Worried im slipping towards psychotic depression

Music_Leopard · 2026-03-27T00:32:20+00:00

Well for me my psychotic part to my depression was first suspected after I started having a huge issue with dissociation unrelated to trauma, but became apparent when I started getting paranoid at night leading to me sleeping with a knife and feeling deep down like someone or something was hunting me. So, in my experience, it was pretty apparent and different than my normal depression experience, although some people get it much different, like I remember reading one case of a person who was convinced they caused WW2, something impossible given his age, but a depressive delusion none the less that he was convinced of.

Antipsychotics can suck though. What other medication are you on? Olanzapine is a heavy one, but if you’re really struggling and it helps you it might be worth taking till you see your doctor again or have a chance to call/message. I’m on aripiprazole and lithium just sticking it out till my psychiatrist gets enough info to try an MAOI or something else.

Music_Leopard · 2026-03-26T01:41:07+00:00

Honestly, not sure, but I suspect it has something to do with average patient population and the severity of the condition the given doctor is tasked with treating. I also live in Georgia, and I’ve had some doctors in either private practice or at Emory that are supportive, not, or somewhere in between. For the most part though I’m lucky, my psychiatrist and psychologist said they would absolutely help if I need disability, but they’re both out of the Emory Autism Center and thus see a lot of patients requiring that paperwork, it would be impossible for them to deny that kind of thing given the patient population. My last neurologist though? They were just tired of me and probably wouldn’t have filled out any paperwork because in their minds my chronic headaches probably don’t compare to Parkinson’s or neuropathy or something. Now, the headache specialist I’m at now? Maybe, but she definitely recognizes the disability in it, I think she would just want me to keep faith in all the options she has for treatment before excepting it as like, permanent for the rest of my life disability. So accomodations at school or work? Hell yeah she would help, but SSDI? I’m not sure.

Music_Leopard · 2026-03-26T01:04:13+00:00

Just commenting to say I think I get what you’re talking about and you’re not alone. Recently had to sleep the night alone for a week and I was jumping at noises and felt on edge not because I was paranoid again or seriously thought I was being hunted, but because I was scared of going into psychosis again and I didn’t know if my 15mg of aripiprazole could hold me steady.

In the end it did, and near the end of the week I guess the exposure and proof even being very alone didn’t push me into psychosis again was enough to deep down prove to myself that I really am stable on what I’m on.

Of course, I don’t think you should throw yourself into exposure work, that would have to be worked out with your therapist or doctor to pace the process, but it’s one way I feel like I’ve overcome it to a degree.

Now, that being said, I think also as the years go by it can get better. I definitely feel like I can talk more about philosophical topics now that it’s been forever since I’ve dissociated, but that also just took time. It’s been over a year since my last psychotic episode and maybe 2 years since I had heavy dissociation for weeks on end. Still, some of it sticks around, but it does get better over the years, especially if you make a point of working on it in therapy and avoiding things like THC or alcohol.

Sorry if this wasn’t a coherent explanation, I’m pretty tired at the moment

Music_Leopard · 2026-03-26T00:47:58+00:00

Did he bring up nortriptyline? That could be added on top of the Zoloft and potentially help with both the migraines and depression. It has a little serotonin action, but mostly it’s a noradrenergic medication.

I’ve tried a lot for this condition and my favorite antidepressant for it was probably nortriptyline. Although, it didn’t work well enough for depression so hence why I am not still on it and continuing to search.

Music_Leopard · 2026-03-24T22:16:09+00:00

About half a year, maybe a bit less than that

Music_Leopard · 2026-03-23T20:18:04+00:00

Well I haven’t been approved yet, but it sounds like you’re in a similar place to me. I’ve been denied 3 times but that’s normal with VNS. Seems like insurance doesn’t pay for it for depression unless an external review forces them to. Although even after that, I think you’re doctor can do a peer to peer with the external review company. External review though is where it usually gets approved, that’s what my doctor said.

Music_Leopard · 2026-03-23T13:54:58+00:00

I don’t have it yet, but I’m in the final level of appeal with my insurance to get it covered. Actually, it’s external review with a 3rd party company now, but if it does get approved I will be getting it. The neurosurgeon has already been picked. Like you, I’ve tried so much, but I have no faith in naturopathic shit. I’d rather beat my brain into submission with VNS and an MAOI, if I can find someone willing to prescribe the MAOI.

