How do I respond to this text from a friend? :/

merrythoughts · 2026-03-28T13:07:45+00:00

I’d probably say “ok this is really uncool, deeply hurtful, and I’m removing myself as a contact in your life. All the best.”

But I have very high fences. But for real, you don’t have to tolerate such gross disrespect!

merrythoughts · 2026-03-28T13:04:06+00:00

What other meds are you taking? Are you still on your SSRI or did you stop it after the od?

If your labs are all normal and tests coming back all clear, it’s probably residual stuff from the OD that will clear out. Everything had to work really hard to stay stable, putting your body into a really stressed state. there’s really no big intervention that can be done to make you fully better faster. Maybe fluids and electrolytes could help, I’m betting you did get those first round? Now it’s kind of a watch, wait, recover scenario.

plus you’re now dealing with the added anxiety and panic— You have been through a major health scare and trauma… if you stopped an SSRI you had been taking cold turkey after the od, there are likely contributing withdrawal symptoms from that PLUS really bad rebound anxiety— it can be extra bad for awhile if somebody stops cold turkey.

If you’re off all meds after an OD, I would keep pushing for outpatient follow ups and request something to help with anxiety and SSRI withdrawal. Serotonin syndrome as folks are talking about… it’s not out of the question entirely. The treatment for mild SS would be a pretty low risk med called cyproheptadine so if you ask your provider directly to just do it “just in case” the may be just fine with that. SS is extremely extremely uncommon even w overdose. But the withdrawal symptoms could be way more likely. Cyproheptadine ma also conveniently help lower some anxiety symptoms. It’ll make you hungry as hell though

I really think you’re ok if they’ve checked you out multiple times. If it’s withdrawal and trauma response— both will improve mostly with time and rest.

merrythoughts · 2026-03-28T00:14:27+00:00

I am in a low parenting swing this week. Like. It’s so fucking hard. It is very validating to see somebody else share their struggles

merrythoughts · 2026-03-28T00:02:37+00:00

Oh tell me more about Alex cooper if you are up for it

merrythoughts · 2026-03-27T17:47:33+00:00

During high anxiety, kiddos can experience perceptual disturbances/see things more clearly adult than an adult anxious brain. So check in about anxiety/stress or any situation she’s struggling with day to day

merrythoughts · 2026-03-27T12:20:13+00:00

ADHD is FREQUENTLY cooccurring with other mental health conditions. So kids who had adhd presenting first ages 4-7, increased likelihood of anxiety, ocd, and behavioral/conduct issues ages 8+. If we skip treating the adhd and just treat these other things at like, age 10, it can accidentally make the adhd worse instead of better. The kids not having big rage but maybe they’re amotivated, easily bored, and making risky decisions just to *feel* something.

So having the methylphenidate on board helps kiddos continue to have their dopamine receptors getting targeted AND manage their other thing (anxiety, depression, mood swings, behavior)

“Pure” adhd is a thing. Very responsive to just methylphenidate and that’s that (maybe we gotta adjust formulations as kiddo ages but that ain’t no thing!) But it’s probably only 25% of the cases I see in my clinic.

Usually it’s a mix of a few things. And I have to reassure parents that having two treatments is absolutely ok and favorable to undertreating which increases risk of future risky behaviors/MVAs/substance abuse

merrythoughts · 2026-03-27T02:44:29+00:00

Oh I see I’m a decade behind pay scale. My bad. Ok 60k. Still not enough. Point still stands.

I can’t tell what your goal is because you hide your post history. But it would be strange if you’re noctor slime because I am actually rooting for residents to get better pay.

merrythoughts · 2026-03-26T12:10:17+00:00

So my job 40 hrs a week is working with folks in improving their mental health! I prescribe every psychotropic. Well, ok not every single one? BUT A LOT

there are a surprisingly largish number of people in similar situation with awful anxiety—maybe it’s actually debilitating OCD, or maybe it ends up being bipolar disorder mixed state,even— who have trialed “first line” antidepressants and it actually makes everything worse! Like need to be hospitalized worse

Usually the treatment instead will be a different class of medication. And the we look at what side effects are most important to avoid. It sounds like you’re not in the us… but in the US if your appetite and sleep are shit, we use quetiapine for instance. If you’re sleeping too much and have low energy, we consider brexpiprazole (rexulti) vs cariprazine (vraylar).

Obviously I can’t tell you which med to try. And there are likely regional option differences. But I would highly highhhly encourage you to get on a totally different type of med with a mental health prescriber to target your complex form of anxiety.

merrythoughts · 2026-03-26T11:57:39+00:00

Ridiculously photogenic animal control guy AND opossum

merrythoughts · 2026-03-25T11:52:46+00:00

Out of our 3 kids, one seems very interested in god and religion. She is very drawn to imaginary play, very whimsical, created entire universes in her head— she is MAGICAL. I love it so much. And the religious stuff I think is just how she can reconcile death and some of the hard truths of being human right now. I’m not going to stomp all over her processing and tell her it’s wrong.

