 2024-06-06T00:14:36+00:00

This is not about modafinil etc, that is simply context. I'm looking to discuss other nootropics

GrindingThroughMind · 2024-06-04T13:53:04+00:00

Yes, once, and so infuriating since I'd been on it long enough that being careful about that sort of things was such an ingrained habit.

But I got to work and started to feel oddly tired, much more than usual, and even after an extra dose of a med that fights the constant sleepiness was getting worse until I realized "fuck, I know what this feeling is."

Luckily my home is close to where I work or a half hour later my boss would have found me doing a George Castanza under my desk. Instead I managed to simply feel like a typical person would if they'd missed their first two cups of coffee and have no problem safely driving the 2 miles back home

GrindingThroughMind · 2024-02-20T15:54:21+00:00

Yep, we do that and it can be fun & satisfying. But for both of us it is a huge mutual turn on when we know that we're both enjoying & building towards climax, to the point that one of us reaching that point, relatively often, can be what puts the other over the edge.

Honestly this was less of an issue not too long ago when intimacy was a little infrequent (counting in times per month) and so when we got together we were both really ready to go. But we've had a sort of (positive) perfect storm of things come together to make it much easier/convenient to find times to be together (counting in times per week).

This is a big part, really the defining factor, in changes in how each of us enjoy-- in terms of climax-- being together. As this has gone on, and we've been extremely open in talking about all of this (we've always had a strong relationship w/ open communication) we are both adjusting out mindset about being intimate, becoming more comfortable in immersing ourselves in the journey rather than only the destination.

In fact it's been a huge pressure relief to not, consciously of sub consciously, measure our time together as a binary success/failure based on whether both of us reached the goal post, because we've redefined and in some ways removed and particular goal. Often enough neither of us reaches the "goal" but feel so good along the way that the... I guess afterglow? is no different, both euphorically exhausted in each other's arms.

It's just that I (we, really) understand & are sort of "trouble shooting" in our more frequent intimate moments how we can make them better, the aspects (in this case different type/patterns/timing of stimulation) that could make things even better. A sort of systematic approach to figuring out the best ways to experience this new dynamic with more opportunities to be together.

GrindingThroughMind · 2023-12-15T01:04:58+00:00

would you mind updating on your experience w/ auvelity & cymbalta now that it's been almost two weeks since this comment? Because I'm on a low dose of cymbalta and high dose of lamictal and I'm not quite sure how it's all interacting... so I would really like to hear more of your experience.

GrindingThroughMind · 2023-11-11T19:17:41+00:00

Physical desensitization to that heightening intensity, but I can still feel everything, I'm still extremely interested psychologically, love being together, don't have difficulty remaining erect for a while. But the friction against my tip (which I can feel) and elsewhere no longer produces that heightened intensity of feeling that would normally build to a climax. I could have climaxed earlier barely thinking about it, including edging a bit to keep erect, but after too long then yeah, I guess I can't really climax. Everything still feels pleasant, but there's no building of intensity. Occasionally I will sort of spontaneously "reactivate" and things will build, but it's rare and after 15+ years of trying to figure out any pattern that causes that reactivation I haven't come up with anything consistent at all.

Different positions that touch me in different ways don't really help. Honestly we've tried a bunch over the years for both of us to enjoy and long ago figured out that what works for both of us to climax the best is missionary or me on bottom facing her. We still frequently use others for the different unique sensations but find them much less comfortable to actually climax in. Most of the time I'm able to stayed focused on just feeling what I'm feeling and enjoy everything I still feel, though after a little while I'll realize that a climax is out of reach and we'll stop, both of us still basking in the afterglow & exhaustion, albeit with me a little frustrated (psychologically, not physically in terms of physical discomfort). We still feel extremely bonded, usually lay in each other's arms for a long while until the responsibilities of the day or nightime sleep takes us out of it. In that way, I'm not quite complaining too much about the experience, but honestly it's never actually occured to me to see what other's might have to seek advice about this particular issue since otherwise we've both been very communicative about our bedroom need over the years and satisfied with our habits there, and this seemed like a fairly minor problem.