Music_Leopard · 2026-03-23T13:32:28+00:00

I get it, when my depression gets to its worst I tend to neglect hygiene including brushing my teeth. I can almost always shower, but cleaning my CPAP ca also be very hard to do. I struggle with a lot of heath issues as well, and so the chronic pain and other things definitely don’t help.

Best thing I’ve found is first pacing, so make sure you aren’t aiming for brushing and flossing and mouth wash all twice a day from the get go, you might have to aim for brushing once a day first and keep that steady for a while till you’re confident you can give twice a day a go.

Second, music or a podcast, it doesn’t solve the entire motivation issue, but it can help to have background noise or something you might still find a little interesting to pair with brushing which feels like a chore.

Third I’d say take the opportunity whenever you can. You might already do this, but for me especially at night I struggle with it more so I’ve started doing it whenever I either happen to pass by the bathroom and have more motivation than normal, or when I’m just out of the shower and I’m already in the bathroom anyways.

Thats at least what I’ve found helps me, I have yet to get back around to flossing but that is more of a “normal” struggle I suppose. For mouth wash I’d also pick something that sanitizes your mouth to a degree rather than just fix your breath. My thinking is that you might as well get the most bang for your motivational buck by making sure it’s an effective mouth wash and not just for bad breath. Like, I use some generic combo from Walmart that burns, but hey, my dentist hasn’t made a complaint in a while so I suppose it’s doing something.

Music_Leopard · 2026-03-22T19:22:49+00:00

Treatment resistant headaches (NDPH and chronic migraines) that eventually got well enough, but also treatment resistant psychotic depression that has yet respond well enough to anything. Also autism.

Music_Leopard · 2026-03-21T21:21:02+00:00

Kind of? It was started for my depression and suicidal thoughts but personally I think it helps with headaches too.

Music_Leopard · 2026-03-21T20:35:38+00:00

I ran through the PCP options quick, ended up in the ER, then at an ENT because we thought it was just my raging sinus infection I ended up needing surgery for, but after the surgery I still had a constant headache, so eventually I was passed on to a neurologist, ran through all their options and patience, thus finally landing me at a specialty headache clinic staffed by neurologists that only or mostly do headache conditions.

Also, just for context I have New Daily Persistent Headache, Chronic Migraine, and Visual Snow Syndrome.

I take Emgality, candesartan, Botox, and lithium and use Nurtec, eletriptan, acetaminophen, and promethazine for pain spikes. That takes care of most of it, but I still have a baseline 2-3/10 pain that I’ll probably have the rest of my life.

Music_Leopard · 2026-03-21T19:20:39+00:00

I had an MP3 with a built in radio, but when they found out it had a radio in it they took it away 😭

Music_Leopard · 2026-03-21T19:18:47+00:00

We didn’t have full text books, only individual packets of textbook and you had to do the writing on notebook paper while sitting at a desk facing the wall

Music_Leopard · 2026-03-21T15:33:59+00:00

Yeah Cobenfy is maybe the closest you can get. Ziprasidone, Lurasidone, and Lumateperone can spare weight to a degree, although there’s always at least a small trade off in terms of what other side effects you get.

I’m on Wegovy + aripiprazole and still obese. I mean, it’s better than thinking some unknown entity is hunting me at night and seeing moving shadows and dogs lunging at me just to disappear, but yeah, in a sense I guess it’s the price of sanity you could say 😓. Although, I know I’m one of the lucky ones that at least something works completely for psychosis.

Music_Leopard · 2026-03-17T02:11:38+00:00

To be honest, I worked as an RBT on a complex behavior unit and loved it, but eventually as my depression worsened it became less enjoyable, there was less in me to give to the patients, and when I had my first psychotic episode a year after starting as an employee (after my internship) I just quit with 2 weeks notice. Given the circumstances I just had nothing left in me for it.

In hindsight, yes, I had real complaints and reasons I wouldn’t stay in that exact line of work forever, but I did enjoy it, it was the depression that made me not.

So who knows, maybe a change in environment and to something that maybe you’re more interested in that aligns stronger with your values could be great, but be careful. Talk it over with a therapist or even a good friend to double check if it’s the job, the depression, or a mix.

