Per our post yesterday, we emailed the practice manager at our NHS GP surgery last night, enquiring about switching from paroxetine to another antidepressant medication.

We've reduced our paroxetine dose from 20 to 10 mg today in preparation for a change in medication. To counteract any ill effects, we're resuming taking half a tablet (75 mg) of bupropion extended release alongside. (We had to acquire this off prescription, as the NHS won't prescribe it for treating depression.)

If we can get a sooner appointment with the senior partner or another GP at our GP surgery to approve starting on something like vortioxetine (10 mg) or another suitable medication, we'll discontinue the bupropion. If not, we'll fully come off the paroxetine and continue with 75 mg of bupropion daily for a while.

#depression #MentalHealth #paroxetine #vortioxetine #bupropion #SSRI #SMS #NDRI

Hey folks 👋

We meant to write this post earlier today, but ended up doing other things, so we're writing this now on our phone in bed 😅

We are currently on the max dose of sertraline daily (200 mg). It's helped a little with depression, a bit less with anxiety, and not at all with executive dysfunction.

We've previously also been on the max dose of venlafaxine extended release (375 mg). We came off this because it didn't work.

Until recently, we had been taking a low dose of bupropion extended release (150 mg) daily alongside the sertraline. It really helped with energy levels for a while, but it lasted only a few months at best. It also caused us to push ourselves too far several times and eventually burn out.

We are trying to ideally find a single medication that will help boost our serotonin, noradrenaline, and dopamine levels, but it doesn't help that most of these are not prescribed by the NHS. Those that are tend to be stimulants used for ADHD, which we presently do not have access to.

We've done a lot of research into the different classes of antidepressants (e.g., sSRIs, SNRIs, sNRIs, NDRIs, SNDRIs, TCAs, TeCAs, atypicals, etc.), but the only available options we see as being worth any attempt are paroxetine (sSRI) and vortioxetine (SMS). We really don't want to try another SNRI like duloxetine or older classes of meds.

Sharing any experiences you've had would be very much appreciated 🩷

#AuDHD #depression #anxiety #ExecutiveDysfunction #sSRI #SNRI #sNRI #NDRI #SNDRI #TCA #TeCA #SMS #antidepressants

Hey folks  

Apologies that it's taken us so long to write this update for y'all. Suffice to say, we've not had the executive function, time, or spoons to do so until now  

For anyone who's not been following us for long, we've been on the StruggleBus™ for a long while now. In fact, our depression would almost certainly be described as chronic, even if it's somewhat under control.

Why are we depressed? SO many reasons, but some of the big ones are:

• Being an empathetic, neurodivergent (AuDHD) spoonie in a world designed by and for uncaring, ableist neurotypicals.
• Being a trans+ person in a world that is continuing to other us, villify us, criminalise us, legislate against us, deny us healthcare, and kill us (directly or indirectly).
• Living in England, UK, which has seen its formerly centre-left Labour Party become a right-wing copy/paste of the Tories.
• Living in a world in constant conflict, where genocides are not only ignored and denied by Western countries, but actively assisted with via arms supplies.
• Living in a world where people downplay conflicts outside Europe or North America and won't consider World War 3 to have started until a NATO country is attacked by the military forces of another  😞
• The institutional transphobia and gatekeeping intentionally baked into the NHS since it first began treating trans people in the 1960s.
• The struggles worldwide of people who are trans, queer, neurodivergent, disabled, and/or struggling with mental health.
  • Doubly so for POC living in countries ruled over by former colonial powers 😢
• Working for an employer who is not standing up for trans rights, despite claiming to do so, and is allied with arms companies 

... and many more things besides 😞

Whilst we have a formal diagnosis for autism (Autism Spectrum Disorder) from 2018, we're still on a waiting list for an ADHD assessment sadly  We're actually on 2 waiting lists: the NHS one (which we went on first) and one for ADHD 360, which our NHS GP surgery referred us to under the Right To Choose.

Consequently, we cannot get any ADHD medication on NHS prescription to see whether it might help.

Our depression hadn't been helped on venlafaxine (an SNRI), even at the maximum dose of 375 mg with the extended / slow release tablets.