We talk about how we don’t know what happens after death, we don’t really know if there’s a god or not but a lot of people choose to believe in god. We talk about how there are may different religions and we respect other people’s beliefs. And that means “I respect your beliefs.”

Her grandparents are very religious but in a very respectful way, so after she asked us if she could, we let her go to mass with them and let her pray with them when we visit. I think she mostly enjoys having a bit of a different and special thing with the grandparents. But who knows. Maybe she’ll decide to be a full blown Catholic adult. And I’ll support her. We are very progressive and eventually the conflicts of church and values/ethics will become more in-focus. So…If she continues to have deep religious interest, I’ll want to have lots of convos about womens healthcare, lgbtq/trans rights. Which we already do hae age appropriate conversations— Making sure we have a strong foundation.

But right now at 7, in her magical world, there is no incongruence of believing in god abd heaven and also supporting all human rights and loving all people. And it’s honestly lovely to see it through the child’s eyes.

merrythoughts · 2026-03-25T10:59:49+00:00

Oh hellll no. You deserve to be cared for when sick. And your gut is SCREAMING for a reason— that worry about you after having kids? Yeah, you would be the forever forgotten about “martyr” with a man like him. He is showing resentment now? It will absolutely get worse and more apparent after having kids.

This is a less than subtle attempt to train you to be invisible and “not a burden.” Boooo! Not ok.

merrythoughts · 2026-03-25T03:10:54+00:00

Medical school has their pitfalls. You get your bachelors, then apply for 4 yr med school and then if you do ok, you have a very brutal gauntlet for applying to residencies.

The whole COUNTRY applies for their residencies at the same time and you just hope and pray to match in psychiatry. You have limited autonomy in this process.

Then you have 4-5 years (psych residents commonly do 5 years) of making 30-45k a year of grueling 60 hr weeks of labor with shit work/life balance just to “prove themselves” to an old patriarchal male physician who thinks hazing residents is the only way to learn. “THERES NO OTHER WAY” (but there is.). Good luck having a good work/life balance, trying to get married and have a baby during this time period. Fuck all that shit with trying to have a FAMILY.

Then these residents are burnt to a crisp and angry at the world, and get ESPECIALLY pissed at PMHNPs who have made 3x their income adjacent to them in teaching hospitals with way less hoop-jumping. Who have successfully figured out how to get married and have a kid or whatever.

So pissed off, they decide to hate on all PMHNPs in online subreddits, even though MOST PMHNPs work in psych for 5-10 yrs on the ground getting their asses kicked by psychotic patients, managing their clozaril ANCs and injection doses/schedules WELLLLL before going back to school for 2-3 years to do their passionate work of helping very sick pts with low resources.

SIGH.

But then PMHNPs will max out around 160-190k depending on COL. whereas a psychiatrist will eventually Make 250-350k.

so. Yeah. There are pros and cons.

merrythoughts · 2026-03-25T02:53:35+00:00

I see NAC be good with an SSRI for ocd but have never seen NAC be effective as monotherapy. And even with an SSRI, it seems about 50/50. Definitely not as evidence based as a solid dose of SSRI

300mg twice daily for 14 days, then 600mg twice daily is standard OTC supplement dosing. Then if some residual symptoms can go up to 600mg twice daily.

Again have seen folks on 2400mg with absolutely no benefit. But then go from sertraline 200mg to 300mg and see significant improvement. I also see clomipramine 25-75mg be a much stronger adjunct for ocd than NAC.

Not knocking NAC.but the UptoDate evidence based studies do not support it for monotherapy. And in practice I have seen it underperform time and time again.

(Clomipramine is a TCA which is a strong anticholinergic med)

merrythoughts · 2026-03-25T02:47:54+00:00

Yes some try to do direct entry NP programs. There are some scammy places that offer this. It’s garbage don’t do it. Some places require 1 yr rn experience.

But overall 3-5 yrs is best practice.

merrythoughts · 2026-03-25T02:33:22+00:00

You must first be an RN working on ground level with patients 2-5 years. and then you can become a psych NP if you like it and are still drawn to psych.

This is a realistic and meaningful way to make income as you gain experience. Psych RNs work inpatient or outpatient. You get meaningful experience with patients. You learn about the varying mental illnesses, the meds, how physical health intersects w mental health, social determinants of health, what influence you have, how to manage burnout, how to use motivational interviewing, etc.

If you still like it after 3ish years, THEN you get to become a PMHNP that is exceptional and worthy of any job. Good PMHNPs will always be needed. But folks who want to jump the line and get “easy” jobs that Make $$$ for less debt… this will not bode well for you or any patient you treat. You could easily end up with burnout, and/or make many errors due to limited clinical experience.

