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Jul 24, 2022Liked by Freddie deBoer

I generally appreciate your writing, which I find frank and thoughtful, but especially this. I’m a recovering stimulant addict working on a book about the twin flames of drugs and mental health; your thorough and unflinching account of your experience helps me make sense of my own.

My tendencies towards addiction have mostly not allowed me to take antipsychotics because of inability to buffer the side effects with benzos or amphetamines. Medical marijuana has brought me immense relief and, for the first time in decades, a feeling of autonomy over my nervous system. I’m not suggesting it’s for everyone but I’d be really interested to hear your thoughts on that phenomena if you’re ever so inclined. Thanks again for your candor!

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My first husband has/had bipolar disorder. I use the ambiguous tense because I do not know if he is still with us. It was many years before he was willing to be medicated for all the reasons that you detail. And then it was a fleeting glimmer of his former self--a years' reprieve before he descended back into the cycles of mania and depression because the side-effects were so unbearable. What is (has) to become of him?

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Jul 24, 2022Liked by Freddie deBoer

My wife and I are dealing with a son who today became an involuntary patient at his local hospital. Thank you for a clear-eyed look into what we may need to walk through with him.

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Jul 24, 2022Liked by Freddie deBoer

As retired professional who has lived with severe anxiety and panic disorder, there are huge gaps in my life that I don’t remember very well. Your article was The most compelling and honest piece of writing about mental health, mental illness and all those four words enclose. You are an amazing writer. I love your Substack. And we are both graduates CCSU, although I graduated from that fine place of higher learning in New Britain decades (maybe two) before you.

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Jul 25, 2022Liked by Freddie deBoer

My sister has a sack of medications for her bipolar disorder. They have the usual unpleasant side effects. Every so often she says to hell with it, and either flushes them down the toilet or swallows a whole bottle of something. Your piece helps make sense of that.

With the help of these drugs and some excellent psychiatric treatment, my sister is still alive. Thanks for shedding light on the challenges of an illness that can be difficult for the rest of us to understand.

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Jul 25, 2022Liked by Freddie deBoer

I appreciate this so much - and more than anything, I'm deeply impressed that, despite all of these intense side effects, you still manage to write so prolifically and so beautifully (even when I intensely disagree with you, which isn't so often, I am never angered because of the way you make a point. That is impressive if you knew me).

More specifically, I want to emphasize with this, which made me tear up in my office to the point where I had to stop reading this piece (I'll come back to it later at home): "I have several times been in a meeting and repeated to myself “I’m paying attention, I’m paying attention” and will suddenly realize that I have been staring off into the distance while the subject of the meeting went whistling past me. I just lose time."

I have ADHD, which has only gotten worse as I age. And when I'm unmedicated, this describes exactly what happens to me on a near-constant basis. I struggle to be present in meetings; if I'm with friends and the topic changes to something like work or politics, something that can bring me anxiety, I feel myself shutting down. All of this is exacerbated by weed, which I used to love and now can't smoke.

On the other hand, when I'm medicated (previously dextroamphetamine, now lisdexamphetamine), I struggle with anger management. Dextro gives me the jitters and sleeplessness, lisdex is much smoother but can make me anxious, or inappropriately horny. Both have at times tempted me toward drugs (which I can usually manage reasonably, but sometimes binge). I worry sometimes that amphetamines make me slightly manic (I was diagnosed bipolar II once by a psych who saw me for only ten minutes and am not sure if I am, but have never had the insurance to be able to seek a proper diagnosis).

Anyway, all of this is to say this piece deeply resonated, I look forward to finishing it, and I empathize and remain impressed by your writing.

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Jul 24, 2022Liked by Freddie deBoer

Thank you Freddie for this brave and enlightening essay.

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"I do not spend my time dreaming of better drugs. I dream of the days when I will not take any."

A huge allure of the MDMA/psilocybin/ketamine treatments is that the protocols all seem to be very short --- a few sessions at most --- as opposed to ongoing medication. Though they do seem targeted at depression / PTSD rather than manic episodes.