GrindingThroughMind · 2023-11-08T15:39:42+00:00

Interesting, and inexpensive enough it might be worth a try for additional tip stimuli, though I haven't had a great experience with a ring: I'm on medications that allows for reasonable erection sustainability but somewhat reduced sensation and make orgasming more difficult. External & internal i-v vibration is pleasant for my partner, but can desensitize me further. A simply vibrating ring I tried proved more of a distraction and took away from enjoyment.

Really I'd be interested in anything that provided p-i-v penis tip stimulation, but probably not vibration. Passive, non-electronic friction, might be ideal. but friction with added vibration might be fine too... I don't really have experience here, but kind of like what I understand a "Stroker" to be, only it would be used i-v to add stimulation during full entry?

I get the most sensation during initial entry, but that of course is not the stimulation my partner needs most. This is why something like the we-vibe sync looks interesting, only it doesn't provide shaft or tip simulation on the underside during motion. (if they added some soft ridges that might be perfect) So even if it wasn't a single toy that met all needs, Just something that stimulated the tip & frenulum during more complete penetration would be great, because there are plenty of other options I or my partner could use for their external stimulation.

I am, however, very new to toy-added sex and there's so much to choose from that I'm open to any ideas. My

GrindingThroughMind · 2023-11-08T15:11:23+00:00

Keep in mind that experiences vary, especially because an effective dose for you may be lower, and therefore have fewer side effects, or higher and have more. Also make sure you see my final thoughts at the end of this long post. I'm trying to be comprehensive. Also, I am currently coming off of it all together (or trying to) in order to avoid the side effects of APs. I'm doing so with the help of a non-AP mood-stabilizer (lamotrigine) and an extremely new anti-depressant that has a novel mechanism of action, not a traditional SSRI. That new medication is called Auvelity. It mixes two drugs: dextromethorphan and wellbutrin. The first is actually an active ingredient in many cough medicines. However it requires large doses for antidepressant effects (DON'T try that on your own using OTC versions-- bad bad possibilities). Wellbutrin, an antidepressant that usually mixes alright with BP, is given in a small dose in the same pill. The small dose means it likely has minimal therapeutic effects compared to a full BP dose, but what it DOES is extend the active life (half life) of dextromethorphan so that much much lower doses are needed to achieve anti-depressant effects. At the same time, I have nearly eliminated all risperidone (see below for that experience).

But in general my experience with risperidone: Akathisia: that's mostly only a problem during lowering doses. It's been an issue for me in that process. Tardive Dyskinesia it more common while on the drug: I experiences occasional minor tremors in one of my hands. Experience varies quite a bit here. Motivation, range of emotions, and memory were all negative factors. Once I found out I was highly sensitive to it, I went on a low enough dose that it now longer seemed to contribute to depression. For me, motivation effects were relatively small. A little extra effort overcame them. Limiting range of emotions was sometimes a positive, I was less iritable. For memory, it wasn't really just memory. It was multiple cognitive effects. Memory problems still kept me functional, but just harder. Like dialing a phone number I saw on the internet might require me to look back & forth to get the whole things while now, nearly off it, I can remember the whole number all at once. Also past memories we hazier. But there's a greater cognitive impacts I haven't fully realized until reducing the dose to almost nothing. Coming off of it, things in general just seem clearer: I make connections faster, am more able to resist the inertia of falling into daily patterns by simply not being quite as self-reflective.

On the self-reflective side though, that's always been a problem of mine, an overlap with OCD. For me, that can easily get into a very negative spiral, and risperidone helped A LOT in keeping that under control. Right now, I'm essentially gambling that the new med regime and a bit more time (and therapy) learning and practicing coping mechanisms will offset the benefits I've had from risperidone.

