Methadone mg to equal 100mg of moraphine

Hi all! 35F here, and I’ve been on Caplyta for nearly a year. I am diagnosed bipolar 1, but I’ve only had one major manic episode in my life (reason for diagnosis in 2018). The rest of my life has been plagued with intervals of depression, hypomania, and waking up with the doom and glooms.
Despite having the same amount of stressors as I did one year ago, I feel substantially different, changed, improved, born again, even. I can’t imagine not being medicated at this point, something that I struggled with at the beginning of my bipolar journey (diagnosed in 2018).
The NP started me off on 42mg, and the dose never changed. Side effects subsided within the 2-4 week mark. And it lifted my depression, but did nothing for my hypomania. I am still relatively excitable and seemingly refuse to go to sleep at a decent hour. I call my lack of sleep self-inflicted because once I CHOOSE to go to sleep, I’m out like a light within 10 minutes. So the bipolar doesn’t keep me from sleeping, but I think it feeds my late night curiosity.
The clinic assigned me a new practitioner to no fault of my own. We added lamotrigine to combat hypomania and irritability, first at 25mg, then 50mg, then 100mg and I don’t feel any different than not having it at all. We added gabapentin 300 mg which seems to make me sleepy along with the Caplyta when not taken at 2am (my usual dosing time, because, well, stubbornness).
I admitted to the NP that I am regularly sleep deprived and that perhaps my irritability will not be resolved until I dominate old habits in that department and start taking my meds at a reasonable hour along with a good bedtime routine. I have been a bit of a night owl since the beginning of time, I can remember being 5 with a TV in my room and no strict bed time and staying up till MAS*H (the tv show) came on, on a regular basis.
Alas, I’d consider Caplyta helpful for my bipolar depression and I’ve had no notable side effects after one year of use.
Hope this helps anyone curious about a 1 year update. Share your feedback on what has helped with sleep the most, be it meds, sleep routine, etc. I am in desperate need of help in that department.

I am posting this very cautiously having not put anything on this forum for over two years. This will be a lengthy post and I don’t make it with any claim of cure, or as a recommendation. However, I feel almost duty-bound to share my experience given the impact PSSD has had on my life and the impact it so clearly has had on so many others. I know some people will have had very negative experiences with trazodone and completely respect that. I can only talk about my own recent experience. The headline is that I briefly took trazodone a few weeks ago and have experienced significant benefits. I can’t say strongly enough I am not recommending trying it. I am just relating my own experience. I am happy to reply to comments, but please be aware that I am not prepared to get into any kind of heated debate about the whys and wherefores of this, or any other medication or treatment. At times people can be very confrontational on these forms and I’m not interested in that kind of conversation. Thank you in advance.
Just for context I am a mental health nurse myself although I don’t work in acute mental health and tend to work in more niche areas. However, my employment has been sporadic in the last couple of years in part due to PSSD.
I have had PSSD without out any real improvement (until very recently) since taking sertraline in summer 2019. This manifested itself as lack of sensation, pleasure and associated ED as well as generalised anhedonia. Prior to this, although I had experienced some episodes of anxiety and depression I had no sexual dysfunction whatsoever. I was aware my testosterone level was low as had started to investigate this as a possible cause for my problems with mood. As I say I had no sexual problems so at this point it was not something I had ever really thought about. Over time I tried to accept it and not focus on it as I found this definitely impacted on my quality of life. Like many people I initially spent a lot of time investigating PSSD but found myself becoming increasingly anxious and hopeless doing so.
I have made attempts to find solutions to PSSD. I have been on TRT at points during this time and have also been seen at Imperial College and UCL for the past couple of years. I’ve tried a couple of medications that have been suggested within this community, such as yohimbine and cyproheptadine but did not experience any benefit though equally they did not make things worse. I attempted some lifestyle changes but have struggled to eat as well as I should and, reduce alcohol and caffeine, increase exercise, et cetera due to low mood. Since developing PSSD the existing anxiety and depression which I have managed pretty well for most of my life have become much more prevalent. I have avoided psychotropic medication since the short courses of sertraline in 2019 and mirtazapine in 2020 that in the first case caused PSSD, and in the second case made it worse (after a brief initial improvement). The only PSSD related medication I take is tadalafil 5mg which was prescribed to me by Dr Mears at Imperial to hopefully improve general vascular blood flow.
Last summer my 27 year relationship ended. Before becoming unwell in 2019 and taking sertraline and subsequently developing PSSD, my relationship was solid though of course it had the usual ups and downs. The impact of PSSD was massive and caused many problems. After the first year where I maintained hope that things would improve, the impact on our physical relationship and my mental state began to really caused problems. Associated anxiety resulted in issues with work and increased alcohol consumption. To cut a very long story short in summer last year my wife told me she wanted to divorce and I lost my marriage, my comfortable home and really everything that had kept me together for the past nearly three decades. After initially coping well inevitably my mood deteriorated and I became increasingly depressed and suicidal and found myself sectioned briefly for a couple of weeks in spring this year. Crisis a surprise has a mental health nurse and not an altogether positive experience!
As I say, I’m very reluctant to take psychotropic medication but I did start agomelatine in hospital. On reflection this was somewhat unwise given my history of alcohol use but I asked for it, they prescribed it, and I wasn’t really in a place to logically think it through. In terms of PSSD it wasn’t beneficial but it had a lot of other side-effects that meant I came off it shortly after discharge from hospital whilst under a Crisis Team.
I then started on trazodone 150 mg at night. Like agomelatine it is used as a third line treatment and suggested for people with sexual dysfunction. It is referred to as pro-sexual and is used at times as a treatment for ED. I was given the warnings about priapism when using it. On the first night I took it I woke up with very strong erections on a couple occasions during the night. They were not painful and after a while receded and I returned to sleep so did not take any action. At this point I had had pretty severe ED for months (I think due to poor mental state). This actually wasn’t a significant problem for much of the time I had PSSD, however, the lack of sensation meant that this was somewhat academic. My general health at this time was in a pretty bad way so although concerned about the side effects of psychotropic medication didn’t worry unduly. The same thing happened for the next couple of nights. Of course given this I attempted masturbation and found that I could achieve orgasm and the intensity increased. There was no huge improvement in sensation but the actual orgasm itself was more like normal. The nocturnal erections continued and I started to find that I was having them throughout the day. As I say there was no pain or discomfort and they resolved so I didn’t take any action. However, as I have said I am very reluctant to take psychotropic medication and given this I decided to stop it after a few days. My worry was I would develop full-blown priapism and this can have extremely serious consequences. You are supposed to get immediate medical attention if you have a painful erection that exceeds four hours. I’m not sure what your chances are of being seen the moment you walk through the door in A&E are – it’s more likely you would be there for several hours so I decided this risk was too high as I had started to experience these erections. I have to add I did this without discussing it with the very good Crisis Team I was under. I did discuss this with them subsequently, and they were understanding and supportive but would of course not recommend stopping any medication without seeking advice first. Even though I am a nurse, this isn’t wise.
However, I have now been off trazodone for about three weeks. I have continued to experience strong nocturnal erections but less so, and have some seemingly random erections during the day. After developing PSSD I lost all sense of myself as a sexual being. I wouldn’t experience interest or arousal when seeing someone who was attractive that as did throughout my life beforehand (I was married a long time-don’t judge me!) but this has returned. I have not had sex with anyone since separating from my wife, so can only judge it based on masturbation but as I said above this is easier with much more powerful orgasms. Like I say, there is still a lack of sensation, but it is a vast improvement on how I was before. It may also be coincidence, or possibly a result of this improvement, but over the past couple of weeks my mental state has improved dramatically and in fact I find myself feeling better than I have done in many years. I would give anything to be able to go back in time and not have taken sertraline and not have developed PSSD. Without it I think I would still be in the long and loving marriage I was but I’m on the road to accepting that. That is difficult and it hurts but I have to accept it to move on.
Anyway, I hope this is of help. I’m certainly not advocating taking trazodone and generally speaking feel that the dangers of psychotropic medication outweigh the benefits unless they are absolutely necessary. I would not have taken medication unless if I haven’t found myself in a situation I did. To put it bluntly, I wasn’t going to survive as my suicidal drive was so high had to do something. I appreciate it must seem ironic saying this as a mental health nurse but I am far from alone in this and I have spoken to many nurses and workers, both on a professional and personal level who say the same thing. Something I have noticed in recent time is the huge increase in the knowledge of PSSD in services. The Panorama program broadcast on the BBC last summer seems have made a significant impact. All the best to you all and keep and do your best to remain hopeful though I know how difficult this is.

