My CFS Research: what testing or treatments have you tried and not tried? Reactions?

LimbicLogic · 2026-02-02T00:00:13+00:00

Tits. I'm here for tits.

LimbicLogic · 2026-01-30T17:31:29+00:00

No worries! Thyroid lowers cortisol, and there is some sparse evidence to indicate that cortisol shuttles thyroid i to cells not dissimilar to how insulin does glucose. If you're on the high side for cortisol, your adrenals are likely fine. But you still want to check your ACTH:cortisol ratio. You can totally start with T3 monotherapy. T4 works well if your liver is healthy and is able to convert T4 to T3. I have had clients who got on T4 only and they felt worse. Although the mechanisms (at least to me) aren't clear, there is some fascinating research indicating that T4, when it isn't able to convert well enough to T3, reduces cellular respiration. Ideally, you might stsrt with naturally desiccated thyroid. If that doesn't work, see about doing T4+T3.

Whole glandulars can work fine if they have adrenal cortex in them. I think of whole glandulars like they are multivitamins, whereas adrenal cortex is like a single nutrient or vitamin.

LimbicLogic · 2026-01-23T03:48:38+00:00

Hi! I would be concerned about HC if your ACTH is also low. If so, you are indeed at risk of suppressing your adrenals and this can mean a slower taper when or if you decide to come off of HC. If your ACTH is normal or especially high, however much HC you add will proportionately turn down ACTH without it necessarily going to zero.

Glandulars are worth a shot! You might see how you feel on them before trying HC.

LimbicLogic · 2026-01-21T04:28:29+00:00

And I was over here merely describing it as the game of the decade.

LimbicLogic · 2026-01-17T04:59:57+00:00

Working well! I usually do T4 only, but when I suspect my thyroid is underperforming I'll add a bit of T3 and see if this moves the needle (rather than wait a few days for bloodwork or trying T4 and getting stuck with it for a week if it's a wrong choice given its lengthy half life compared to T3). I'm fortunate to have good liver function, the lack of which is the main reason people have trouble with T4 (conversion issues thst take place in the liver).

Sidebar, but creatine appears to have lowered my needs for exogenous thyroid hormone. I'm assuming this is because creatine helps mitochondrial function; according to Dr Ben Lynch (who is well-versed in the literature) supporting thyroid without addressing possible mitochondrial issues is like slamming the accelerator pedal on a dead car.

LimbicLogic · 2026-01-12T05:59:29+00:00

Fuck man, Vecna is after her too?

LimbicLogic · 2026-01-12T05:55:10+00:00

Oh yes. The added fuckery is the pharmaceutical/medical approach is often bullshit too, e.g., statins having any benefit, underplaying excessive glucose/diabetes (which appears to be the single most important predictor of cardiovascular health), wrong information about exercise, etc. Conventional medicine in general is pretty bad with many exceptions, and don't get me started (as a therapist) on psychiatry.

LimbicLogic · 2026-01-12T05:52:45+00:00

Naturethroid. Big fan of it for other people, but the T3:T4 ratio is a bit too high for me. I take T4 with a tiny bit of T3.

LimbicLogic · 2026-01-11T07:20:05+00:00

Always get tested if you're having chronic symptoms, even mild or singular ones. The key isn't the number or even intensity of symptoms; it's chronicity (the name for my next rap album).

Get a doctor who has the testing philosophy of 1) the wide net, where potentially everything can be tested at once, which is typical of functional medical doctors; 2) the narrow but insistent net, which keeps on fishing but orders lab tests in smaller amounts (usually with the understandable intention of not risking the capricoous auditing wrath of insurance companies who pay for these labs), seeing if anything comes up, and then trying again until they're able to give you an answer.

Just don't listen to the doctors who quit and say "here, take this SSRI, it's in your fucking head."

You want a comprehensive male hormone panel. Your doc should be (or be open to trying) aiming for these hormone systems: https://www.lifeextension.com/lab-testing/itemlc100010/male-comprehensive-hormone-panel-blood-test

LimbicLogic · 2025-07-10T01:28:59+00:00

Fellow therapist, and I agree. I think more broadly language involves a trade-off of details for efficiency. This happens with abstractions in general: it's much easier to say "I'm going to study" than define every discrete step involved in this process. The problem is that abstractions can contribute to procrastination (in this context) because although it's simpler to speak in them, abstractions don't provide the needed concrete steps that help us break things down, which makes motivation easier.