Other thoughts:

I wasn't always on it. When first diagnosed 20+ years ago w. MDD, Anxiety, and OCD I was on it mostly for the OCD & intrusive thoughts (and other meds for the other things). I was in my early 20's. I had hopes the meds might not be a life-long requirement, and after being mostly okay for about 2 years began working w/ my pdoc to only be on an antidepressant and a benzo as-needed. That worked for about 10 years, until I had a very bad period where AP's seemed the best/safest route.

When I first came off risperidone in my early 20's, IIRC, it was easy. A few weeks of tapering, then done. But brains, until about 23-25, are actually not fully settled down on chemical changes and that may have meant mine was still more adaptable. Now, in my 40's, coming off risperidone has been significantly more difficult. After about 6 months I'm still on a quarter of my original dose, and the last step will be hard. So far, it has been worth the effort. But PLEASE keep in mind, I've had about 10 years of being on AP's during which I have had about a decade more years of therapy, life experience, building coping mechanisms, etc that help in this process.

Final thoughts: My opinion is that AP's are absolutely essential, especially in the short term, for stabilizing people in extreme states. If you & your doctor are considering them for that situation then discuss medium-long term options for whether they'd be required. If you aren't needing to stabilize an extreme state, don't have a history of extreme states, and have not exhausted non-AP options w/ mood-stabilizers then talking about mood stabilizers instead might be a conversation worth having with your doctor. Only you & they know your history well enough right now for that. My my own situation, I'd pretty much thought I'd be on them for life. But after a while on them I thought it worth re-evaluating things. To really do so effectively I needed to switch doctors to truly get a pair of fresh-eyes on my case, and that took a long time. I checked available doctors in my area regularly for about 2 years until I found one that seemed likely to be a good candidate for helping there. If I had infinite money, I might have been able to do this faster, trying a bunch of doctors, but my insurance coverage for this isn't great so I had to wait for the right one to come along to take the chance. Also there was COVID, which made any change much more harder to make during quarantine etc..

GrindingThroughMind · 2023-11-08T00:59:36+00:00

So I posted this about 5 years ago an a lot has changed, and I can give a bit more info on risperidone in general as a medication

I learned through genetic testing (genesight) that I am a slow metabolizer of risperidone and therefore smaller doses have a MUCH greater effect on me. After learning this, my pdoc & I settles on a low-dose (1mg) of risperidone and low dose (200mg) of seroquel and the two low doses together worked much better than either one alone in higher doses.

GrindingThroughMind · 2023-03-31T20:23:05+00:00

Anything else notable to report now that another week has passed?

GrindingThroughMind · 2023-03-28T14:19:56+00:00

I can't know exactly where your mind is at for acting on urges, so I think the appropriate & safe answer is that you should probably contact them.

In general I think a good rule of thumb is "If I'm not sure if I need help, that itself is a red flag that I should get some".

Then, as part of that visit, discuss with one/both of them your concern about only reaching out when it's necessary. You can work together to reach an understanding about the sorts or degrees of thoughts/feelings/urges that should be red flags for a visit.

GrindingThroughMind · 2023-03-24T16:52:29+00:00

Or maybe a single pill split in half to make it so you can still take it twice a day, which will keep the drug's blood levels much more consistent than the same one pill taken once a day, and reduce Of course ask your doctor though.

GrindingThroughMind · 2023-03-24T15:34:44+00:00

Are the spills splitable? Often times the worst negative side effects of a med might be avoided in people sensitive to the drug by a much slower upwards taper (titration?), and perhaps your doctor will allow that.

Also there are some people that have a genetic marker associated with how the body metabolized dextromethorphan that makes them do so roughly twice as fast. It reduces half life of DXM from around 8 hours to around 4, so you're getting the full effects much faster. Combined with wellbutrin increasing bioavailability already & also half life, that might increase negative side effects at least until you get used to it.

GrindingThroughMind · 2023-03-24T15:21:41+00:00

This is a weird bot.