Playing around with formulas and might try this out in. Trichosol Base from Fagron since it is hypoallergenic won't irritate the scalp etc and thus doesn't require sketchy corticosteroids
Thoughts on formula are as follows. Finasteride at 0.025% to equal 0.1-0.2 mg topical systemic absorption per perfect hair health formula for 70% scalp DHT reduction with < 20% serum DHT reduction estimated
Studies showing Minoxidil 0.5% + Tret has statistically significant results at 6+ months. I think Minoxidil is poison personally. Lowest dose possible to not affect heart
Fagron TrichoXidil is doing the heavy lifting as the growth stimulant here per Fagrons studies showing increased IGF-1 etc similar to minoxidil in a 2.5% vs 2.5% study they did.
Caffeine is obvious. Studies done on this showed 0.001% to 0.005% as the effective dose. No idea why some topicals use 0.1% which is 20x higher
Tea tree oil at super low dose to modulate hair, unclog pores, reduce inflammation. One of the few oils actually worth a damn. Used to treat cold sores etc.
Aloe and biotin I will throw out unless good reason to keep. Might ditch the Minoxidil and Tretinon too to beta test the TrichoXidil
Unclear if 0.025% Fin is strong enough without propylene glycol enhancing absorption
Aloe 0.05%
Biotin 0.05%
Minoxidil 0.5%
Tretinoin 0.01%
Caffeine 0.005%
Melatonin 0.003%
Tea Tree Oil 0.05%
Finasteride 0.025%
Fagron TrichoXidil 2.50%
There's a somewhat similar interesting formula here from Bayview Pharmacy
https://www.bayviewrx.com/formulas/Minoxidil-5-Tea-Tree-Oil-1-Niacinamide-0-5-Finasteride-0-016-Tretinoin-0-01-Topical-Solution-Androgenic-Alopecia-Acne-Vulgaris-Hirsutism-Hyperpigmentation-Rosacea-
And a Brazilian pharmacy where Fagron products are bountiful
https://www.bspharma.com.bmino-xidil-turbinado/p

I'll try to keep this simple. I have lupus, pseudo tumor cerebri, lupus nephritis, Hypothyroidism, chronic pain, nerve damage, POTS and some other minor issues but the list is already to long.
I have started to have a very strong smell of something that's not there. It smells like stale cigarettes. I don't smoke and neither does husband. Also some times if I'll smell like I was at a bon fire. The smell will get so intense it make me nauseated.
I made an appointment to see my PCP for next week. The soonest I could get in.
So is this something I should take action now or I'm okay to wait for my appointment. I'm asking because my husband is really worried.
Female Age: 37 Weight 260lbs Hight 5'2"
Current meds: Atenolol 25 mg Levothyroxine 100mg Amitriptyline 75mg Gabapentin 400mg Pre-natal vitamins ***** Zubsolv 0.7 mg
Let me know if you have any questions. This started a could months ago and has gotten extremely worse.

Hopefully this isn't a question with an obvious answer that I've just missed.
In the guide, it says:

400-600 mg of Magnesium daily. Avoid the oxide form.

but I was wondering if there's a form that's preferred? I seem to have issues absorbing the oral forms (excessive diarrhoea from supplements; magnesium citrate and glycinate both do it to me with as little as 100mg). I'm wondering if there might be a form that works better / if I'm just not taking it right somehow. Taking with food, mixing it into water, etc. all seem to make no difference. I am working on increasing dietary magnesium intake, but in the short term I'm wondering what other options might be viable.