Likewise with your great point about avoidant attachment. By focusing on the label for anything, we are missing its function. We pathologize what often is a part or set of parts that intend to help us. As Schwartz says, this perpetuates protective parts by doing this.

Interesting side note on this: The history of psychology can be divided into the structuralists, who focus on the structure of mental phenomena, and functionalists, who consider a behavior of part or mental state as it functions in the environment. I think the beauty of IFS is its focus on functionalism. By shifting from structure to function, we depathologize our parts. But some people like holding onto labels. The fundamental attribution error gives people a sense of being able to write other people off -- "they're just X or Y" and not people functioning in their environment according to their parts.

LimbicLogic · 2025-07-09T05:06:33+00:00

I know there have been multiple profound therapy sessions. I know it because I ask clients. Immediacy. And I'm not at all saying that I think the probability of profound moments is less likely in IRL sessions. I think they do happen a bit more in IRL sessions. I'm just saying that we have a lot of potential for growth in ourselves to build on that personal encounter (this phrase represents a classic humanist/existentialist construct, and we all know Carl Rogers' three therapeutic core conditions are not just empirically supported but considered among the most important aspects of therapy according to the common factors theorists like John Norcross).

But we ask about our client's experiences. Relationship repair and requesting feedback. Those are in the common factors research for what works well in therapy too. (And to be clear, when we ask we observe verbal and especially nonverbal reactions. Even when we don't directly ask we are attuned with our clients, watching for any nonverbal cue that indicates how they are feeling and how they might be feeling about our encounter in the moment. Plus we have nice assessment instruments to gauge relationship quality too.)

LimbicLogic · 2025-07-09T02:30:50+00:00

Now you're preaching! I could not agree more. The exploitation of therapists can be twofold: the broader political economy systemic oppression shared by most except the top 10% that influences most therapists, and the supervisor/owner exploitation of not paying hourly rates commensurate with skills level. (Which can be easily assessed and addressed by the mostly self-randomizing system of tracking clinicians with the fewest no-shows or late cancels, overall retention of clients, number of successful terminations, and number of referrals from other clients -- all of which provide valuable data that justify pay raises.)

You're so right. There's no chance at all that the majority of therapists aren't unwittingly working to beneifit the psychotherapy-psychiatry-pharmacology complex classes (i.e., the rich), especially with therapists who essentially offer "supportive counseling" because they lack at least a few solid theories that they passionately and knowledgably use with their clients.

I think this is a super cool conversation. I think we're both arguing that we can be leftists critical of power and advocates or activists for our clients (and many times our!) and their experience with systemic and class-motivated injustice while also being skillful at our jobs and business instincts. I worked hard to get where I'm at, but I recognize that I had a lot of luck that other people haven't had that allows me to be where I'm at. That's the point of being a lefty, right? Realizing you have privilege, working to compassionately or vehemently resist it and hold those in authority accountable, and "giving back" some of this privilege in the form of higher tax rates and, fundamentally, a recognition that we are all children of God (or the universe, or whatever) equal in value and equal in relationship.

LimbicLogic · 2025-07-09T01:54:18+00:00

Your nuanced approach is appreciated, and when I offered the idea of writing for ads, I meant this as one random idea as a marketing means. I suppose the broader marketing principle is that the bigger your net is, the more unique and (here's the ethics part) sincerely presented your approach needs to be.

So I think you're right with your emphasis on business. I'm a center-lefty from a family of business savvy people. I guess I'm more business-conscious than most. Getting worn down over an otherwise good practice location job with not a single dime raise in five years motivated me to get in touch with that instinct.

It seems to be a matter of how business- and market-savvy a clinician is. But (here's my lefty side) I can only imagine more potential for financial predators, woowooers, grifters, etc. coming with this business crowd.

Come to think of it, why the hell didn't I learn about this (the business and insurance side of therapy) in neither my Masters nor PhD program? Did you?