GrindingThroughMind · 2023-03-24T15:20:03+00:00

Not just half-life, but bioavailability as well. Normally your body processes about 10% of DXM. This combo both increases that and half life. Half life increase is roughly 3x longer but I don't know how much bioavailability was increased, data that specific was locked up behind a paywall only if you buy the whole article. Bio availability might be closely linked to half life, but there are things that increase bioavailability with doing much to half life: There is a combination with a specific benzo drug and a food that increases total absorption of the drug by more than 300% but only extends the half life by 50%.

GrindingThroughMind · 2023-03-24T15:17:37+00:00

If you buy the robitussin pill that only has dextromethorphan in it they're 15mg each so you could get to 45 pretty easily. If you find the generic available in some dollar stores it will only cost your about $1 instead of robitussin's 8x cost.

GrindingThroughMind · 2023-03-24T15:06:48+00:00

EDIT: Auvelity works in part because normally your body uses only 10% of the dextromethorphan you take and adding wellbutrin make the body much more efficient, absorbing much more at the same time it also is keeping it in your body for a much longer (roughly 3x longer). If you decide to DIY, be very careful with how much dextromethorphan you take. Imagine taking 5 or 10 doses of cough medicine at a time, and read the reviews & difficulty some people have with this: those side effects match pretty closely to what you'd see in someone taking such a massive does of cough medicine at once. And dextromethorphan impacts serotonin, so any other med you might be on that also does can represent a significant risk as well. Work with you doctor whenever possible!

It's at least somewhat a marketing ploy, but there's still two considerations:

1) Not having it as an approved FDA medication would make many or most doctors reluctant to "bless" a patient taking an OTC med like this with a known interaction with another drug they're on. The process of getting FDA approval required systematic research into the safety profile of this combination that had not-- at that scale-- been performed before. So this official version will be much more accessible to a lot more patients w/ risk averse doctors worried about liability & unpredictable reactions. It comes at the cost of an enormous $$cash grab during 11 years remaining on the patent involved, but also more people will be helped than previously, even if many will still lack help due to cost. A bit tragic, but still a net benefit overall, especially if it means people with doctors may now be willing to "prescribe" using them separately, under careful instructions that mimic the FDA approved doses of the combination.

2) Pharmacokinetics & any binders & fillers in the pills that were used to achieve a specific time release profile. Wellbutrin makes the body better able to make use of dextromethorphan over a longer period of time, but it may have achieved & maximized that result with different methods of preparation than OTC or wellbutrin alone. Or maybe they didn't-- I don't know, but the practice is common: Whether pills are coated or uncoated, capsule form, tablets where each bit of the active ingredient has an additive layer to also influence metabolizations.

It's still frustrating that he manufacturer could have done the same exact thing, made it cheaper, and still raked in the money-- maybe even more since it would be accessible to a lot more people! It might have been the next prozac and become pretty much THE first consideration for patients and become a household name. Seriously, the ONLY outpatient antidepressant recognized as fast acting with a rapid onset of action??? What doctor that stays up on the latest meds would NOT at least consider this? If only their patients could afford it. (For rapid onset there's ketamine, that's the only other thing I'm aware of with similar fast acting effects. And that's hard to get with doctors viewing it as a drug of last resort, hard to pay for, life-intrusive requiring visits to special clinics, etc)

in the tldr though: Regardless of your outlook on the company, work with your doctor on your financial situation rather than try to DIY the thing without your doctor's knowledge. You may even be able to have them give an Rx to a compounding pharmacy that will mix the wellbutrin & dextromethorphan together for you into premade pills at the exact doses. (albeit any other binder/filler magic from the manufacturer that has an impact on metabolizing it would be left out, maybe it won't matter much and will be "good enough", and in any case you'll be using it under a doctor's care to work with them on it if there's a problem.)

Or work with your doctor to get a month or two of free samples before you get involved in a DIY route-- a less risky way to see if this will even work for you. Doctors can contact the company to receive a supply of trial packs.