At the risk of seeing everything through a "what worked for me" self-centered filter: in my experience with hard-to-treat physical issues, medical doctors, even good ones are very far behind "the state of the art" in terms of research. Fortunately, medical research papers aren't actually that hard to understand, so you can go and read a bunch (even as a civilian!) and get a reasonable view of what the current thinking is. What is hard to understand is how to weigh different claims, esp given that research is crippled b/c they cannot ethically randomize experiments. Fortunately, your professional expertise in weighing evidence, cross-checking, etc applies here as well.

I hesitate to give an example since accuracy requires length and length makes me seem like a standard blog crank, but in the interests of concrete evidence, here's one: I had achilles tendinopathy for years and went to afaik a widely respected podiatrist at an expensive hospital for many of them. Treatment was standard: ice, stretching, heel lifts, possible long term immobilization to "rest" it. Condition stayed bad. Eventually I got irritated and spent a few hours going through NIH pdf's. Immediately, the use of eccentric calf exercises to treat popped out (" Alfredson protocol "). I did this and within a few months, no pain, seems cured (at least as far as that kind of thing can be --- could easily pop up again). Key things: (1) the MD I had been seeing had never heard of this, despite it being widely known in the research community, (2) the recommended treatments of immobilization would have made things worse, (3) any intelligent civilian could read these papers and figure this out.

Same thing happened with plantar fasciosis (incorrectly called fasciitis in many cases).

Of course, mental health is way more picked over, so perhaps the gap in knowledge is not as severe. But could be worth a few hours.

Good luck!

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I've been avoiding reading this post even though you're one of my favorite writers. I can tell you that reading this article was physically painful for me because I recognized so, so many of these side effects in myself. I take two medications for my mental health, one of which is mentioned here. I have gained so much weight that excess fat is now being expressed in a rash that appears at random all over my body, a condition called eruptive xanthomatosis. A succession of dermatologists was unable to diagnose this phenomenon, and the anxiety from that medical roundabout led me to stress eat, which I know now made the rash worse. I, too, pee 10-12 times a day, and the extreme and constant constipation has absolutely wrecked my butthole. I will tell no one of these troubles, and I confess to them here only because I am anonymous. This article was very painful to read, yet I know that were I to go off these medications, there is a significant risk that I would die or suffer permanent disability.

You are exhausted because life is pain.

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You are really cool for sharing this (and thanks to the shout-out to ADHD-ers). Congrats on sticking with the meds!

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Thanks for telling me things I never knew.

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With regard to focus, amphetamines, and feeling too "hot": Speak to your doctor in 2023 about Vyvanse. It goes off patent then. As you probably know, Vyvanse (Lisdexamfetamine) is less habit forming, less euphoria inducing, and for many people avoids some of the jittery 'speedy' effects of amphetamines.

Those who qualify (by making less than $~60,000 USD a year) can get Vyvanse for free or substantially less than the typical $300 per month. https://www.reddit.com/r/ADHD/comments/d63gky/i_applied_for_shire_cares_prescription_assistance/ Other countries have similar programs via Shire or elsewhere if insurance does not cover Vyvanse -- Google "Vyvanse patient assistance program"

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Bipolar Type 1 here. I can’t thank you enough for writing this.

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I love your writing, especially about mental health issues—it’s why I’m a paid subscriber. I think that, considering your self-described problems, the prodigious amount and quality of your writing is amazing, heroic!

Not sure if you’ve touched on it elsewhere, but what is your position on what to do about severely mentally ill homeless people who refuse medication, thus making them, truly, “a danger to themselves and others”? I live in Portland (the infamous one), and what once was a thriving, clean and functional city, a model of civic order, has become unwelcoming and in some areas dangerous because of this problem. The libertarian in me recoils from forcing people to take anything. The liberal part wants to treat them with compassion and help them function in society. The conservative in me thinks too much compassion is unhealthy, and that you need civic order for everyone to prosper. And for that to happen we need much more funding of psychiatric services, but also, unfortunately, coercion to force potentially dangerous people to take their meds. Opinion?

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bipolar is reversible, with work, google reversing bipolar on google images and message me, I have all the get well plans, truly

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Thank you so much for writing this. I’ve been suffering from depression and GAD and gained 10-15 kgs within 2 years after my hospital stay. I used to have really good metabolism and be very skinny despite not being a sporty person, and now I can’t bear to look at myself anymore. I’m glad someone I read a lot and respect has been open about a similar problem.

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