Managing diabetes goes beyond monitoring blood sugar levels; it encompasses handling the various tools we use, such as insulin pumps and different insulin formulations. Throughout my journey, I have encountered numerous challenges, especially with skin reactions to different insulin types and pump cannulas. I hope sharing my experiences will help others facing similar issues make informed decisions.
Understanding Skin Reactions
Skin reactions in insulin therapy can stem from multiple sources and often develop progressively with more exposure:

• Adhesives: Adhesives are a common cause of skin reactions, characterized by redness, itchiness, and sometimes pain over the entire area where the adhesive was applied. Reactions can intensify and occur more rapidly with repeated exposure. These can be easily overcome by underpatches or completely removing the adhesive and replacing it with hypafix glued with hotglue.
• Cannula Material: Individual reactions to cannula materials vary. 'Plastic' cannulas (made from teflon) initially worked for me for about five years before they started causing reactions, prompting me to switch to steel cannulas. Cannula skin reactions are subtler than adhesive reactions, usually presenting as redness and bumps at the cannula site with intense itching.
• Insulin Formulations: Distinguishing an allergy to a cannula from an allergy to an insulin component can be difficult as both present similarly (itchiness and redness around the insertion site). In my experience, ingredients in insulin, particularly m-cresol, have triggered skin reactions. For example, both Humalog and Apidra contain higher levels of m-cresol and caused significant issues for me.

Differentiating Between Cannula and Insulin Reactions
One way to differentiate between an insulin skin reaction and a cannula skin reaction is to switch from a teflon cannula to a steel cannula. Unfortunately, with devices like the Omnipod, you cannot use a steel cannula. Instead, have your healthcare professional fill the pod with saline instead of insulin and wear it for 2-3 days to see how your skin reacts. If there's no reaction to the saline, it's likely the insulin causing the issue.
Investigating Skin Reactions: My Personal Journey
It's crucial to be vigilant when interpreting changes in symptoms, as improvement with a steel cannula may not necessarily indicate resolution of the issue. In my case, switching to steel cannulas initially appeared to resolve the problem. However, after about two years of use, I began experiencing local absorption site problems despite careful rotation of injection sites. To address this, I experimented with inserting the steel cannula more superficially by bending the Tandem trusteel needle at about a 45-degree angle. While this improved absorption, it also led to a recurrence of skin reactions. This led me to conclude that the teflon cannulas were not the primary cause of the reactions, but rather the insulin itself. Infusing the insulin more superficially, whether with a teflon or bent steel cannula, allowed me to observe the skin reactions more clearly, while deeper infusion masked them.
This hypothesis was confirmed when I conducted the saline test with Omnipod and experienced no skin reaction, indicating that the issue likely stemmed from the insulin rather than the cannula material.
The Role of M-Cresol
Research indicates that m-cresol in insulin formulations can cause skin reactions. Insulins with higher concentrations of m-cresol, like Humalog and Apidra, are associated with more inflammation. Studies suggest that removing m-cresol can lessen these reactions.
Detailed M-Cresol Concentrations in Insulin Formulations:

• Fiasp and NovoRapid: 1.72 mg/ml
• Humalog: 3.15 mg/ml
• Apidra: Approximately 2.8 mg/ml
• Lyumjev: Same as Humalog, 3.15 mg/ml
• Biosimilars: Like Admelog and Trurapi, mirror the m-cresol content of their originals, providing no benefit for those with sensitivities.

My Personal Journey with Insulin Pumps

• Initial Experience: I used a Tandem teflon cannula for about five years before developing skin reactions.
• Switch to Steel Cannulas: After switching to steel cannulas, I thought the problem was resolved. However, about two years later, I began developing problems with local absorption sites. This was exacerbated when I bent the Tandem trusteel needle to direct insulin more superficially, improving absorption but leading to renewed skin reactions. This prompted me to conclude that it might not have been the teflon causing the initial reactions but the insulin when infused more superficially.
• Saline Test with Omnipod: Conducting a saline test in the Omnipod confirmed no skin reaction, which reassured me that the teflon cannulas were not the issue.
• Experimenting with Insulin Types: I tried Humalog (Ademlog) insulin with an Omnipod, but after just 2 days, I immediately started experiencing local skin reactions, despite using FloNase before applying the pod.
• Switching Insulin Formulations: We then decided to switch to another insulin with less m-cresol, Fiasp. It worked wonderfully for about 2 weeks, but I then developed insulin resistance, a phenomenon described by many people after some time using Fiasp. Fiasp is the same insulin as NovoRapid, but it contains vitamin B3, which is used to facilitate faster absorption. Some people hypothesize that this vitamin may increase insulin resistance over the long term. Despite trying various strategies to mitigate this, such as combining Fiasp with other insulins or alternating between Fiasp and other insulins, I still experienced resistance and skin reactions.
• Transition to NovoRapid: I have now started using NovoRapid, which contains less m-cresol than Humalog, and everything seems to be going fine for now.

