Well if people around you haven’t ever noticed any manic or hypomanic episodes in you and you didn’t report having these to the nurse practitioner then I feel like the bipolar diagnosis probably isn’t a good fit.

Atomoxetine

I really shouldn’t gloat by saying that I called it. Suffice it to say that your post set my expectations for this clinic at that level and this tracks.

Sorry you’re having a bad time with it. Go rest up and come back to this post/situation/both of them when you’re feeling up to it - there’s no time pressure.

Not to come off as dismissive of your concerns but it’s basically a rite of passage for a late-diagnosed ADHDer or autistic person to collect at least one mood disorder before arriving at the correct diagnosis. If you’re AFAB or PoC then you can pretty much expect to run a gauntlet of mood disorders before you reach the finish line.

Try not to invest too much in the label - it’s just a descriptive term but the condition that you have, whatever it happens to be, and the symptoms you experience are the same today as they were yesterday. You could call yourself haunted, you could call yourself bipolar, you could call yourself mad; that doesn’t have a determining effect on what you’re dealing with.

Obviously I’m not saying that you should go collecting diagnoses or that there isn’t a degree of impact that a prior diagnosis may have on the type of treatment you receive but try not to get too caught up in the whole thing.

As a personal example, my psychiatrist has broached the idea of a diagnosis of chronic fatigue with me on multiple occasions. Each time it has been mentioned I have expressed my reticence towards it - I am not in the business of collecting diagnoses, a chronic fatigue diagnosis doesn’t open up opportunities for better management or treatment of what I’m dealing with than what I already have, and I don’t really need clinical validation where it’s basically saying that I’m tired all the time, except it’s Medically-Approved™. For me it seems as though getting diagnosed with chronic fatigue would serve no purpose and so I see no use in it. Whatever it happens to be you can name it, you can choose not to name it, but ultimately if naming it doesn’t create opportunities for you - whether that’s a better way of understanding and managing the condition, more avenues for treatment, access to supports and accommodations, or that sort of thing - then a label is not a useful thing and in that situation I’d seriously consider whether I need to carry it with me at all.

Yeah, I definitely think there’s a role for nurse practitioners and I feel like some of the more commonplace psychiatric conditions like depression and anxiety is up their alley. Agreed on tweaking and maintenance work too.

But if I had bipolar I’d be going to a psychiatrist, same for ADHD.

The hasty bipolar diagnosis is iffy and then going to aripiprazole just doesn’t seem to have a good rationale behind it - we can presume that they didn’t give a Bipolar I diagnosis for obvious reasons. That leaves BD II and BD NOS, but if this is the first time seeing a patient then you can’t really eliminate schizoaffective disorder and messing with dopamine in this situation is simply ill-advised.

Chances are if it was one of those 3 the aripiprazole would probably be fine but it’s just a bit of an unnecessary risk and tbh I’d expect a prescribing professional to want to stabilise the condition first before (potentially) introducing antipsychotics, all things being equal.

Definitely echoing the need for a second opinion on this one.

I’m afraid to take this drug she gave cuz I really don’t need to be even more tired all the time… or tardive dyskinesia or something

Aripiprazole isn’t too bad. Obviously it’s a psychiatric med so there’s going to be some people who don’t vibe with it, naturally. It’s unlikely to knock you out like quetiapine - some people find it activating and some find it to be a bit sedating depending on how you happen to respond but it’s very unlikely that you’re going to be a zombie on it.

There’s a chance that it might have an effect on your ADHD symptoms but evidence supporting this is pretty slim.

Honestly I’d be looking for a different prescribing professional. A hasty bipolar diagnosis is sketchy, aripiprazole as the first treatment is very questionable… I think that’s a fair indication that you’re going to be pushing shit uphill trying to get an accurate diagnosis and a coherent approach to treating symptoms.

Without knowing more, this is the kind of situation where I’d expect it to take at least 3 months, likely longer, to eliminate bipolar and to move onto a more accurate diagnosis. Then you have to cross your fingers and hope that they land on ADHD. Then I wouldn’t be surprised if they prescribed you something wack like guanfacine monotherapy or atomoxetine straight off the bat, which could easily blow out your timelines by another 6 months before you might be able to get around to the first-line treatments. Idk if I’d be willing to piss a year up the wall trying to chase down an accurate diagnosis unless it was my only option.

