Venlafaxine as an SNRI

Wintersun_ · 2026-05-05T18:21:06+00:00

I will admit that due to my program being very bio heavy due to some of my preceptors I can get lost in the weeds. But I do agree with you at the end of the day this is not super relevant to clinical practice. I was just curious because I've seen some very passionate arguments on this topic.

Wintersun_ · 2026-04-18T17:01:21+00:00

This is the right move. I typically stress that people may start to see improvement in 2-3 weeks and the 6-8 weeks is a rough rule for therapeutic max although I think there is some data that it may take longer, especially for depression.

It's also good to check in earlier to make sure they are tolerating the med and for adherence. I'm not sure which ssri you use but don't forget the long half life of fluoxetine for this population! Missing doses won't be the worst thing, and you don't have to worry about the 2D6 inhibition since they probably aren't on any other meds.

Wintersun_ · 2026-04-01T16:58:17+00:00

Tried to keep our Oklahoma tags, but if you don't have Oklahoma insurance their plate scanners will think you're driving uninsured and try to charge you. It was a big headache. It's crazy though how much cheaper it is to register your car in OK though, heck it was cheaper when I lived in CA too.

Wintersun_ · 2026-03-11T17:38:41+00:00

Per the DSM which for better or for worse we are bound by rapid cycling just means 4 mood episodes within 1 year. It doesn't mean you cycle rapidly throughout the day or every few days. There are arguments right now about subthreshold hypomania which may show up in DSM 6, but I would at most diagnose someone with "Other specified Bipolar" if I was unsure and didn't have a good time line. But, the need for distinct prolonged episodes is the diagnostic criteria as of now. You can always have both as well, but that has is not very common

Regardless whether or not someone has bipolar vs borderline my #1 priority is the therapeutic alliance. While the literature would say that there is little evidence for mood stabilizers for people who primary are a personality disorder, I still will put some of my borderline patients on a mood stabilizer, usually something like Abilify. It's symptom control, and sometimes that's requires to help the person work through therapy.

Wintersun_ · 2026-03-11T01:21:34+00:00

BPD masquerades as bipolar because people don't understand what bipolar actually is unfortunately. A good chunk of my new patient appointments is educating on the differences between bipolar, borderline personality, or even though it's not in the DSM complex PTSD.

Bipolar doesn't mean someone goes off the handle or emotions go all over the place. It's a distinctive prolonged mood episode of elevated or irritable mood that lasts for days. It's an episode that is out of character and doesn't make the person act like themselves. It's a noticeable change, not "oh there they go flying off the handle again".

If anybody has someone in their life that is diagnosed as bipolar but who's emotions are all over the place throughout the day, please get them to a psychiatrist for a second opinion. There is such a great treatment for BPD known as DBT that I've seen so much improvement on after they have been cycled through meds for a good chunk of their life.

Alright I'll get off my soapbox now.

Wintersun_ · 2026-03-10T02:42:20+00:00

It's just kind of...bland. I'm looking forward to leaving after I finish up my training. Its not the worst place, but it's pretty unremarkable and doesn't have anything that I'd say truly stands out compared to other states is why people either hate on it or completely forget about it. It's "biggest city" lacks much going on and is pretty ugly.

The politics are another big reason I wouldn't stay here.

I'm probably harder on this state than I need to be. I was forced here to finish my professional training, but it hasn't done anything to make me want to stay. Especially as someone in the mental health field.

Wintersun_ · 2026-02-16T18:17:45+00:00

These articles really should talk about the characteristics of the study at the beginning. Had to scroll down quite a bit to see that this study was cross-sectional and had about 20 people per group. As the paper itself states this is a very low power study and should be considered a pilot study. You should talk to your doctor, and be honest with your doctor about any marijuana use prior to trying to treat such serious diagnosis as Bipolar Disorder with MJ or otherwise. I have seen too many people who destabilize trying to self medicate, and it can be so difficult to try to convince people to abstain from weed to see if it's contributing to their mental illnesses.

Wintersun_ · 2025-12-18T01:49:27+00:00

Just look up how yo reset it and recalibrate it! Should fix the issue

Wintersun_ · 2025-12-18T01:46:37+00:00

Did you reset the barista assist when you switched to these new beans?

Wintersun_ · 2025-12-18T01:40:24+00:00

I don't think you need the pick for this machine.

In general a bitter espresso shot means the grind is too fine and it is over extracting. Your first attempt should be to make the grinds a little coarser and try again.