Skin reactions can be mentally taxing and complex. The best approach is to methodically test different cannulas (teflon/steel), different perfusions (insulin/saline), and different insulin types until you find the right combination. Research on removing m-cresol from insulin formulations has shown promising results in animal studies, offering hope for less inflammatory and equally effective insulin therapies in the future (https://pubs.acs.org/doi/10.1021/acsptsci.1c00047).
Also, if you keep having skin reactions even with insulin containing less m cresol, know that some physician were able to desentitize a children to this component so he could use insulin in insulin pumps https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-6-263
References
· https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9760098/pdf/nihms-1843053.pdf
· https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1398-9995.2007.01567.x
· https://link.springer.com/article/10.1007/s11095-017-2233-0
· https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-6-263
· https://pubs.acs.org/doi/10.1021/acsptsci.1c00047

Hello- I was hoping to see if anyone could help advise me on going back to spiro or not. I am, and have been, on injectable EV since the beginning of my transition 9 months ago. Since then, my levels have been as such:
3 month followup: E 72 pg/ml, T 27 ng/dl Dosage 6mg EV 1x weekly, 100mg spiro/day, 0.5 mg dutasteride/day End of month 3, Moving up ev to 8mg, switching to 2x weekly (every 3.5 days) and eliminating spiro
6 month followup: E 240 pg/ml, T 36 ng/dl Continuing prior dosage of 8mg 2x weekly with dutasteride
9 month followup: E 361 pg/ml, T 46 ng/dl Presently continuing prior dosage
So it looks like my T has been trending upwards since discontinuing spiro, yet my E is "too high," as my provider believes I should be in the 100-200 range. I disagree with her on this point, which is why I am asking y'all for a second opinion. She has suggested that I could go back on spiro 100mg/day, to lower my T and "encourage additional breasts growth," but I have seen zero evidence that spiro can contribute specifically to breast growth, beyond continuing to lower my T, and weak evidence that it could conceivably hurt my breast growth. I am definitely visibly feminizing but I had hoped for more fat redistribution by 9 months, but perhaps that could just be from being a runner and being on a slight calorie deficit. She is unable to prescribe a different AA apparently so spiro or boosting E higher are my only options here.
So TLDR, ultimately, to distill this down to a simple question; is 46 a problematic T level for feminization? Do y'all think I should go back on spiro to further reduce T, and is the slow upward trend in testosterone problematic for the future of my feminization? Are there any ADVANTAGES to taking spiro to make this feel less like a failure to me? Would love to hear any thoughts anyone has on any of this. Thank you! ❤️

I have an almost 14 year old boston terrier. He is most definitely reactive. He has a whole host of other issues as well. He has suspected sundowners as he gets very agitated and barks in the evening, worse than the day. He also has general anxiety. He also has atypical cushings. He recently had cervical surgery for a herniated disk. That is important because he started trazadone during the pre and post surgery. Prior to his disc issues he was taking: 100mg gabapentin as needed for pain or as a sedative 0.5 mg of Xanax as needed (usually evening) 15mg Selegiline every day Mitotane one day a week for cushings melatonin and lignans every day for cushings
Pre and post surgery he was on a heck ton of pain meds and other things. They added the trazadone to keep him calm. Now that he is mostly pain free he is not on the pain meds. We brought up with primary what we can do to keep him calm since he can't have as much activity out of risk of re-injury. They suggested adding Prozac. Their current recommendation is to do: Prozac 10mg once a day Selegiline 15mg once a day Xanax 0.5 mg every 6-8 hours
They also said I could give trazodone on a situational basis. The idea of Selegilline and Prozac together is concerning? I've read that is not a good combo? But maybe it's okay? He would also continue the meds for cushings. I hear of serotonin syndrome and I don't know how common it is. I have been hesitant to start the Prozac because Trazadone has seemed to work the best but I know it may not be the best long term. BUT, he is almost 14 and he has never shown his age as much as he has the last few months. I've heard Prozac can take a long time to work and can make things worse before they get better. We've been through hell the past few months and I am scared of a long loading period or making anything worse.
Because of his reactivity and risk of injury we don't go for "normal walks". I have a treadmill that we walk on. I have a fenced in yard for going potty and roaming around. We just have to be careful for neighbor dogs making noise and or bunnies/squirrels. He can't play with most toys because he gets aggressive with them. What I have done is kongs and other puzzle toys with peanut butter and treats but he gets them all so quickly and just barks and barks. I can't give unlimited pb and treats!
Does anyone have experience with this medication combos?
I’ve posed the question of its time multiple times to multiple different doctors lately and none think we are there yet. The thoughts have been creeping more and more though. The main concern is the combination of drugs and the safety to see if they help.

I’ve been plagued by RLS since my first pregnancy 30 years ago. It’s gotten progressively and steadily worse to eventually include my whole body. It amps up a lot around my cycle. For 3 days now, it’s been gone. I don’t know if I’ve done something or if it’s going to come back. I take 1.5 mg of requip per day, starting when I feel the first quiver or 8:30 pm, whichever comes first. I assumed I’d have this forever. My friend’s mom is 80 and has to take methadone for it. I feared that would be me one day. I’m not getting my hopes up too high but it would be a life changer if it didn’t come back. I didn’t know what to put for the flair!

Hello! I am conducting my thesis rn and I have some problems with the TPC part. The conc. of my calib curve was in mg/L, however the absorbance of my samples with a conc of 100 mg/L is too low resulting to a negative concentration of TPC. On the other hand, when i tried to use my 100mg/ml sample, a positive conc of TPC was obtained.
My question is that would it be okay for me to use the 100mg/ml sample?
PS: with all the papers that I have read, either the conc. of the calib curve or the conc. of the sample is not stated. Hence, I am so confused huhu

My psychiatrist became ill and stopped practicing medicine. He had me taking Lamotragine 100mg twice daily, and a combination of Ziprazidone sizes that resulted in a total daily dose of 240 mg (20 morning 20 lunch 40 dinner 160 before bed). Now that he is gone, with great difficulty I found a new nurse practitioner. She said that this is too much Ziprazidone and exceeds the FDA guidelines of maximum dose (she said it may cause metabolic syndrome). She says she will reduce my Ziprazidone by a third until I am below the daily dose of 160 mg.
I am already feeling it. If I go more than 4 hours with at least 20 mg I get really twitchy. If I don't take more than 80 mg at night, I have restless sleep and have trouble staying awake at work. And if I take 20mg three times a day my insurance intervenes and is like "you should really be taking one 20 and one 40 instead of three 20s". That is where the 20 20 40 daytime dose came from. My nurse practitioner's plan was to give me 160 at night and take nothing at all for the other 23 hours!
I am now taking 20 in the morning, 40 at lunch, nothing at dinner, and 160 at night.
I was solid as a rock for over 5 years in the 240 mg daily dose. I am really concerned about tapering down and I don't feel well between 4 pm and 9 pm (I am primarily manic).
My question is how hard and fast is the 160 mg limit? Is it worth shopping around for other doctors who will give me the old dose, or is it something my doctor shouldn't have been doing in the first place?