To try to combat this, we asked our NHS GP to switch us to sertraline (an SSRI) and bupropion (an atypical antidepressant and NDRI), so that we'd have our serotonin, noradrenaline, and dopamine levels raised. Sadly our local NHS ICB wouldn't allow my GP surgery to prescribe bupropion for us for any reasons, but sertraline was no issue.

So, we gradually lowered our venlafaxine dose (by 12.5 mg every other day) until we reached 150 mng daily, then cross-tapered with sertraline until we were solely on sertraline at 100 mg daily. We acquired bupropion from outside the NHS and began taking 1 tablet (150 mg, extended release) daily. This helped a lot with focus, energy, and executive function, but it wasn't enough to keep us functional enough, so we went up to 150 mg sertraline daily, and eventually the max dose of 200 mg daily.

Even with these doses, there was only so much that the meds could carry. So, we started reducing how much help and support we offered others in the community, as this was draining us. We even sadly paused streaming on Twitch, which we used to love doing 😞 We'd already broken the habit of doomscrolling or checking the news daily long beforehand, but due to the communities we're a part of and our current job role, there's only so much hate and suffering we could block out.

Eventually, it broke us. We have been signed off work since 28th October and have an extended fitness note last until 3rd December (inclusive).

During this time, after a lot of research, we took a gamble to see if it might help us: switching from bupropion to [atomoxetine](Atomoxetine), which is most-commonly used to help with ADHD.

As we don't yet have a formal ADHD diagnosis, we couldn't get this through the NHS, so had to acquire it elsewhere. We were able to do this as it's not on the UK controlled substances list, presumably because it's not a stimulant. Instead, it's an sNRI, which boosts noradrenaline and dopamine levels.

In theory, it sounded really good. In reality, it was one of the most awful experiences of our life... and considering we've experienced some truly traumatic things in our life, that's really saying something 😖

We started off on a low dose of atomoxetine (20 mg) and gradually increased it up to 40 mg over the first week, rather than jumping in a 40 mg. We then gradually tapered up to 80 mg daily by the end of the next week, rather than just doubling the dose.

The effects were not overnight, but those 2 weeks were a nightmarish blur. The effects came on gradually, so we didn't spot them as being linked to the medication at first. Additionally, as one of the effects was increasing brain fog, it made it harder to think.

It didn't stop with brain fog though. We became irritable, restless, constantly tired, more depressed, more anxious, and more RSD-prone. We had increasing passive suicidal thoughts, which were beginning to tip us over the edge into the void.

Early into the 3rd week, we realised that we could no longer hear or communicate with our headmate, Hannah. It's hard to describe how we felt at that moment, but it's like having a piece of you torn out, taken away, or hidden from you. The best descriptions we can think of are extreme despair and feeling isolated and alone in our mind.

We stopped atomoxetine cold turkey, and resumed taking 150 mg bupropion daily the next morning.

There were side-effects (especially the first night) from doing this, but it was worth it to start to become functional again. It was only over the next few days that we realised just how negatively the atomoxetine had affected us, how intolerably painful it had made existing, and how close it had pushed us to the brink of the void.

The only good that came out of it was that it put many things into perspective for us, like how relatively lucky we've been with sertraline and bupropion, how resilient we've become in spite of all odds, and how we need to get out of our current job ASAP.

It also highlighted to us how fragile our existence is that a change in one medication could affect us so profoundly and dangerously. And, sadly, atomoxetine was our best hope for a prescription ADHD med, as we don't do well with stimulants typically. Methylphenidate (a stimulant and NDRI) is still a potential option, but it cannot replace bupropion as even the extended release version has too short an elimination half-life (2-3 hours) and duration of action (6-12 hours). For context and comparison, bupropion breaks down quickly (~1 hour) into 3 metabolites with long elimination half-lives (hydroxybupropion 20 hours; threohydrobupropion 37 hours; erythrohydrobupropion 33 hours).

After getting back stabily on bupropion at 150 mg daily, we've today increased our dose to 225 mg, as it's the only variable we can change right now to see whether it helps us.

Anyway, we've written a lot there, and it's past time for us to get some lunch.

Hope this provides more detail for everyone about why we've been so absent and down.

