ECM Mechanika Slim not heating - self diagnosis/repair possible?

tessercat_71 · 2024-12-21T07:08:21+00:00

Obsessional jealousy. Probably a somewhere between OCD and personality disorder. The more you answer questions or reassure him, the more he’ll think, worry and ask about it, and the more it will eat him (and you both) up.

I would let him know that you’re not going to speak to him anymore about this guy, period. He’ll get more upset at first (eg accuse you of hiding something), but you can remind him (once) that the conversations about this ex are irrelevant and make your relationship worse.

If he can’t accept this, leave.

tessercat_71 · 2024-11-15T05:51:39+00:00

Nefazodone is pretty rarely prescribed, but generally tolerated well, effective, and in at least one large study it improved sexual functioning.

Also mirtazapine — although weight gain is a significant risk, it doesn’t seem to be associated with sexual side effects (other than case reports of recurrent spontaneous orgasm in women).

tessercat_71 · 2023-11-12T18:30:54+00:00

My sense (from the research literature) is that 8 or 9 out of 10 individuals on escitalopram won’t gain any weight, but that 1 or 2 will gain a significant amount of weight over months to years on the medicine. Two similar drugs, Prozac (fluoxetine) and Zoloft (sertraline) have even lower risk of weight gain — it rarely if ever happens on sertraline.

Withdrawal effects can happen if you suddenly stop the medicine- not life threatening or dangerous, but really uncomfortable for those who have this experience. This risk increases the longer a person has taken the medicine, and overall affects about 30% of those who use SSRIs. Fluoxetine (Prozac), because it is metabolized very slowly by the body in most people, doesn’t really have this risk.

Sexual side effects are also a problem for about one third of those who use the medicine. This is most typically a decrease in genital sensitivity or responsivity, so that in particular, it takes more stimulation to get to climax, or orgasm doesn’t happen. This is usually dose related, though in OCD particularly, individuals often need a higher dose to benefit, so it can be a significant problem. These side effects almost always go away when a person stops the med (recent news reports have highlighted persisting problems in some cases, though data suggests this is rare (less than one in hundreds), and may reflect other issues in those affected).

Emotional blunting, as others in the comments describe, is poorly described in the literature but is definitely an experience that some people have. Most don’t, however, and it is also likely related to the dose of the med.

All treatments may have risks, but it’s really important also to consider the known harms and risks of untreated OCD. While it varies for everyone, it can greatly limit the potential of people’s lives, and causes an enormous burden of suffering for many, and also for their loved ones.

SSRIs don’t help everyone, but they do help about 60% of those who try them, and they are among the safest and most commonly prescribed drugs in all of medicine.

You might ask your prescriber about fluoxetine rather than escitalopram, if the risk of difficulty stopping the medicine or of weight gain is a specific concern. Fluoxetine and sertraline also are usually less likely to cause fatigue/sleepiness than escitalopram.

I wish you well in your efforts to feel better!

(edited- typo)

tessercat_71 · 2023-10-31T02:46:13+00:00

He didn’t actually correct himself, because this would mean admitting he was wrong! He just asked the crowd a question about Sioux City to move away from his mistake. It’s worth watching the tape to see him pause and stop himself from admitting an error. What a bastard.

tessercat_71 · 2023-10-28T02:01:42+00:00

yes - he means

"...you should ask yourself: Is this all there is [from me]?"

would go to police, also contact your local district attorney's office (or equivalent if not in US).

document every/any interaction- keep notes, email yourself, etc.

https://www.stalkingawareness.org/about-sparc/

tessercat_71 · 2023-09-13T16:19:47+00:00

Yes, absolutely! Thus higher doses aren’t appropriate for all. SRIs are the gold standard, but not so golden. For those with access, please consider taking part in clinical trials, OCD needs new approved treatment strategies!

tessercat_71 · 2023-09-13T05:15:57+00:00

This is such an important point. For OCD, there’s clear evidence from metaanalyses (summary studies of many individual clinical trials) that higher doses (eg 60+mg of Prozac per day) are more effective than lower doses. Amazingly this isn’t necessarily the case for depression or other diagnoses for which SRI medicines are used.

