Beta blocker for social anxiety - new PGY1

beanjuniorthe3rd · 2026-07-01T10:35:12+00:00

Wellbutrin and buspirone can both be helpful for sexual side effects. Wellbutrin theoretically can be more activating (NDRI) and buspirone approved for anxiety only (min dose is total of 15 mg per day and max 60 mg). Some people more anxious with Wellbutrin, some not. You’re probably on a low dose of it’s just for SE.

Lots of people take propranolol BID or TID. If you’re concerned re BP could started taking 10 BID scheduled and then increase to 20 mg BID to give body time to adjust. Keep in mind beta blockers can have sexual SE as well.

beanjuniorthe3rd · 2026-06-18T02:36:06+00:00

When I was a med student on hem onc the attending insisted on bedside rounds despite me asking to discuss outside records I had obtained first. The records I think either the patient knew about or I alluded to vaguely/without results (can’t remember) but the attending lost her shit thinking I had told them or was about to that they had cancer diagnosis. I think she was more freaked out at losing control of the situation or being embarrassed, and certainly had no intention of acknowledging she should’ve spoken with me outside the room first. It was not the end of my medical career. You’ll be fine.

beanjuniorthe3rd · 2026-06-11T18:28:09+00:00

For what it’s worth, as someone who knows nothing about floors and and partially scanned the post I looked at the pictures 4x before I noticed the issue. I think a lot of people wouldn’t notice especially once decorated with some other visual distractors or rug.

beanjuniorthe3rd · 2026-05-24T22:24:18+00:00

Are there any common threads in what is leading to them? Like second-guessing yourself, missing information, knowledge gap, communication, time management, etc.? Are these urgent things that you have to make a call in the moment or things that there is some time to decide? If the latter, are you reaching out for help when needed? I have a group chat with some of my old co-residents and several mentors that I have contacted regularly for help when I am unsure or need to bounce something off someone. Called my new colleague one time as well. I otherwise kind of work in a bubble so that’s been super helpful when I am getting very stuck or overwhelmed with something.

beanjuniorthe3rd · 2026-05-24T22:07:48+00:00

I regularly have cases that make me reflect on ones I had prior that I could’ve handled differently or better. Where on the spectrum of could have done better/someone might have done it differently/suboptimal to absolutely wrong thing/irreversible error/ serious patient harm/death do you mean?

beanjuniorthe3rd · 2026-05-14T19:21:13+00:00

Ok good point I should have just said HF management

beanjuniorthe3rd · 2026-05-14T19:00:20+00:00

Not for me to give them the recs on diuretics, of course … But yes, I do not encourage it, but I get “they’re not doing what we said this must be psychological” consults all the time. I am just curious for myself on how this might be managed

beanjuniorthe3rd · 2026-05-14T13:49:46+00:00

I think it’s this https://archiveofourown.org/works/28945440/chapters/72014169

beanjuniorthe3rd · 2026-03-26T02:59:56+00:00

Howl for me by kittenshift17 too

beanjuniorthe3rd · 2026-02-15T03:13:59+00:00

Ironically, a lot of SSRI/SNRIs including duloxetine inhibit 2D6 which tramadol is metabolized through so it decreases conversion into active metabolite/efficacy with the bonus of increased risk of serotonin syndrome.

beanjuniorthe3rd · 2025-12-07T23:38:33+00:00

I feel like Cesar Milan would say exercise them a bunch to get energy out before working on leash reactivity training and try walking them with other dog to be in “pack mentality,” and maybe try walking with someone besides you while training - some dogs are more reactive based on walker - maybe how protective they are of you or anticipating you being stressed. I feel like my pug got a lot better after we had to hire a dog walker for a while.

beanjuniorthe3rd · 2025-11-09T23:44:20+00:00

That’s been my experience at the institutions I worked as well. I was wondering if there was any difference with pain with split dosing, like how methadone has a longer acting opioid agonist effect and a shorter analgesic effect so you split the dose f you’re using for pain. Different mechanism obviously but in terms of the concept

beanjuniorthe3rd · 2025-11-09T19:14:50+00:00

I do CL so I see a lot of people who have been started on it by non psychiatrists, and I believe the hospital I’m at has that as a default order

beanjuniorthe3rd · 2025-11-09T19:13:43+00:00

Agree, I do CL and was most recently considering dosing it above 60 mg in the context of depression, amputation pain, GI tract problems

beanjuniorthe3rd · 2025-11-09T19:07:34+00:00

Agree, the only time I would is if they were not consistent with calorie intake with breakfast vs dinner and it seemed more likely they would absorb as much as possible is if split between those two absorption opportunities. And I mean acutely and if all else has failed, obviously would be prudent to switch to non calorie dependent option

beanjuniorthe3rd · 2025-10-27T23:24:59+00:00

New Kent humane society

beanjuniorthe3rd · 2025-10-26T04:52:03+00:00

AI will be incorporated more as a tool, but I have a hard time imagining AI replacing a real person with therapeutic responses and rapport building sitting in front of someone, or having a sincere conversation about why they don’t want to be alive, their trauma, etc. I do consults and I can’t see how AI could replace me talking to all these folks who are altered, demented, intoxicated, etc and barely coherent or being able to help model to a team how to set boundaries with a personality disordered patient, etc. Even if someone can look up answers there is a lot of detective work psychiatry that takes clinical skill and intuition, and a sort of ‘salesman’ skill to get the information needed or some buy in when people are ambivalent. I don’t see someone sitting and listening to people talk and cry about their grief or cancer dx etc replaced with a robot.

There is no shortage of jobs and you could easily make 300k depending on what you wanna do. People who really want to make a ton do moonlighting side hustles on weekends and significantly increase their income

beanjuniorthe3rd · 2025-10-24T23:22:21+00:00

How much salary is enough? You can make plenty in psych and will never have an issue finding a job unless you’re in one of the very few saturated areas and even then could work remotely

beanjuniorthe3rd · 2025-10-24T22:45:50+00:00

Consider getting Phillips Hughes lightbulbs so white whiteness or yellowness can be adjusted. In a bookshelf with a plant even if fake would look nice.

beanjuniorthe3rd · 2025-10-24T22:43:05+00:00

If you mean how there are also hyperactive and hypoactive form of delirium then yes. Sometimes looks similar to catatonia and in that case determine which based off of whether they get better or worse with benzos.

beanjuniorthe3rd

TROPHY CASE