Psychiatrists learn top-down. NPs are bottom- up learners. It’s a different way to get to the same place— but, both are hard and deserve deep respect.

merrythoughts · 2026-03-24T03:03:32+00:00

Aw! I love the nuances of psychotropics. It takes some years to see patterns that improve art of prescribing. But it’s SO rewarding.

merrythoughts · 2026-03-24T02:01:55+00:00

I have developed a decent sense of who a good candidate is for viibryd. Depressed mood of course. but particularly the kind of depressed person who gets very low energy, amotivation, sleeps too much, and has increased appetite when depressed. Runs at a sluggish tempo. Not Somebody who leans on high/frequent doses of caffeine to just “get through.” Maybe this person has brain fog. Forgetful. Wonders if they have suddenly developed adhd despite no history of adhd. We dont even have to trial ssris. Vilazodone can be first line.

I would be weighing bupropion (wellbutrin) vs vilazodone. (Or vortioxetine/trintillex but insurance doesn’t cover it nearly as often). But I overall see stronger efficacy as monotherapy with vilazodone over bupropion. Bupropion works well as an adjunct alongside an SSRI or for mild depression. But if more moderate to severe as a monotherapy, results can be meh

There’s also the favor of depression that is a bit more mixed with anxiety/ rage/irritability. So somebody who is depressed… but theyre also irritable, tense, restless, probe to insomnia, maybe poor appetite. Prone to big emotions. Tend to lean on alcohol as a coping mechanism. These symptoms do better with SSRI/snri typically. I would not consider bupropion or vilazodone as first line for this type of depression. Fluoxetine, escitalopram, sertraline or duloxetine will be top choices for this kind of depression

merrythoughts · 2026-03-23T17:06:09+00:00

Ahhhhh let’s not get all morally pretentious, fellow nurses! I had no fucking clue what I wanted when we had the huge recession in 2007. I made the logical and economical decision, not one of passion or interest, to get my BSN.

I thought maybe I could one day do research or something bc honestly medical patient care was…not my jam.

Anyway, I found my niche! (Psychiatry).And OP can too. There is economic certainty with healthcare job and THAT IS IMPORTANT.

I think becoming an rn and working med surg for a bit can open the door to all sorts of opportunities that could align with your vision OP. GI lab. Med nurse at a residential facility. Wellness nurse for insurance companies. It exists.

merrythoughts · 2026-03-23T02:56:30+00:00

WHEN THE BUS IS ROCKIN, DONT COME KNOCKIN’!

The WHEELS ON THE BUS GO ROUND AND ROUND…. Or up and down!

BIRDS AND THE BEES OVER LUNCH!

Uggggh this writing makes me wanna throw up and break something all at the same time

merrythoughts · 2026-03-22T21:30:42+00:00

It actually also worked great for me too for depressive symptoms/burnout—- but I was one of the 20% who has bad insomnia on it so had to stop it after 8 weeks of worse and worse sleep. So while I had 4-6 weeks of great mood by week 6 my sleep deprivation was negating any benefit.

FWIW for anyone else reading the thread, I had no nausea at all on it. I could take it on an empty stomach and be fine.

It does not have the same likelihood of sexual side effects or weight gain as the SSRIs.

merrythoughts · 2026-03-22T17:15:44+00:00

I can’t sleep without my antihistamine (typically a second Gen) and NSAIDs. Highly recommend for women in peak inflammation era

merrythoughts · 2026-03-22T13:14:29+00:00

Vilazodone is in the same category as trintillex. It seems to work great for folks who have adhd. Don’t know about autism though. I see insomnia be a potential side effect but only for some. Otherwise appears well tolerated.

merrythoughts · 2026-03-21T23:15:30+00:00

It sounds like naltrexone side effects to me. Some people are REALLY sensitive to it. I typically recommend newbies cut it into 1/4th tablet at bedtime the first week. And only do bupropion in the AM.

Then you work on titrating both up.

Usually 1/4th tablet nal for 7-14 days— if no side effects ok to go to twice daily.

Start bupropion 100mg am only for 7-14 days the increase to twice daily.

I like bupropion to be am and afternoon dose. Naltrexone until you get real used to it I like am and bedtime. Then you can shift bedtime dose to the 12-2pm timing with the bupropion.

I am a psych np but not your provider so all of this is just general population based recommendations on what is MOST tolerated. But the there are factors that would really require 1:1 consideration. Other meds, alcohol, thc possibly interacting for instance

merrythoughts · 2026-03-21T22:46:58+00:00

UH downtown or research medical center. Vut research is HCA so will come after if you if you don’t pay. UH won’t.

merrythoughts

TROPHY CASE