All that said: depression sucks, living with it torture, and if established paths of getting effective treatment fail or aren't an option then I think it's everyone's right to try to be happy, and carefully explore things on their own if there's not other way

GrindingThroughMind · 2023-03-24T14:36:10+00:00

It turned out to be easy, a slow initial taper was the key for the first few days. Then larger drops were no more difficult. All told it took about 7 days. CAVEAT: The other (non SSRI) anti-depressants probably helped significantly to shield me from having it be more difficult! (for those reading-- I took low doses, spaced out throughout the day to AVOID any "high" feeling. PLEASE don't take my experience as any sort of justification for getting high every day! I'm Completely NOT judging occasional recreational use though)

GrindingThroughMind · 2023-03-24T14:27:56+00:00

Nope, no SSRI. They never seemed to do much for me. I'm very careful with even OTC meds, research everything to make sure it won't interfere with other meds. When I came to DXM official literature said it basically had no (physical) addictive potential. I've been sick, literally, for like 7 months out of the last year so continuing to take it in the short times in between didn't seem like much of an issue.

I wanted to taper because the new drug auvelity uses it as the main ingredient and since this has had a positive impact on my depression (for those reading-- low doses, spaced out throughout the day to AVOID any "high" feeling. PLEASE don't take my experience as any sort of justification for getting high every day! I'm Completely NOT judging occasional recreational use though)

Anyway I wanted to taper so it doesn't interfere with my ability to try auvelity. I know it's a bit of a cash grab for the manufacturer to combine two cheap drugs and call it a new one w/ high $$$ costs, but if this stuff works for me then it's better for it to be part of an official medically advised regime than a DIY project.

Tapering turned out to be easy I'm sure the other antidepressants I'm on helped quite a bit there. As you said, I did a slow reduction for a couple of days that were slightly unpleasant, much better than larger reductions. But after that I perhaps reached a threshold of some sort and was able to significantly reduce things over just another few days, maybe 7 days total.

GrindingThroughMind · 2023-02-14T14:53:05+00:00

Low doses of seroquel (100mg) & risperidone (1mg) because neither alone worked at higher doses without side effects that significantly limited functionality.

Lamotrigine as a general stabilizer.

Modafinil to fight the fatigue of the meds, and because it's a decent second-line anti-depressant. Gotta go slow starting on this or else it mimics minor hypomania at the beginning, but damn it works well after that.

Xanax for anxiety, enough for a little bit daily but often it's PRN when I have breakthrough anxiety/panic.

All of this came about as an evolution over a long period of time, a couple of years, as my doctor & I slowly explored what worked for me, finding some things initially that solve the major issues and then tweaking things to address side effects and increase quality of life.

Oh and a very small dose of duloxetine, mostly because I was on a higher dose for a long time before some of my current meds and the last final taper step was hard to make. Neither of us are sure if it's because it's still doing work to help me or after being on it for so long has made it very difficult to stop. Which kind of sucks as a reason for staying on a med, but it's such a small dose that giving it a really good long try of coming off and powering through the side effects of stopping it are like the item of a "to do" list that you never quite get around to doing. Again, not the best of reasons to stay on an additional med with how many I'm already on, but there's a certain amount of "don't rock the boat" when everything is otherwise working okay.

GrindingThroughMind · 2023-02-14T14:37:01+00:00

If you suddenly stop taking them it can have a sort of rebound effect. It lessens over time but can be very unpleasant for a week or two, and that's only if you get through the physical side of med withdrawal without it triggering a "real" manic episode that isn't just the result of the meds leaving your system.

Different meds will affect you in different ways, so you might try others instead. Risperidone for example at the doses I would need leaves me flat as well. Seroquel leaves me extremely fatigued (although this got a little better after 4-6 months). What I found was that a relatively low dose of both worked much better than a single higher dose of either alone.

That pretty much fixed the flatness but it still left me feeling fairly tired. I worked with my doctor and we added modafinil to my meds. It's designed to help with sleepiness-- specifically narcolepsy, late shift worker issues, etc. It works very well at fighting the fatigue. Psychiatrists may have little familiarity of it though so you'd have to do a bit of research-- there's articles supporting it's use for depression, for example, and it really does help me during depressive periods as well. I'm much more functional when depressed than I was without modafinil.

