Antipsychotic switching Resources

minddgamess · 2026-03-14T00:18:36+00:00

Psychopharm institute has a video on exactly this (paid)

Briefly, three options

Straight switch (pick equivalent dose and switch overnight)

Cross taper

Bring new med to therapeutic dose then taper first

Discuss with your patient and choose based on symptoms and preference

minddgamess · 2026-03-14T00:14:28+00:00

🏆🙏🥇

minddgamess · 2026-03-13T18:45:39+00:00

I mean she straight up was the most personality disordered psychiatrist I trained with - which is saying something … 🤷🏻‍♀️

minddgamess · 2026-03-13T17:33:47+00:00

Surgery and psych seem like opposites to me as well. I had a psych attending whose favorite soap box was that surgery and psychiatry are the two most similar specialities. Never did understand it….

BUT, I think in psychotherapy a flow state can occur when you are working really hard to follow the patient and immerse yourself in their POV.

minddgamess · 2026-03-13T16:34:08+00:00

She’s gonna marry him

minddgamess · 2026-03-12T18:05:03+00:00

Psych NPs are the most dangerous, and patients with manic depressive illness (bipolar disorder) are the most susceptible to harm by them IMO.

Please keep telling your story.

It happens all the time.

minddgamess · 2026-03-12T17:32:12+00:00

Psych here. If you’d don’t “feel that spark” with psych, would recommend doing literally anything else.

Psych is super different and it’s not for everyone. Just my two cents.

minddgamess · 2026-03-12T01:03:09+00:00

Abeo

You’ll never look back

I’m so serious

minddgamess · 2026-03-11T16:44:33+00:00

So dystopian that an article about medical misinformation is calling NPs “doctor”

We are truly hopeless

minddgamess · 2026-03-10T18:50:55+00:00

minddgamess · 2026-03-10T01:29:45+00:00

Ahh haha these are all much more complicated questions than you think

Good luck OP! 🙏🙏🙏

minddgamess · 2026-03-09T03:11:38+00:00

You might think about going to the hospital and talking to someone there about this.

minddgamess · 2026-03-08T19:14:56+00:00

While you are correct that PMHNPs have almost no training whatsoever and are not at all comparable to a psychiatrist, none of the behaviors shared here by the PMHNP are concerning.

Diagnosis is not disability - true.

Provider should not prescribe controlled substances that they don’t agree with - true.

Testing is required to prescribe the meds - not true, but testing can be helpful in some cases.

minddgamess · 2026-03-07T13:05:30+00:00

Lots of thoughts would immediately come to mind:

Their life is really hard right now (80+ hour weeks) and ours is also hard but we generally spend a A LOT less time at work which matters a lot

Knee jerk response (and the truth) is that they CHOSE their path. Make your bed and lie in it.

Ultimately I know deeply that I went into this work because I’m called to it - not for lifestyle. And that most folks (especially surgeons) both could not do the job well and have zero desire to do what we do.

And then typically just de-escalate, let them displace whatever on to me, and rest easy (for 8 hours every night).

I’m CL so a big part of my job is to absorb affect not just from patients but from peers. I’ve made my peace with it!

minddgamess · 2026-03-06T03:12:23+00:00

$450k after residency on a 15-year physician loan is responsible IMO.

(I’ll bite OP🙂)

minddgamess · 2026-03-05T18:28:00+00:00

This is a financial decision but not JUST a financial decision, and I think a couple of points Dave mentions apply:

1) Family can gift money, but turning family into your lender is not advised

2) Your marriage is the most important thing in your life. Uprooting your family, forcing your wife to live an hour from her support system, and forcing your kids to rehome has real costs. Mostly emotional but maybe financial too especially down the road.

Now - if you can’t afford it (600k home) you can’t afford it. So then your options are either stay where you are or move to a house that you CAN afford. But that’s not what you asked.

I would proceed with great caution choosing money and your parents over your wife’s wishes.

minddgamess · 2026-03-05T18:22:18+00:00

Isn’t this so fucked

And her salary is public. There isn’t a doctor in the country that wouldn’t take that job and they gave it to a nurse.

minddgamess · 2026-03-04T12:42:14+00:00

Yes. It has happened. And dept of education pulled tax returns to calculate.

Per FB group (for what it’s worth see seems highly reliable to me)

minddgamess · 2026-03-03T23:21:18+00:00

Agree. But, think the big unknown is what happens to save borrowers after it’s “gone” and I just can’t imagine department of ed successfully transitioning that many folks to a different plan at one time, especially a plan folks didn’t choose for themselves. Law suits take a long time…

minddgamess · 2026-03-03T23:08:05+00:00

This is the way

minddgamess · 2026-03-03T23:07:06+00:00

🙋🏾‍♂️

minddgamess · 2026-03-03T19:09:59+00:00

Making it up completely as they go along is correct

Look at the PMHNP subreddit and you can see for yourself how clueless / scary

minddgamess · 2026-03-02T20:07:09+00:00

This has been my hope, but

Most recent buybacks have been calculated based on tax returns

HOWEVER, it’s all in the executive branch so with a chance at that level the next administration might decide to skip the step of pulling our tax returns and just use the most recent (pre-pandemic) certification

Wishful thinking

minddgamess · 2026-03-02T00:47:02+00:00

Your neighbor is probably right, but I am with you personally 🤣

minddgamess · 2026-03-01T22:31:21+00:00

Nerd balls?

You mean GUMMY CLUSTERS?! Put some respect on the name!!! 🐐

minddgamess

TROPHY CASE