SleepyCattenHey 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 StruggleBusβ’ 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 π
- 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 π’
- 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 π
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 π 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 π
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
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β‘οΈ π΅πΈ 
Gaysis
S. H. Pratt