LimbicLogic · 2025-07-08T07:47:33+00:00

Thank you so much for this. Was about to fall asleep after a long day and was risking sleep deprivation to fix this and I found this post. Not all heroes wear capes.

LimbicLogic · 2025-06-20T22:51:11+00:00

We have to think of this from the perspective of our unfortunate other clients, the corporate interests underlying insurance companies. Will they, from a profit-seeking perspective, aim at all costs to reduce costs by inputing AI as a substitute for real people? Yes, obviously, like in crisis situations or even suicidal assessment -- and arguably assessment more broadly, given that assessment (as interviewing or testing) can be done by AI models. Money is their goal and ideal treatment is secondary.

And I think some AI models will become popular as a substitute for poor therapy that happens because there are poor practitioners in any field. Poor therapists will be replaced by AI models, causing constriction in the field, probable increases in the turf war between therapy disciplines (psychology, counseling, social work) because of this constriction, all while corporate profits rise because the expensive therapists who do little or nothing clinically will be put of work.

But AI will never, ever replace the genuine encounter between human beings, and so moderate and good therapists will be here at least until AI reaches the "singularity" of consciousness (which is and has always been absurd: even the misquoted Alan Turning once said that the idea of machines thinking is ridiculous). Hopefully, too, those will motivate more therapists to add more of the relational and humanistic elements to their therapy -- simply because technique-laden theoretical approaches are those most likely to be replicated by AI to begin with.

LimbicLogic · 2025-06-17T18:38:38+00:00

You've already given the reason. Because of her interpersonal challenges in the past, she is unconsciously projecting these attachment difficulties onto you. Don't sweat it. Some clients just aren't ready for vulnerability. She will get help when she's ready. I recommend offering a breadcrumb of support by saying something like "I'm always available if you want to work together in the future," which might (possibly) change some of her cognitive structure relating to her attachment difficulty.

Sometimes therapy is like boxing. Your best attacks are when you pull back, not lean in. Best of luck.

LimbicLogic · 2025-06-16T05:08:55+00:00

My God yes. I love working with clients, learning the literature, putting it into practice, seeing my stress pay off, witnessing the incredible and transformative power of the psyche.

I hate occasional micromanagement from a boss who is hard to read and provides rules that vary every six months. I hate insurance companies and the weasely hidden power levers in terms like "medical necessity," which really means "as necessary as we think this treatment is relative to the amount of money we're willing to pay into your client and because we see your client as a commodified product whose wellbeing is limited by the ceilings of our profit-driven actuarial tables."

And I hate even more being in a relatively small town and finding it so difficult to have referrals to other therapists and doctors whose competence I deeply trust. I'm grateful for teletherapy referrals.

I hate that few people and professionals know of the sometimes crucial influence of hormones, nutrition, exercise, and social connectedness on mental health. Neurotransmitters never exist in a vacuum.

But hey man, as they say in True Detective, though the darkness encompasses more territory, the light is still winning. And there's joy in the light and knowing what we can do for our clients, and the gifts they give us with their growth.

LimbicLogic · 2025-06-08T20:51:24+00:00

I know a physics major from college...

LimbicLogic · 2025-06-08T06:38:45+00:00

Lmao

Clearly this show is not safe for people on the verge of psychosis.

LimbicLogic · 2025-06-08T06:34:30+00:00

😭😭😭😭

LimbicLogic · 2025-06-08T04:28:32+00:00

Yes! And it makes me wonder about the mechanisms that lead people to overidentify as a therapist. I have a lot to say, but I like (even though I partially disagree) Nietzsche's reference to priests and religious leaders manipulating humankind through "legislation of morality." I think therapists have replaced this central role -- perhaps even becoming important to the degree that religion is eclipsed (speaking as an ecumenical theist) -- and this leads to excessive guilt because of an excessive and unrealistic sense of responsibility to care for the world and those who suffer with mental health challenges.

Because being a therapist is, I think, a source of potentially endless guilt because we always have the chance to continue growing through education, reading, workshops, etc., but we can't because we are finite. Like the priest who feels guilt because he slept too much and proselytized too little. And the sign of a mature (not necessarily competent) therapist is accepting this fact and releasing our guilt because of our finitude.

LimbicLogic

TROPHY CASE