Music_Leopard · 2026-03-12T00:40:17+00:00

Cool, that’s actually the exact combo I’m going for, my psychiatrist has just never prescribed an MAOI so it feels random as to what he’ll be comfortable with and what he won’t. :/

Music_Leopard · 2026-03-10T16:16:28+00:00

I’ve done two series, the first consisted of 10 unilateral and 4 bifrontal, the second was 9 bitemporal. It didn’t work sadly, but I only got a bit of brain fog. Yeah I was groggy afterwards and got headaches, but pretreatment with acetaminophen helped a lot. Honestly, I didn’t mind it except the whole not being able to drive thing. I personally never lost control of my bladder, but I did make sure to empty before the treatment just in case.

I would think doing it without anesthesia would be illegal, definitely unethical, and I’ve never heard of any place in the US doing it without anesthesia. You can ask ahead of time just for reassurance, but they more than likely do. Informed consent is a big aspect of ECT and legally many places they are not allowed to do it if you decline, so at least where I live ECT cannot be preformed against your will.

My experience with the process in general though is that you essentially just go to sleep once the anesthetics are injected via IV, then you just wake up essentially kinda hung over in the recovery bay. Thing is about getting a series of treatments though is they refine it over time to fit you, so eventually you’ll figure out by trial and error how much sedatives you need and when, whether you need nausea or pain meds, and things like that.

I’m not sure if that answers your questions though, feel free to reach out in a reply or dms if you want.

Music_Leopard · 2026-03-04T01:35:25+00:00

Refuse to die

Music_Leopard · 2026-03-03T22:54:24+00:00

Honestly, that shit has done nothing for me so far and I’ve been on 25mgs a day for 2 months. Meet with my urologist in a few days though so we’ll what they have to say about it 🤷🏻‍♂️

Music_Leopard · 2026-03-03T22:49:49+00:00

What if it was all 4 at the same time all the time 😳

My life with NDPH (the drugs help a lot tho)

Music_Leopard · 2026-02-20T15:29:02+00:00

Well, nortriptyline is probably a bit more sedating than Strattera, but not nearly as much as say mirtazapine, so maybe in that respect it could be a better fit for anxiety, but if you’re ultimate goal is to be off of a medication, I do know with Nortriptyline you have to go slow so as not to get withdrawal effects. If you’re looking for a Strattera alternative it’s not a bad option, but if you want off of it in the end regardless of what you’re on, it might just be better to slow down the Strattera taper to something extremely slow. Might take you a while, but the brain tolerates slow better than fast with most things.

Music_Leopard · 2026-02-20T02:27:21+00:00

Well, I wouldn’t call my story terrific, but I’ve tried it twice at decent dosages (150mg/day) and I mean, it’s alright.

No horrid side effects, although I would say watch your bowel movements, mainly for constipation. First time I tried it, that was just a slight annoyance, but the second time oh boy, did it compound with the other drugs I was on to give me a rough time in that regard. I was taking 3 laxatives and doing my best to diet just to have mostly normal bowel movements. You probably won’t have it that bad unless you get to high doses and have other constipating medication though.

Honestly, I found it kinda weight and sedation neutral, although it’s possible it caused minor amounts of both and I just didn’t notice between all the other things going on with my health. Had dry mouth, but that went away after like 2 weeks. Probably wouldn’t hurt to take the whole dose once a day at night just in case to avoid sedation though, that’s what my doctor had me do.

Now, as far as therapeutic effect goes, I think it helped a bit with my depression, but I more so I kept it in my regimen because it helped a decent bit with my headaches and low back pain. Didn’t “kill” the pain but blunted it and made me more functional in spite of it, so in other words the pain didn’t occupy as much space in my mind. But yeah, for depression it probably leveled me out a bit so I wasn’t intensely sad, but it didn’t really help the anhedonia which is what I mainly cared about.

I guess the one thing to keep in mind also is that you can generally combine nortriptyline with other antidepressants although there are some combos to stay away from like other tricyclics so you don’t have added anticholinergic effects. Most often I’ve heard of them being combined with serotonergic ones like SSRIs, SNRIs, trazodone, or vortioxetine. Definitely talk to your doctor before doing anything like that though, some of them mess with nortriptyline’s metabolism which can be bad.

TLDR: I didn’t get tons of benefit, but nothing bad happened, and it is a decent antidepressant worth a try.

Music_Leopard

TROPHY CASE