I am prescribed 120mg test cyp per week. My labs came back as :
Total testosterone: 421ng/dl
Free testosterone : 9.1pg/ml
Estradiol: 30.5pg/ml
The total test kinda had me shocked I figured it would be at least 600-700ng/dl seeing how everyone seems to be near the top or over the top of the reference range on 100mg test cyp a week .
I pin mon/weds/Fri divided equally sub q with a slin pin.
My free test is pretty much on the border of low ( low end of reference range).
Is there anything you guys can suggest or that I can do to improve the free testosterone ?

Helldivers 2 has gotten a little stale recently with the Polar Patriots warbond new additions being mostly bad, the Airburst Rocket Launcher also being bad, and the new anti-tank mines actually look decent but will probably have to long of a cooldown so they will be niche. I'm proposing changes that could spice up the game by changing up enemies, modifiers, and weapons. Let me know what you think about the changes and what could be improved as I'm not a game designer and just want to see Helldivers 2 be better.
Assault Rifles
Assault Rifles are probably the worst class of guns in Helldivers, they don't excel at anything and aren't even that good allround. They need massive help
Liberator: Currently the base Liberator is just a worse Sickle. Not only does the Sickle have infinite ammo but for some reason it has higher DPS. I would reccomend changing its damage to 70 per shot and 11 shots per second bringing up its damage to 770 DPS. To go with the higher firerate, changing the reload time to 1.5 seconds on tactical reload and 2 seconds on a full reload would make the gun feel much better as a starter gun because it would just feel faster and kill better.
Liberator Penetrator: Liberator Penetrator is one of the worst weapons in the game. It has medium armor penetration but lacks any stopping power for it to be useful. Bringing the damage per shot up to 60 and upping the ammo to 35 bullets per magazine will take it a long way, having 640 DPS and medium armor penetration but having less bullets
Liberator Concussive: Liberator Concussive has the same probelm as the Liberator Penetrator in that it can't kill but even worse. I would reccomend bringing its damage up to a whopping 90 damage per shot. This sounds crazy but the changes to enemy spawns makes this more fair which i will discuss later. This increase in damage would give it a niche of a long range way of stunning bot enemies and actually being able to kill them. DPS would be 480 which isn't that crazy but the concussive ability would help. If I'm being honest this one might still be to weak so tell me what you reccomend changing for this gun.
Tenderizer: Tenderizer is in a very bad spot because it's an inferior Liberator even without my changes. I would reccomend bringing up its damage up to 70 per shot giving it a DPS of 700. In addition, because the DPS is lower I think giving it a small amount of stagger where enemies can't move or shoot back could go a long way in differentiating itself from the Liberator. Making the Tenderizer stagger enemies such as Hunters, Brood Commanders, Scout Striders (Striders wouldn't be damaged because of the lack of medium armor penetration but would be staggered if hit from the front), and standard Devastators would make the gun much more fun. Also make it fully resupply when refilling with resupply boxes like all other weapons.
Adjudicator: Adjudicator is in a pretty bad spot right now. It has poor handling and the damage isn't high enough to reliably one shot trash mobs, but it also doesn't have good enough damage to deal with more serious threats. I would reccomend bringing the damage up to 100 per shot for a total of 916 DPS. This would help justify the lower than average 25 bullets in a magazine.
Marksman Rifles
Marksman Rifles are in a decent spot with only the Diligence needing some help so that's what I've focused on.
Dilligence: The Dilligence is hard to balance as it is decent on bugs and bots but excels in neither of them. In addition it's hard to juggle balancing the Adjudicator, Dilligence, and the Diligence Counter-Sniper to make sure they're all good in their own ways. I think it might be fun to make the Dilligence the "easy medium armor penetration rifle". Get rid of almost all of its recoil and sway to promote more aggresive playstyles. The Dilligence would have lower DPS than the Adjudicator but it would be much easier to control and would just feel fun.
Dilligence Counter-Sniper: Honestly this weapon is perfect right now. It fulfills its role on bots perfectly and is fun to use. I worry that the Adjudicator changes would make this gun obsolete but I think it would still have its own niche. No changes
Sub-Machine Guns
One of the most consistent weapon types in the game with really only the Knight needing some help.
Defender: One of the most well balanced weapons in the game. No changes
Pummeler: It might be to early to say but the Pummeler feels good to use and fulfills its role, being worse at trash clear compared to the Defender but better against heavier targets thanks to the stagger. My opinion could change but for right now I don't think it needs any changes. no changes
Knight: The Knight is right now pretty bad just because it has a low ammo count for its firerate and fairly long reload time. These 2 factors just make the gun feel unfun to use because you are spending so much time reloading. It takes only 2 seconds to unload a full clip and 2.5 seconds to reload a full clip so you literally spend more time reloading than shooting. I would reccomend increasing the ammo per magazine from 50 bullets to a staggering 100 bullets per magazine and lowering the total number of magazines to 5. This would change the weapon's problem from "I have no ammo" to "I need to control my recoil so that I can kill better". This gun would reward close range play and good recoil management, being able to deal massive DPS if you can hit your shots.
Shotguns
Shotguns are probably the best class of weapon, issue being that some shotguns heavily outclass others. My goal is to equalize the difference between the shotguns and give them their own niches
Punisher: The most forgettable shotgun, the Punisher really just doesn't feel special. I admit that I don't have much experience with this gun so please tell me what you think about this gun currently. I think it would be cool if this shotgun was a jack of all trades shotgun. Reduce the spread but still have it be there and increase the firerate to 2 shots per second for a DPS of 810. It wouldn't have the range of a Slugger or the close range damage of a Breaker but it would have a little bit of both.
Slugger: Honestly just give it back its old stagger. This gun would functionally but the "precision shotgun" staggering and killing larger targers but having lower DPS in exchange
Breaker: Really the Breaker doesn't need help. It tears through trash mobs and does well against larger targets as well. The Breaker is fun and fair. It has lower ammo and not the greatest range but it's 100% workable. No changes
Breaker Spray & Pray: Breaker S&P isn't a bad weapon at all but it's 100% outclassed by the Breaker Incindiary. The only change I would make is to give it a 30 round magazine with 7 magazines to further lean into the "Spray and Pray" aspect of the gun.
Breaker Incindiary: This gun needs nerfs. I love the thing but it outclasses the Breaker Spray & Pray and fulfills its own niche at the same time. I would reccomend bringing down the firerate from 5 shots per second to 4, lowering its DPS from 1200 without accounting for fire damage to a DPS of 960 without accounting for fire damage. This lowered firerate would make the gun lean into its gimmick and have the fire do more work.
Explosive Weapons
Explosive weapons are probably the hardest to balance due to all of the recent nerfs to the Eruptor and Crossbow. I've decided to skip these weapons as I don't fully understand how explosive damage works
Dominator: A gun with good strengths and a fair amount of weaknesses to hold it back, making it fair. No changes
Energy Weapons