#depression #PassiveSuicidalIdeation #anxiety #MentalHealth #venlafaxine #sertraline #bupropion #SNRI #SSRI #NDRI #atomoxetine #sNRI #ADHD #AuDHD #ExecutiveDysfunction #neurodivergent #neurospicy #spoonie #NHSEngland #StruggleBus #disability

Hey folks 👋

For those who don't already know, we're currently signed off work due to depression, anxiety, and burnout.

Our employer is supportive, but there are multiple, fundamental, ongoing issues with the organisation that no amount of individual support can resolve. We cannot go into more detail.

During the last 2 and a bit weeks, we've done a mixture of resting and doing tasks we've been meaning to do for ages, but neither had the time nor spoons to do.

We're still on 200 mg sertraline (an SSRI) daily, but we've made the switch from taking 150 mg bupropion (an NDRI) daily alongside to 40 mg atomoxetine (an sNRI, not an SNRI) daily alongside. We're slowly titrating up to the recommend 80 mg dose.

As we came off the bupropion steadily, we definitely felt it (i.e., mood; executive function; energy etc.), but the effects are levelling off as our atomoxetine dose steadily increases.

The bupropion had helped us for a while, both with our mental health and some ADHD struggles, but could only do so much. As such, we decided to make the unorthodox switch to atomoxetine.

Bupropion is an atypical NDRI and antidepressant: it boosts noradrenaline and dopamine (to a lesser extent). However, it's only prescribed off licence for ADHD, as it's not been shown to be effective. Atomoxetine, conversely, is mainly used to treat ADHD in people who do not respond well to stimulants, such as methylphenidate. It directly boosts noradrenaline and indirectly boosts dopamine in the prefrontal cortex by a decent amount.

Since we do not tolerate any stimulants well (even caffeine), atomoxetine is our best bet in terms of an ADHD med that also helps with our mental health.

Unlike bupropion, it doesn't have any major interactions with sertraline (only moderate), and we can take 40 mg propranolol tablets alongside to help keep our anxiety under control, rather than turning straight to 10 mg diazepam tablets.

So far, we're doing well with the switch, both physically and mentally, but it'll be a while before we know for sure whether this the ideal medication combination.

We are still very much in low power recovery mode, so don't expect anything much or consistent from us.

A last note to sign this off: from the above listed drugs, the only one we can currently get via the NHS is sertraline. We may be able to get atomoxetine through the NHS in the future, but that's dependent on us ever actually getting a formal ADHD diagnosis 😮‍💨 The waiting lists are rather long... even when using the Right To Choose a mental health service provider.

Apologies for any typos.

#MentalHealth #depression #anxiety #burnout #neurodivergent #ADHD #AuDHD #NHS #NHSEngland #sertraline #SSRI #bupropion #NDRI #atomoxetine #sNRI #serotonin #noradrenaline #dopamine #RightToChoose #propranolol #diazepam #stimulants #methylphenidate

Hey folks 👋

We'll try and keep this short, as we are running dangerous low on spoons, which is kinda the purpose of this announcement  

As you likely already know, we are a non-binary, trans fem, disabled, neurodivergent (AuDHD) spoonie, who additionally struggles with major depression, requiring multiple meds daily in order to keep functioning at a full-time job  

Despite this, we have been pushing ourselves regularly beyond our limits, causing increasing tiredness and irritability, exacerbating many of our AuDHD traits, and leading to complete verbal shutdowns at times, as we so very much wanted to help as many people as we could 

This has inevitably led to pretty-much complete burnout 🤦‍♀️

We'd already taken steps back in terms in terms of the amount and scale of support we were giving to people, as well as spending less time on fedi and other platforms, but it's not been enough 😞

As such, until further notice:

• We won't be streaming on our Twitch channel and have deleted our schedule.
• We won't offer private support about gender affirming hormone therapy, mental health, or anything else.
• We will largely be invisible on Discord and will not be on fedi as much as we used to be.

Of course we feel guilty about this, but right now we need to put ourselves first, so that we can fully recover from this burnout, then take steps to reduce the risk of further recurrence.

We want to stress that we are stepping back, not stepping away, from everywhere and everyone.

We'll still be in contact with folks when we have spare spoons, and we'll still interact and post on fedi occasionally.