Obviously this is just speculation but it’s what I’d expect from a nurse practitioner who is apparently so haphazard in their clinical practice.

aripiprazole can be diagnosed to help with bipolar I depression, but the first-line treatment remains lithium. I’m not a medical professional, just a guy with Bipolar II, but immediately giving you abilify without trying you on lithium first does not sound like the usual course of treatment.

Agreed.

I could absolutely see someone prescribing valproate instead of lithium because it’s a bit easier to manage the dosing of it. Same for lamotrigine but I would be questioning why a prescriber would reach for that first if they did.

The only way that I can square aripiprazole-first treatment for bipolar is if it was a BD-NOS diagnosis, and even then…

I’d love to witness the chaos if English switched to IPA for spelling because of all the differences in accent and regional pronunciation.

I feel like it would fragment written English into something that is borderline mutually-unintelligible between different regions.

If you’ve ever read any old English writing that hasn’t been edited to reflect modernised spelling but instead it’s a wild mess lacking standardisation that you sorta have to read aloud as you sound out the words to make sense of them, like a kid learning to read, I think that’s what it would devolve into.

It would be super neat to have someone whose native written script is the IPA too - it would be fascinating to see how that shapes the way they see the world.

Geoduck
Colonel
Yacht
The whole ought/bough/dough/thorough/slough mess
Debt/receipt/island and associated re-Latinisation of spelling

I think ballet gets a pass, being a loanword. Design isn’t so bad either because it’s just de+sign with a bit of a shift in the consonant, although it gets messy when you dee-zine something but you give something a dez-zig-nashun - are we going long or short on the Dee part? Are we going to say the G or are we going silent on it? Can we please aim for a little bit of consistency?

At the risk of being guilty of self-promotion, what do you make of my recent comment?

Does it come off as full-on Russian propaganda to have a very dim view of Putin repatriating Denikin’s corpse and interring it with state honours, and considering what the implications are for Putin’s political position?

You’d think that a Russian bot would uphold Denikin as a national hero and that they’d applaud such a thing…

Interesting.

This reminds me of a game I came across that was pretty similar which took you through the dawn of civilization and it was choose your own adventure where you were posed different binary choices based on historical developments and you’d take a path (e.g. opting to domesticate grain leads you down a mesopotamian path and opting to herd animals leads you down a Mongolian nomadic path) but it was really pretty materialist and it didn’t shy away from class conflict.

I wish I could remember the name of it.

Edit: Don’t ask me how I managed to find it - Idle Civilization: World Story
https://play.google.com/store/apps/details?id=su.nkarulin.cardshistory

That’s peak crybully shit.

The SPD very clearly signalled who they were willing to work with and who they were unwilling to work with. History stands as testament to this.

Blaming the KPD for having the correct line on social fascism and recognising the SPD for what it was is political victim-blaming.

This is pure speculation but I could guarantee you that if the KPD had collaborated with the SPD then they would have been scapegoated for it. Instead they took the correct line and resisted, and they get blamed for being too intransigent and engaging in factionalism that facilitated the Nazi rise to power. It would have been yet-another example of that unfalsifiable orthodoxy.

I have such a soft spot for Gore Vidal.

One of my favourite quotes to drop on a liberal who is in the process of radicalising comes from Vidal:

There is only one party in the United States, the Property Party … and it has two right wings: Republican and Democrat.

Republicans are a bit stupider, more rigid, more doctrinaire in their laissez-faire capitalism than the Democrats, who are cuter, prettier, a bit more corrupt — until recently … and more willing than the Republicans to make small adjustments when the poor, the black, the anti-imperialists get out of hand. But, essentially, there is no difference between the two parties.

This was written half a century ago, which I like to remind people of when I drop it on them.

It’s all well and good to quote Lenin or Luxemburg at someone but it’s easy for a lib to dismiss this as commie propaganda. But when you have a respected figure like Gore Vidal laying down the truth in very plain language which is free from Marxist jargon, I think it becomes pretty difficult for them to ignore it.