One of my favorite types of weapons and one that doesn't require much balancing.
Blitzer: The only change I have in mind for this weapon is the way that targeting works. Make it so that when you aren't aiming it the gun will always try to target as many enemies as possible and when aimed in it will aim all of the shots at the crosshair
Purifier: This weapon needs more testing but is unanimously agreed to be trash. If the gun works the way I think it does then the damage is much lower than people think it is, with the bolt dealing a respectable 250 damage but the explosion dealing much less. I would reccomend making the bolt and the explosion do 250 damage, essentially one shotting any low or medium level bot including Scout Striders. This should be fair because it has a large charge up time inbetween shots
Punisher Plasma: One of the most underrated weapons and a personal favorite of mine. I love what they did to the weapon but it deserves a small nerf. Revert the projectile speed to the way it was before it was buffed or find a middle ground from where it is now and where it was before
Scythe: The problem with the Scythe is really the way damage is dealt. It deals 350 per second. The issue with this is it's slow to kill anything because it at minimum takes 1 second for damage to be applied. I would reccomend making it so that damage starts as soon as the laser touches something for the first time. This could be abused so i would also reccomend raising the charge up time to .6 seconds. I'm not 100% sure if this would work how I think it would so please let me know what you think. I'll try and illustrate what this looks like
Current version
(Laser touches, 1 second passes, damage)
Changed version
(Laser touches and damages at the same time, 1 second passes, damage)
Sickle: Fantastic weapon that is fun to use. No changes
Scorcher: Fantastic weapon, great all around with low ammo to balance it. No changes
Pistols
Pistols are in an ok spot right now but some overshadow others largely
Peacemaker: I bet you don't even know what the Peacemaker is because nobody ever uses it. The Peacemaker needs some massive help. I would reccomend raising the Peacemaker's total ammo to 25 rounds per magazine, raising the magazines to 7 magainzes total, and raising the damage anywhere from 80-90 per shot. The damage would still be just ok, being good on trash mobs, but would be a big help on builds that waste a lot of ammo. I want the Peacemaker to one shot Hunters and Pouncers as I think that's the only change that could make it actually strong and not overshadow other secondaries
Redeemer: No changes. It's very useful as an "Oh shit" tool. It would have lower DPS than the Peacemaker but would be easier to use in a pinch because it's full auto where the Peacemaker is semi auto
Senator: No changes. Great gun with it's own niche
Dagger: Literal trash, it has the lowest DPS in the game, has a large cooldown, and builds heat quickly. I would change it so that it can't overheat at all and even then it might still be trash. Let me know if there are any better ways to balance it
Grenade Pistol: Great utility weapon. The only change I would make is to make the explosion radius a little bigger to more reliably destroy bot fabricators
Verdict: It's to early to tell but the Verdict looks strong, being similar to the Senator with a better ammo economy but no medium armor penetration. Making it a reliable anti medium target weapon. No changes
Grenades
Grenades are in a weird spot right now, with some being amazing and some being bad and I aim to raise the lower end of grenades to be in line with the rest
High Explosive: No changes. It's decent having a larger blast than impacts but being slower
Frag Grenades: These things are bad. I would change the max number of grenades from 4 to 6 when holding these grenades, making them great against fabricators and bug holes
Incindiary Grenades: Raise the blast radius and it's good
Incindiary Impacts: As long as the Impact grenades radius is smaller than the normal version, it's good
Impact Grenades: No changes
Stun Grenades: No changes
Thermite Grenades: These things need help. They really only have 2 uses. 1-2 well placed Thermites and and an anti-tank shot will kill a Bile Titan and 1 Thermite will destroy a Cannon Turret. I would reccomend increasing the final explosion blast radius size, damage, and the thermite burn radius. This would cause 1 anti-tank shot and 1 Thermite to consistently kill Bile Titans, it would be easier to hit Hulk eyes with Thermites and 1 shot them, and Thermites should kill with 2 grenades if hitting a Tank heat vent. Thermites should also strip Charger armor with 1 Thermite
Support Weapons
Expendable Anti-Tank: No changes, great support weapon
Recoiless Rifle: Increase the size of the explosion making it easier to hit weakpoints, Making it stronger than other anti-tank options in exchange for the backpack slot
Spear: Fix the tracking to be much more consistent. The Spear just doesn't have enough ammo and should have 6 shots instead of 4
Quasar Cannon: No changes, has unlimited ammo but has a cooldown and charge up time
Airburst Rocket Launcher: This thing is so dogshit. It requires a backpack slot, needs to shoot enemies far away from allies or you'll kill them or yourself, doesn't gurantee killing everything in the blast radius, etc. This thing needs a massive damage buff to be worth using. Increase the amount of cluster bombs to gurantee that whatever is in the radius is dead including Hulks. Increase the armor penetration value to at least strip Charger armor and do big damage to it, if that's not enough it should kill Chargers outright
Grenade Launcher: Increase the amount of magazines from 2 to 3. This thing is great but the low ammo makes it unviable so increasing the magazines by 1 will go a long way
Railgun: This thing needs help. It should require only 2 level 7-8 shots to strip Charger leg armor. It should 4 shot a Bile Titan in the face when using max charge shots. and 3 max charge shots should kill tank vents
Stalwart: The Stalwart is IMO an underrated pick on bugs. Its main issue is really that it's only good at unarmored horde clearing, leaving the user prone to being attacked by armored and high level enemies. I would propose that giving it medium armor penetration would take it a long way as one of the best horde clearing weapons, being able to deal with Hive Guards, Bile Spewers, and Scout Striders easier
Machine Gun: The Machine Gun might be the least used support weapon in Helldivers 2. It just doesn't really do anything special that another support can't do better. I would reccomend giving it heavy armor penetration, allowing it to kill Hulks when hitting the eye and it would go through devastator armor
Heavy Machine Gun: Unfortunately, from its inception the HMG has been bottom tier. It recently got a crosshair but even still it just gets outclassed by the Anti-Material Rifle, Laser Cannon, and even the Railgun. I think it could be cool to up the ammo to 100 rounds per magazine and add an optional backpack. This backpack would add an extra magazine and would increase the armor penetration to go through Charger & Hulk armor
Anti-Material Rifle: The AMR probably needs a small nerf. It 1-2 shots anything on the bot front. I would reccomend reverting its damage so that it needs to headshot devastators to one shot them
Autocannon: No changes
Laser Cannon: No changes
Arc Thrower: Make the Arc Thrower staggestun lock Hulks again and its great. Right now it's useless on bots
Flamethrower: The Flamethrower is great because it can horde clear and kill Chargers very efficiently. This is most likely unintentional but it is very fun. I would reccomend lowering the total magazines from 4 to 3 to balance out the Flamethrower's strengths.
Backpacks
Guard Dog: Guard Dog is currently just overshadowed by its Rover variant. I would reccomend changing the gun from the Liberator to the Liberator Penatrator, with the damage being the same but giving it medium armor penetration. Ammo boxes should also refill its ammo