And we'll still be doing some helpful activities at work and behind the scenes that we can't discuss  ✊

But yeah: you won't see us as much, but it's because we're allowing ourselves to prioritise our own health and needs.

#streaming #streamer #Twitch #TwitchStreamer #queer #trans #transgender #enby #femby #NonBinary #TransWoman #TransFem #CatGirl #LGBTQ+ #LGBTQIA+ #neurodivergent #neurospicy #ActuallyAutistic #ADHD #ActuallyADHD #AuDHD #ActuallyAuDHD #spoonie #NoSpoonsOnlyKnives #disabled #disability #burnout #VerbalShutdown #MentalHealth #depression #SSRI #NDRI #sertraline #bupropion

Hey folks

Apologies that we've been AWOL and still haven't replied to a lot of your notifications 😞

The short version is that we've overextending ourselves (again) in terms of the support we've been giving people. This has led to us becoming overly tired, easily irritated, and emotionally spent. Our RSD (rejection sensitive dysphoria) is through the roof right now  

The last time we pushed ourselves too far, we had an empathy overload (sometimes known as compassion fatigue) and we can feel it starting again.

We're not going to ignore everyone or forbid ourselves from using fedi, Discord, or other such places we frequent, but we need to cut back and recharge a bit.

We've got a number of stressors IRL right now, and we're only even functional due to a combination of an SSRI (setraline, 150 mg daily) and an NDRI (bupropion, 150 mg daily).

The bupropion is probably the only reason we're able to deal with any of our AuDHD stuff right now 😅 However, it's also let us push ourselves beyond our safe limits until we basically... break.

We're a neurodivergent spoonie. If we push ourselves too far, sometimes we will literally lose the ability to speak out loud. There have even been occasions where Hannah (Evie's lovely headmate) has had to dictate to Evie what to write in WhatsApp messages to her wife!!!

So, just to clarify, we're not stepping away, but we are stepping back a little bit from the support we've been offering people.

Anyways, that's enough for now. Sorry for the long post.

Please look after yourselves, okay?  

We will return. Promise.

#burnout #neurodivergent #neurodivergence #AuDHD #autistic #ADHD #spoonie #MentalHealth #SSRI #NDRI #sertraline #bupropion

SleepyCatten's log.

Earth date: 2024-07-21.

As of yesterday, we're down to 25 mg venlafaxine. Although we've only been prescribed 100 mg sertraline, we had sufficient spare 50 mg tablets to increase our sertraline dose to 125 mg daily, which has offset the reducing venlafaxine dose.

We've got a phone appointment with our NHS GP this coming Wednesday (the date we're completely stopping venlafaxine) to formally request an increase to 150 mg daily of sertraline.

The 150 mg bupropion extended release is continuing to work its magic, but it's been a bit limited by us physically and mentally pushing ourselves further than we should have for chores, looking after wife, etc.

We're still waiting for our backup supply of sertaline to arrive from an IndiaMart seller, so if the official sertraline prescription difficulties continue, we won't be at risk of running out.

We've said this before, but honestly we're just SO looking forward to being off venlafaxine entirely.

#MentalHealth #depression #TreatmentResistantDepression #SNRI #SSRI #NDRI #venlafaxine #sertraline #bupropion #SleepyCattenLog #AuDHD #ActuallyAuDHD #ADHD #ActuallyADHD

SleepyCatten's log.

Earth date: 2024-07-13.

As of yesterday, we're down to 75 mg venlafaxine and up to 100 mg sertraline, alongside our 150 mg bupropion. Can't wait to be entirely off venlafaxine now.

Definitely getting the feeling already that 100 mg sertraline won't be enough by itself, so getting ready to ask for an increase in the prescription to 150 mg sertraline daily.

The bupropion is continuing to work its magic. Having to get reaccustomed to hyperfocusses though... and not getting snappy if someone interrupts them 😅

Also, looks like we picked a fun time to move to sertraline: many pharmacies are having trouble getting hold of it 🙃

Guess what we've just ordered on IndiaMart to give us a backup supply?

#MentalHealth #depression #TreatmentResistantDepression #SNRI #SSRI #NDRI #venlafaxine #sertraline #bupropion #SleepyCattenLog #AuDHD #ActuallyAuDHD #ADHD #ActuallyADHD