Is it the be-all and end-all? Of course not. If I had it my way they’d be reading Lenin and Rosa and all of that good stuff. But if someone takes the message from this quote on board then it will achieve far more for the left than anything that Va*sh could ever lay claim to.

I don’t think that this is a very charitable interpretation of what I have said.

I explained why I do not agree with Russia’s military offensive as being about denazification. I didn’t explain how I personally understand the conflict myself or what I am drawing upon to analyse it.

Eyyy, I’m really glad to hear it! It’s a deceptively simple game but it’s super addictive and I’m glad that the recommendation was a good one.

Yeah, the Casus Belli is flimsy af. Just because it is true, or largely true, is not sufficient to mean that this was the real reason for Putin’s move.

I think that the breakaway states in the Donbass need(ed) to be defended and that the Crimea was under threat as the next likely target but this was a geopolitical manoeuvre imo.

Idk it’s just hard to swallow Russia’s military offensive as being anti-fascist when you have Putin repatriating the remains of Denikin and Ivan Ilyin to inter them with state honours.

I wonder if it should be something like /c/healthcare since /c/medicine implies a lot, whereas healthcare doesn’t carry the same baggage of implication but it also casts a broader net given that someone might be seeking advice about, idk, navigating the healthcare system or developing skills for self-advocacy as a person seeking healthcare and similar things. Just a thought.

This man is a lawyer.

Do you know who else were lawyers? Fidel Castro and Vladimir Lenin.

The woman who killed Che’s murderer.

I forget her name but she was of German descent and was raised by Nazis who escaped Germany to South America by the ratlines.

I’m not saying that she was a Nazi herself that did a full 180 but to be raised in a culture like that and then in adulthood to join the ELN and to take out the Bolivian military commander who ordered Che be killed is very impressive and also heroic af.

Nietzsche

Interregnum

Getting strong Rick Roderick vibes

I struggle with writing a lot too. In fact, speaking as well. There’s a lot of things, even insignificant stuff like comments that I will draft and halfway through I drop them or I’ll have a whole comment written out and as I’m proofing it for clarity of reading and for errors I’ll just be like “Nope” and I delete it and not respond.

There’s a few elements that I think can be teased out from your post:

• Autistic masking

• Understanding your purpose for writing

• Criticism, internalised criticism, self-consciousness, and how people are remembered

• Maybe radical acceptance sorta stuff

I’m just going to do a scattershot reply so don’t expect this to be particularly coherent.

With regards to understanding your purpose for writing, I think this is worth reflecting upon; are you writing for self-expression, for enjoyment, for recognition and praise, or maybe other things.

If you are writing for self-expression it’s not necessarily going to be enjoyable. Think like people writing down their thoughts after a difficult breakup - it might be useful and cathartic but it’s not necessarily going to be an enjoyable process. Gratifying, perhaps, but it’s hard to imagine tear-streamed writing about heartbreak and being like “This Is fun, I should do this more often!”

If you enjoy playing with words and finding ways to describe things then obviously it’s a leisure activity of some sort to you.

If it’s about getting a publishing career or to edify others or for recognition then your purpose is obviously going to be very different.

Worth noting that these things and others can overlap too.

But if you’re writing for your own pleasure or self-expression then it doesn’t really matter whether other people get anything from it, y’know? It can be hard to internalise this idea without pondering it and maybe hashing it out with the self-critical part of you or the part that feels that deep shame.

I have known artists and they tend to be pretty insular about their craft. If you get it, cool. If you like it, cool. If you don’t understand it or it doesn’t vibe with you, whatever. There’s a significant degree of generosity on behalf of a person who decides to share things with you, even if it’s just some rambling armchair psychologizing comment on Hexbear, and it’s important to keep that in mind - they are inviting you in as a guest, to some degree, and if someone is going to demand that you rearrange your furniture then you don’t really need to take that on board or to invite them back in as a guest in future. That’s probably a bit abstract, I know, but when you are sufficiently satisfied with what you do then you don’t really need the validation of others and so if someone doesn’t like what you do then you aren’t going to be inclined to chase their approval and if they think it things could be better then it’s easier to take an attitude of “Okay - if that’s your preference then you can make something to your tastes yourself or you can look elsewhere”. Not in a bitter, vindictive sort of way but just an amicable sort of recognition that this isn’t for them and that’s their responsibility that you don’t have to take on.