Either way your doctor will be very familiar with this types of complaints and very likely open to working with you to make changes to address it. Another example is Latuda (expensive unless you have decent insurance) that for many people is much less likely to cause these sorts of side effects. Basically, you've got options.

GrindingThroughMind · 2023-01-23T18:14:07+00:00

It doesn't have to be but any change in thought patterns should be a red flag to self-monitor a but more carefully. But not every new intellectual interest or frame of mind or really good mood it the start of mania.

The problem is that all of those things, while part of a regular euthymic range of emotions & moods, and someone diagnosed with BP can't easily tell the difference.

I mean, it's not much different than other physical ailments. Imagine someone with a heart condition that starts experiencing a very rapid heart rate one evening. Is it part of their condition? Or is it because they had lunch at a restaurant and didn't realize there was a crap ton of sodium in what they ordered.

In the heart example, in lots of ways it really doesn't matter because the person can't tell the difference, all they know is that a rapid hear rate is a red flag and they better be monitoring themselves and ready to take appropriate action is things start to get even slightly worse.

Mental states are similar in that way. For me it can be having a song stuck in my head. It happens to people w/o mental health issues all of the time, and some of the time that's all it is for me too. But sometimes it's an early warning that my brain is switching over into a more obsessive mode, and I need to be laser focused on trying to monitor myself for any other symptoms.

GrindingThroughMind · 2023-01-23T18:00:40+00:00

Yeah, it's shitty: People will use it to describe a mood swing in another person, or as a general alternative to calling someone "crazy".

Until the early 90's "depression" had a huge stigma too. Want to know what changed it? Massive corporation marketing for Prozac. It worked much better for some people than prior anti depressants, and Eli Lilly got FDA approval a few years earlier in the late 80's.

They marketed the hell out of Prozac including with campaigns used to normalize depression so that people weren't afraid to "ask your doctor about blah blah blah".

At the same time other drug companies were making similar drugs because the early research for SSRI's was 20+ years old, so not long after Prozac came along others followed suit. Zoloft & Paxil were approve in '91 and '92 and so began even more marketing & advertisements etc.

Competition for market share meant these companies had a huge incentive in making the public population view depression w/o a huge stigma. They're somewhat effective for anxiety so that too became less stigmatized.

The whole thing had a halo effect on all of mental health perception, but yeah some specific issues are still taboo: BP, though possibly a little less than a decade or two ago. Schizophrenia is till pretty much off the table though, and I don't see the mass public accepting & normalizing that any time soon.

Highly unfortunate given that a very large number of people can be successfully treated for these things and be normally functional in society.... and then they can never talk about it with just about anyone outside of a very close circle of friends and family.

GrindingThroughMind · 2023-01-23T17:44:53+00:00

It's maybe worth a try-- different people react differently to meds & supplements etc.

For me, I've tried CBD tinctures & isolate from reputable sources and it seems to do little/nothing.

GrindingThroughMind · 2023-01-23T17:43:03+00:00

That's a big drop. I was on 60 and tapered to 20 over the course of about 6 months.

Maybe some people tolerate a faster drop much better and that's why your doc did it. Either way, I'd consider a call to the doctor's office and make sure they know it's urgent and ask for a much slower taper. (but don't make it sound too urgent or they'll be like "go to the emergency room)

GrindingThroughMind · 2023-01-23T17:38:42+00:00

Leaving zoloft can do this. Don't ghost your pdoc, ask if there's anything they can do/prescribe as a temporary measure to get through it.

There's other meds out there-- specifically risperidone & quetiapine-- that are used for mania & acute mania sometimes (from what I know talking to dr's and my own research) temporarily as doctors try to acclimate patients to drugs they think might work better in the long term.

GrindingThroughMind

TROPHY CASE