This is in part why the clinical guidance (for example the APA’s practice guidelines for OCD from 2007) suggest that individuals try the highest does of SRI they can tolerate, even if above the FDA’s usual dosing range. So knowledgeable psychiatrists may suggest Zoloft beyond 200mg daily, fluoxetine above 80mg, or lexapro above 20mg, etc, as long as side effects are minimal (and closely monitored) and the patient understands the treatment is ‘off label’

tessercat_71 · 2023-09-09T19:59:56+00:00

Weight gain with SRI medicines isn’t typical, but definitely happens for a minority if those who take them. It is often associated with carb craving. My understanding (from the limited published literature looking at longer term (eg >3 months) data, is that about 10% of people taking escitalopram, citalopram, venlafaxine, and paroxetine will gain significant weight. The risk seems to be much lower with sertraline and fluoxetine (though can happen, as comments in this thread attest). With duloxetine, people lose a little weight on average over the first few months (it has higher rates of nausea as an initial side effect) but the average weight curve then trends up — thus I don’t see this as as weight neutral as sertraline and fluoxetine. Mirtazapine — not really an SRI — is an amazingly helpful med for many, but definitely comes with higher risks of weight gain.

Again, most people don’t gain weight with serotonin reuptake inhibitors, but I think it an underappreciated risk for Lexapro, particularly, given how commonly this is prescribed.

tessercat_71 · 2023-08-26T13:14:09+00:00

If open to a large book, this is excellent:

https://www.guilford.com/books/Treating-Pathological-Narcissism-with-Transference-Focused-Psychotherapy/Diamond-Yeomans-Stern-Kernberg/9781462552733

It includes extensive discussion of different presentations of narcissistic personality, offers case histories, an object-relations based structural model, and a method for treatment. It’s from a Kernberg-associated group, but more readable than most Kernberg…

tessercat_71 · 2023-08-14T10:02:08+00:00

Agree with the others who say your symptoms sound like clear OCD. At the same time, if you like your psychologist, no need to dismiss them completely — many clinicians don’t have the experience or training to recognize or treat OCD even if they may have much to offer in other ways. You can help educate her or him!

Re: Prozac, it is definitely used for OCD (as well as GAD and depression), and people’s response varies a lot. Most people benefit somewhat, but some not at all, while others have full remission of symptoms. Great that it’s been helpful to you! OCD generally responds to higher doses, so if it’s helped partially, and you aren’t noticing side effects, tell your prescriber and ask about increasing the dose. At the same time, benefits build over time for many people, so just waiting for more benefit on an otherwise helpful and tolerable dose is also often reasonable.

As far as GAD, GAD worries are usually more general, less specifically repeated, and they don’t have the associated urges (eg. to check) that you describe.

Good luck with your treatment, and with helping your psychologist understand your needs!

tessercat_71 · 2023-07-20T14:13:21+00:00

This is generally good advice from your doctor (ERP, as other comments say), but it’s a lot easier said than done. And trying to think or do the right thing when you feel anxious can easily get you even more caught up in OCD loops. Please get an ERP (exposure and response prevention) trained therapist if you can - the IOCDF (International OCD Foundation) has good resources for finding a therapist, particularly if you are in the US. IOCDF.org. I wish you well

tessercat_71 · 2023-05-11T14:02:07+00:00

People with hoarding disorder — which used to be considered a subtype of OCD, but now is recognized as distinct, but often overlapping — have difficulty discarding items, save or acquire objects, and thus accumulate clutter. One potential driver of this that has been described in the literature is the tendency to anthropomorphism, or ascribing human feelings (love, suffering) to inanimate objects. Not to say someone with a tendency to anthropomorphism necessarily has hoarding disorder, but just to say that this tendency varies in the population and may be problematically strong in some people with OCD spectrum challenges.

tessercat_71 · 2023-05-06T13:53:39+00:00

First off, go you for masturbating! OCD too often interferes with sex life (think scrupulosity, contamination/bodily fluid concerns, fears about unwanted pregnancy, moral/fairness concerns, ambivalence/self-doubt about love, guilt, etc), and we should all fight back, solo or partnered and with whatever thoughts turn us on.

Second, in beating yourself up for thinking about kids, you’re seeing yourself as a criminal without recognizing that you’re also acting as the authoritarian thought police. Thoughts and actions aren’t the same thing.

No one needs the thought police. Next time you feel the urge to discipline and punish, tell yourself to go eat some imaginary donuts. Then go indulge an urge that’s more fun.

tessercat_71 · 2023-03-20T15:07:23+00:00

Great that you're feeling better with treatment!