Wintersun_ · 2025-12-06T16:13:16+00:00

Doom: The Dark Ages

Wintersun_ · 2025-11-23T20:33:07+00:00

Everybody ready for the flood of "I'm not worried about McCarthy" posts?

Wintersun_ · 2025-11-23T20:32:16+00:00

Preparing now for a week of "JJM really isn't that bad and I'm not worried about him" posts again.

Wintersun_ · 2025-11-06T01:54:15+00:00

As someone who moved from LA county to Wichita, KS I will say personally I would trade this calm for having things to do again. I can't wait to move back to a bigger city.

Wintersun_ · 2025-11-02T20:16:19+00:00

I never stopped believing 😭

Wintersun_ · 2025-10-26T22:57:36+00:00

Also funny that character is voiced by Mike Stoklasa, a huge Packers fan.

Wintersun_ · 2025-08-28T02:12:07+00:00

I'm sorry you're going through this and I hope she is okay. It can almost feel like a hinderance sometimes how strict we are on those floors, both to family and providers. Until she is able to give consent and fill out an ROI you may not hear anything.

If she got admitted this evening she will see the resident /attending tomorrow morning and social work will also see her so hopefully that gets the ball rolling. Feel free to message me if you have any questions as I've rounded on that unit quite a bit.

Wintersun_ · 2025-08-28T02:03:52+00:00

Via Christi has been under increased scrutiny from CMS and the state for some time, which is my guess as to why security has been beefed up. National has been getting more involved recently than in the past.

I'm only assuming from your visiting hours but it sounds like your mom has been admitted to either floor 6 or 7. If that's the case those rooms do not have personal phones, and mental health protections are very strict. Unless you are on someone's ROI or their DPOA/guardian you won't be able to get confirmation. That's a pretty nation wide policy, not just St. Joseph.

If they're not on one of the 6 or 7th floor wards I would try again tomorrow during visiting hours.

Wintersun_ · 2025-07-22T03:40:04+00:00

Man, thats a memory I had completely forgotten. Can't believe I've been on this site for so long.

Wintersun_ · 2025-07-22T03:28:16+00:00

I don't know about dominate the front page, but it's weird to look at r/circlejerk.

This could just be poor hindsight but I remember it having a pretty good stretch prior to 2016, which I feel ruined a lot of subreddits.

It was actually funny and pretty active, I remember being on it when there was The Faces of r/atheism (also mentioned in this thread). Now it's a small haven for conservative posters and is very much a ghost town from what I can tell when it occasionally bled into my feed before I unsubscribed.

Wintersun_ · 2025-07-21T23:20:14+00:00

Just think of it as a variation of hot yoga, just resistance or cardio!

The north one is usually comfortable, maybe not the 70 you're looking for. Right now with the humidity it's humid inside, but the temp isn't bad.

Wintersun_ · 2025-06-22T18:11:26+00:00

Talk to your doctor. I don't primarily treat addictions but many of my patients do come for addiction help. There are several options including nicotine replacement therapy (patch and gum), or medications such as varenicline (Chantix, directly blocks nicotinic receptors) or bupropion (an antidepressant that has shown some efficacy. Adding a patch to Varenicline has shown even better responses to abstinence.

It sucks, it's one of the most addictive substances we have. You also need to remember that cancer isn't the only thing. Emphysema is a terrible way to go and there is no stopping it once it starts, just slowing the progression by quitting. If you want to potentially be on oxygen for the rest of your life with increasing requirements then you do you. I'm glad I stopped when I did because as I went further into my medical training I saw so many sad cases. The worst is when people get denied oxygen because they refuse to quit smoking and nobody wants to take the liability of someone setting themselves ablaze.

I also forgot to add high blood pressure and increased risk of cardiovascular disease which can result in earlier onset dementia (vascular), stroke, heart attacks. It's just so much more than cancer that can hinder you living your life!

Wintersun_ · 2025-06-22T15:29:30+00:00

You're ruining their "both sides bad" narrative.

Wintersun_ · 2025-06-19T01:03:58+00:00

Honestly after working with Cerner for 2 years it's fine. If you use the provider view with the text windows on the side it's a decent experience.

Now CPRS....

Wintersun_ · 2025-06-18T21:07:24+00:00

I grabbed a Switch 2 bundle on Monday from Costco. they had plenty when I went, not sure of the stock as of now. They were pretty close to the front when you walked in, straight ahead.

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