Guard Dog Rover: No changes, the nerfs were justified. This is still a great horde clearing weapon but it doesn't play the game for you anymore
Supply Pack: No changes, you give up a backpack slot but you get 4 resupply boxes which is a big help and is balanced
Ballistic Shield: No changes, it fulfills its niche on bots and will get even better as time passes with new 1 handed weapons
Jump Pack: No changes, the Jump Pack is decent but it becomes much better depending on the primary weapon you use
Shield Generator Pack: No changes
Emplacements
Anti-Personnel Mines: Mines are completely terrible right now, their damage is decent but the cooldowns are just to long to be useful. I reccomend reducing their cooldown from 3 minutes to 1 minute
Incendiary Mines: Just like the Anti-Personnel Mines, the cooldown should be brought down to 1 minute but also since fire damage is weaker than explosive damage, there should be more Incendiary Mines in a larger radius
Machine Gun Sentry: The Machine Gun Sentry is just a weaker version of the Gatling Sentry. Instead of bringing the power of the MG Sentry up, I think it would be cool to lower the cooldown of the MG sentry. The idea with this sentry is to be the disposable horde clear sentry, similar to how EATs are the disposable anti-heavy support weapon
Gatling Sentry: No changes
Autocannon Sentry: No changes
Mortar Sentry: No changes
EMS Mortar Sentry: No changes
Rocket Sentry: Right now the Rocket Sentry is just largely inferior to the AC Sentry. I think it could be cool to increase the range and projectile speed of the Rocket Sentry massively. This would make it a lower DPS but longer range sentry with more ammo compared to the AC Sentry. The AC Sentry would be better in terms of DPS but would require better positioning and defense while the Rocket Sentry is something you could put farther away that would help with larger targets, which is what a missle should do.
Tesla Tower: I haven't used the Tesla Tower enough to discuss what should be done about it, please let me know what ideas you have for it
HMG Emplacement: Really just make the HMG Emplacement affected by sentry upgrades. These upgrades would give the HMG Emplacement more ammo, a better turn speed, and more health
Eagles & Orbitals
There are to many to list so I'll only be listing Offensive Stratagems that should be changed
Eagle Strafing Run: Give it heavy armor penetration. It would be good way to horde clear and kill larger targets but wouldn't excel at either role
Eagle Airstrike: Reduce the uses from 2 to 1. This thing is just to good to have 2 uses. It horde clears, kills bosses, destroy fabricators and bug holes, has multiple uses, etc. Nerfing the amount of uses before it goes on cooldown brings up a lot of other stratagems
Eagle Cluster Bomb: Reduce uses from 4 to 3
Orbital Gatling Barrage: The OGB should target and move around instead of being a stationary stratagem. Instead of targeting high level enemies it should target groups of low level enemies.
Enemy Changes
I might be in the minority but I feel like the main game mode (Helldive difficulty, 4 players) is to easy. I would reccomend buffing up the enemies to not only account for all of these new buffs but also to make Helldive hard again. All of these changes would only apply to Helldive difficulty as that's the only difficulty I have enough experience to have a good idea of what should change
Increased spawns on objectives: Objectives currently need to have more spawns, there is just to much downtime. Of course each objective will need its own spawnrates based on how long and how difficult each objective but generally there needs to be less enemies
Pouncers: Low level bug enemies are currently not threatening enough. They have low health, low damage, and are slow. I would reccomend increasing the Pouncer's movement speed to increase their ability to swarm players.
Warriors: Just like the Pouncers, Warriors just aren't very scary and should have increased movement speed to make them still a threat with their ability to swarm
Bile Spewers: These things need to be shot. Their spit attack is 100% broken. Damage on the spit attack needs to be reduced so that it isn't a one shot. I think a cool change though to make them still a threat is that diving would get rid of the slow debuff, but it would also increase the DOT from the acid, giving the player the choice between their movement or their health. Slow debuff should only be applied if the acid attack hits, not if the acid is in your general area
Bile Titans: These things are honestly just to tanky and completely define bug missions. There are to few ways to kill these. You either need an anti-tank support weapon or an anti-heavy stratagem. I think a good change would be that the legs should have lower armor (maybe heavy armor penetration and explosive weapons can do damage) and that if a leg is hit enough the Bile Titan would die. Hitting the head with anti-tank weapons would still be faster and leg shots would probably require 2-3 people to shoot the leg to kill the Titan at a reasonable pace but Titans wouldn't be unkillable.
Heavy Devastators: Devastators just need an accuracy nerf. They kill incredibly quickly and they frequently spawn so nerfing their accuracy would make them more fun to fight
New Additions
These are a few new additions to the game that I think would be cool
Gas Grenade: A portable version of the Orbital Gas Strike. It would have a larger AOE compared to incindiary grenades but a lower DPS
Thermite Breacher: A new support bolt-action sniper rifle that uses large thermite bullets. There would be 3 shots per magazine and 4 magazines total. Shooting this weapon sticks a large thermite bullet that deals high damage over time that explodes, similarly to the thermite grenade. No 3rd person scope. 1 leg shot would strip Charger armor, 2 headshots would kill. 3 headshots would kill a Bile Titan. One eye shot would kill a hulk, 2 shots would destroy heat vents
Incindiary Grenade Launcher: A grenade launcher with 4 magazines that shot incindiary grenades
Gas Grenade Launcher: A grenade launcher with 4 magazines that shot gas grenades. These grenades would have a larger AOE compared to the Incindiary Grenade Launcher but a lower DPS
Arc Spitter: An arc assault rifle that had lower damage per shot and firerate, but would also fire arc shots that could arc to 1 other target per shot
Glide Pack: A varaint of the Jump Pack. It doesn't have as much vertical height but you can hold the space bar to slowly glide back to the ground
Roman Exosuit: A new Exosuit meant to be used against bots. The left hand would have a shield that could block bullets from the front and would break after taking enough damage. The right hand would have a large Laser Cannon that could overheat and would have a long cooldown when overheated
Angel Support: A Pelican would come down from the Super Destroyer to hover over the player for 30 seconds. Would have unlimited ammo and a 4 minute cooldown. So far the 2 weapons I think it could have is an Autocannon and Gatling gun
Care Package: Once every 1.5 minutes, call down a Care Package that gives the player a random one time use stratagem that goes away upon death. Can only hold 1 Care Package stratagem at a time
Fido: A new stratagem that summons an AI controlled car. This car would go around spotting enemies, finding side objectives, collecting ammo, supplies, and samples
Sharpshooter: A new armor passive. Hitting weakpoints on medium and high level targets would reward the player with ammo, stims, & grenades. If a weakpoint breaks such as a brood commander leg or the target dies due to being hit in weakpoint, get some supplies back. This effect does not apply to low level targets. 5% chance to get a stim, 15% chance to get a grenade, 20% chance to get a support weapon magazine, 60% chance to get a primary and secondary magazine.
Thick Skin: A new armor passive. 25% damage reduction when being hit in the back or side
Extrasensory: A new armor passive. Gain the ability to detect enemies offscreen in a 25m radius
End of thread, please let me know what you liked and what you think should be changed