One piece of wisdom that I came across a long time ago is this: you will know that you have a sense of fashion when someone else doesn’t like your style.

I think this can be applied pretty broadly - you know you have a personality when someone clashes with it, you know you have made good art when someone dislikes it etc.

It’s not a hard rule nor am I saying that people should be as offensive and confrontational as possible but I guess it’s worth reflecting upon - few things are universally loved, especially when it comes to art, and if you are writing something that is completely inoffensive and that nobody will take a dislike to then you’re probably a technical writer and you’ve probably authored something with all the flair of an instruction manual.

So maybe just do some writing exclusively for yourself. Or maybe write for the sake of writing and make a clear committment that you aren’t open for criticism on it, it just is how it is and that’s the end of the discussion.

It’s also worth keeping in mind that even highly regarded artists are remembered for their best works and the stuff that is middling often gets ignored or overlooked. And their bad stuff that gets produced usually doesn’t get much attention, especially outside of the period that it is released. And I can guarantee you that there’s a mountain of material that ends up on the metaphorical cutting room floor too.

Often a lot of it is about honing your craft and producing a lot. Some stuff you produce is naturally going to be better than other stuff and that’s fine. It’s very rare that an artist will just produce one thing or one set of things like an album or whatever and that’s it, especially if you take into consideration their pile of drafts and their discard pile.

So maybe it’s about embracing the fact that some of the stuff is necessarily going on be mediocre or worse. There are plenty of examples of novels that are highly regarded as stories which have varying degrees of bad writing - whether throughout the book itself or whether it’s some really clunky sex scene or there’s a character that’s written in a really goofy/awkward/annoying way or something else.

It’s exceedingly rare that every sentence is poetry and that each sentence builds upon the last to create a finished product that is the pinnacle of flawless writing.

Then there’s the stuff about autistic masking and how it’s etched into your brain via social trauma.

This is a big discussion but if you have people who accept you for who you are, and more importantly if you are accepting and nurturing of yourself, then it might be helpful to reflect on this and to recognise that you aren’t going to experience the same rejection for your writing as it happened in that time in your past. You aren’t going to lose anything by writing, there’s not a whole lot at stake especially if you aren’t choosing to stake a lot of your identity or self-worth on something that you have written.

You are allowed to afford yourself the grace to write things that are imperfect or flawed or, heck, even just straight-up bad.

[CW: for discussion of meat]

Start incorporating TVP into your meals, learn some good lentil recipes, work on transitioning your comfort foods and favourite recipes to being vegan.

Substitute products like vegan “meats” are great but they’re usually pretty pricey and tbh if you can make them a sometimes food rather than basing your diet around them it’s going to be better for you and your budget.

I like Bold Flavor Vegan and Chef Jana on YouTube - they’re a really good intersection between good recipes that generally do not require extremely elaborate methods or really obscure or expensive ingredients. Sauce Stache is… okay and he’s been improving on the last couple of years where it was really clickbait viewing-experience cooking where it’s like “iain’t makin’ that…”

Try to pitch low with your cooking and your recipes - you want to make your stuff easy and accessible for those low energy days or when you’re been extremely busy. Save the fancy stuff for if or when you feel like spreading your wings.

Also take a scientific approach to replacing animal products based on what purpose they serve in a recipe, don’t look for a 1:1:

Does ground meat add texture to the dish? Is it protein that you use it for? Does the saturated fat provide delicious mouthfeel and richness to the meal?

Once you understand the purpose(s) that an animal product serves a dish, you can replace those with other ingredients that serve as a good approximation.

For bacon, usually it’s saturated fat + smoky flavour + pork taste.

You can replace bacon in most recipes using non-virgin coconut oil, smoked paprika and/or liquid smoke, and vegan pork broth powder.

if a recipe uses butter to add richness and a little bit of sorta creaminess then a bit of cashew cream can replace it since you don’t need the cream for its other qualities, if that makes sense.

It’s really hard to say exactly what the path for you is because it’s really dependent upon your lifestyle and especially your food preferences - if your food is pretty culturally Thai then it’s going to be wildly different from if it’s culturally Greek or culturally American, y’know?