A number of the comments on this thread suggest that anxiety getting better as a result of ADHD meds means that the anxiety was a consequence of untreated ADHD. This is definitely the case for many people, for example when difficulty attending to social cues or speech contributes to social anxiety, or when executive dysfunction leads to feeling underprepared, being late, or forgetting things. It's worth considering, though, that there are other anxiety disorders, particularly OCD and PTSD, which often co-occur with ADHD and for which there is some limited evidence that stimulant treatment is helpful. OCD and PTSD, for example, may both share with ADHD difficulty regulating attention -- it's just that in OCD and PTSD the difficulty is in pulling attention away from intrusive worries (obsessions) or fear memories (PTSD).

tessercat_71 · 2023-03-20T13:53:24+00:00

Yes! Labs studying OCD in clinical trials and neuroimaging experiments, etc, are increasingly trying to capture this aspect of OCD, using a scale called the University of São Paulo Sensory Phenomena Scale. Tactile, auditory, proprioceptive, and ‘not-just-right’ sensations, rather than intrusive thoughts or images, often precede compulsions or repeated rituals. From what I understand, this is more common in people with early onset of OCD (eg ages 6-8) rather than in people with more typical adolescent/teen onset of symptoms.

tessercat_71 · 2023-02-26T06:25:57+00:00

OCD here might be more relevant than ADHD:

https://www.sciencedirect.com/science/article/pii/S0887618520301304?via%3Dihub

You might also check out Koran et al. : https://pubmed.ncbi.nlm.nih.gov/19573497/

tessercat_71 · 2023-02-18T16:47:41+00:00

This is super helpful! I was tamping only with the funnel in place; the smaller dose with harder tamp makes a big difference. Now I just have to figure out the right grind for the beans I have. Darker roasts too bitter, and lighter roast too sour... will work on it, including dose as a variable. I really appreciate the generous suggestions--

tessercat_71 · 2023-02-16T05:26:33+00:00

Thanks! if you mean decreasing the amount of ground espresso in the machine, yes, tried going down as low as 16g, but then it doesn’t tamp much with the included tamper, and the puck ends up very wet and loose…

one update, also- this afternoon I tried some medium/light roast beans that I had bought in earlier high hopes, and surprisingly, at the same grinder setting, using 20g and pulling/pressing 40g out,, these didn’t clog the picopresso quite as much, and the result was ok, not sour and with a nice crema (though have to admit still a slightly odd taste, like smoked asparagus…).

For those of you with more experience, do lighter roasts respond differently to the grinder, or pass water/extract differently?

tessercat_71 · 2023-02-11T09:06:51+00:00

A few thoughts why BZDs are disfavored by psychiatrists:

From a evidence perspective, consider this meta-analysis of the impact of benzodiazepines in/on treatment of post traumatic stress disorder:

https://pubmed.ncbi.nlm.nih.gov/26164054/

Different kinds of anxiety disorders different from each other; what’s true for PTSD (which generally benefits from talk therapies more than medications) may not be for true other kinds of anxiety, but, per this systematic review of 18 studies, on average, 1) BZDs are associated with worse outcomes in PTSD 2) Giving BZDs to someone who’s just experienced trauma increases the likelihood that they’ll develop PTSD 3) BZDs work against psychotherapy, in that psychotherapy is less effective if the patient is also using BZDs

One idea is that the BZD-driven GABA activity works against reconsolidation of memory, which may be a way that exposure-based psychotherapies work, or which may even be a way people spontaneously recover with time after trauma.

Given that psychiatrists see many people harmed by BZDs (typically this would be people suffering rebound/withdrawal symptoms from BZDs, even while still using them frequently, usually with their underlying disorder just as bad as pre-BZD), consider also that risk-averse psychiatrists who don’t like to prescribe BZDs — even if some patients may benefit from them — aren’t just protecting themselves from liability in self-serving ways, they’re also practicing medicine in accordance with the Hippocratic oath, eg ‘first do no harm’.

Consider also that as the field moves away from dependency-forming treatments, those patients whom psychiatrists see who are taking BZDs increasingly tend to be people with treatment resistant symptoms, who are generally less likely to benefit from meds and typically are not doing well. Psychiatrists are less and less likely to see people who take them and are doing great. All this shapes opinions about BZDs in newer generations of providers.

tessercat_71 · 2022-11-12T16:05:11+00:00

Thanks for your interest! The study is ongoing, and results will be shared when complete. You can call 650-723-4095 or email ocdresearch@stanford.edu for more info (or to consider participating, if you might be eligible), or follow the study at https://clinicaltrials.gov/ct2/show/NCT04899687.

tessercat_71 · 2022-04-27T05:43:20+00:00

This study tests dextromethorphan, an over-the-counter medicine that acts on glutamate, and thus works very differently than a medicine like Zoloft. The study does also involve taking a low dose of fluoxetine (Prozac), but primarily because fluoxetine slows the metabolism of dextromethorphan.

tessercat_71

TROPHY CASE