My psychiatrist isn’t the brightest crayon in the box

Has anyone ever thought that their psychiatrist was prescribing inappropriately? Mine has prescribed 450mg SR and I’m supposed to take it all in the morning. But all the reason ems I read say that for the SR formulation the maximum dose is 400mg per day and should be taken as no more than 200mg in a single dose and doses should be eight hours apart. I’m not concerned about the 450mg vs 400mg as in my country we only have 150mg tablets, so 400mg isn’t an option. 

Doc said to take in the morning as otherwise I won’t sleep. But I’m no expert but I think I would rather take my chances on the insomnia than decreased seizure threshold. But doc’s risk benefit:analysis isn’t particularly strong.

I have already been taking them as prescribed but I’m considering just moving 1 150mg tablet to the evening.



I’m really dark at the moment because my boss knows about my mental health, and in quite a lot of detail I might add. Yet last week, when I was obviously having a bad week they didn’t even ask me if I was ok.

It’s so weird that when you first meet people you can tell whether someone is a good person to tell about mental health issues. On the bright side, I was on point with my judgement. But I’m still pissed.

I’m just trying to function and people want me to function better. I wish people weren’t so shit.

I Need Treatment Goals…

I just seem to be off in my own little world at the moment. It kinda reminds me of being a child. I think I’m overtired. . .

So I started this post a few days ago, haven’t gotten any further. Probably a nice summary of my general motivation to do anything right now. On the bright side if I’m not posting it usually means that my sleep is going good because if I’m posting regularly, it’s usually in the middle of the night and because I can’t sleep.

I have so many things that I need to do and I keep putting them off until the last minute. It needs to stop, but I can’t stop it. There is just this weird mental block there.

It’s really weird being at work, being a mental health patient and having no one know about it. Hearing the way people speak about mental health related things. People act like the people who get really angry are “mental”. But the thing is associating those people with mental health issues is wrong. The majority of people with mental health problems have way too much anxiety to express their anger at someone. Most of the time they can’t even go back and tell the cashier that they were given the wrong change.

I think I have been outwardly way more “flat” recently, which is annoying because soon I will have to deal with all the comments that go with that. If my boss bitches about it I will be annoyed because they told me not to chew gum, so with that comes no facial expressions. The person who is my main person I deal with through mental health was like maybe try mints…. what is the difference, how are mints ok and gum not? The strange concepts that go on in neurotypicals minds…

When I complained about the whole gum thing to other people they said, just claim its nicotine gum. The idea is good, other than the fact that I obviously don’t smoke. But the idea that it’s only ok if you are doing it to try quit smoking…

Sometimes I wonder how the people at work would react if they knew how mentally fucked I was, “I think they would be like oh shit have we said anything bad?” To which the answer would be, no, but you’re very nieve.

Anyway back to me. Mental health wants me to set goals… I’m not really a goal setter, all they do is make you feel shit when you fail. But they will get angry if I don’t have any, so please comment with any treatment goals you have had in the past…





I’m in the mood for some philosophical thinking around psychology/psychiatry.

Reality is defined as the state of things as they actually exist, as opposed to an idealistic or notional idea of them and psychosis is defined as a loss of touch with external reality, as per Google of course. These seem like simple definitions, but lines get very blurry very quickly.

Let’s start with religion, so many people claim that they hear or see God. a very minimal percentage of this group get a psychosis diagnosis. But if you hear voices that are from other not visible beings you’re “psychotic”.

Some scientists believe that it is more likely we live in a simulation than not. We could be the Sims 100. Imagine if all my depression could be attributed to some loser picking the gloomy trait for their sim…

Anyway, this whole thought came about because the psychiatrist asked if I had ever heard voices. Which I have but only when I’m trying to get to sleep so I don’t think that counts, well hopefully not.


My Psychiatrist is an Idiot

My Psychiatrist is an Idiot

So last week I saw the psychiatrist, in short, they were an idiot. They, first of all, wouldn’t shut up about therapy bullshit. It’s not that they were wrong, but the reason I was referred to a psychiatrist was that the general consensus of the people who had assessed me was that I was too busy to be able to do therapy properly. Which is true.

That wouldn’t be too bad but the medication option was to switch out venlafaxine for sertraline. The Psychiatrist was all like, have you tried sertraline? And I was like, no, but I have tried fluoxetine and escitalopram. For anyone who doesn’t know their antidepressant pharmacology, which apparently includes psychiatrists… Fluoxetine, escitalopram and sertraline all fall under SSRI. General guidelines say try one SSRI for about 8 weeks if there is still no response switch to another SSRI for another 8 weeks or you can increase the dose it varies a little bit. But overall once you have tried two SSRI you then switch out of class, which is when I was put onto venlafaxine.

Fluoxetine, escitalopram and sertraline all fall under SSRI. General guidelines say try one SSRI for about 8 weeks if there is still no response switch to another SSRI for another 8 weeks or you can increase the dose it varies a little bit. But overall once you have tried two SSRI you then switch out of class, which is when I was put onto venlafaxine.

Venlafaxine is classed as a SNRI so instead of only inhibiting the reuptake of serotonin it also inhibits the reuptake of noradrenaline. A lot of Drs will use venlafaxine to switch out of the SSRI class as it offers some additional opportunity for response with a minimal increase in side effects. I also take mirtazapine which is an atypical antidepressant so is also not a SSRI.

Anyway back to me, because that is the real importance of this rant… My main point isn’t what the guidelines say, it’s that when I tried both the SSRI’s I had no response at all, they did nothing. I got no side effects, but also no response, it was like they weren’t there. When I took venlafaxine above 150mg I have an improvement in my concentration, but other than that not a lot happened and long term I got a lot worse purely because my depression just wasn’t being treated.

Then sometime late last year I managed to convince my GP to add mirtazapine on top of the venlafaxine. Which within a week actually did something. I mean not fully recovered but at least it pulled me out of my suicidal phase.

The thing is the fact that my response to mirtazapine occurred so fast would suggest that the venlafaxine may have contributed to the response. Don’t get me wrong this combination is far from perfect but it is doing something and to seriously rock the boat by removing one for a fucking SSRI is just stupid based on my past history of response.

Anyway please tell me someone else follows my logic. If anyone got this far that is…..


So after the last time when I tried to ask for help with my studies I was told to make a Dr appointment, I did. They increased my medication so that’s something. But they said they would refer me to the mental health team because I would be better suited there. Which would be great if I wasn’t already with mental health a month and a half ago, but they decided I wasn’t sick enough. Typical mental health care, it’s all just circles. 

I’m supposed to be getting some free councelling though, through another seperate thing that is short term. Even though throughout my medical records it specifically says”needs long term psychological support “.