Hey everyone, wanted to share my current stack.
Context: Active 34M - play racket sports, roughly 6 hours a week. Don't lift at the moment, plan to, but it's just so boring.
I haven't had blood tests done to check levels.
Morning:
Shake: Collagen - Vital Proteins 10g Creatine - Thorne 5g Protein powder - 27g of protein Cocoa powder: 10g

• Curcumin Phytosome Meriva - Thorne - 1000mg
  
• Omega 3 Wild Fish Oil- Innegus - 1360mg
  
• Astaxanthin - BioAstin - 12mg
  
• Hyaluronic Acid - Pure Clinica - 300mg
  
• CoQ10 (Ubiquinone) - Thorne - 100mg
  
• BroccoMax (Sulforaphane Glucosinolate) - Jarrows Formula - 17.5mg
  
• Nicotinamide Riboside - Tru Niagen - 300mg
  
• Vitamin D3 & K2 drops - Thorne - 1000iu & 200mcg respectively
  
• Zinc - Simply Supplements - 15mg
  

NOT YET ADDED:
NAC - Pure Encapsulations - 600mg CaAKG
Evening:

• Melatonin - 300mcg not MG - (3x per week)
  
• Magnesium - Together - Magnesium (from purified dead sea water) 180mg 5-HTP 100mg - Hop Extract 100mg (4x per week)
  
• Protein shake w Collagen 10g
  

Would like to hear what everyone thinks? If there's anything that's helped you with energy levels or think i'm missing something when it comes to anti-ageing & longevity.
I wanted to add NAC but i've read some comments here about checking glutathione levels before doing so.
I track sleep with a Whoop band and usually score 75% average with sleep.

Hi everyone, I'm new to the group and thankful. I would like support/advice regarding holding a full time job and living some what of a full life. The depression is really bringing me down and I'm just about ready to give up.
I struggle with bipolar 2 disorder with episodes occurring monthly. 20 mg Trintellix + 100mg Lamotrigine has put hypomania in remission but I still struggle with 1 to 2 weeks depression. My Dr recently added 25mg Valdoxan.
I know it's bad news when I start to feel tired/fatigued even after 8 to 12 hrs of sleep.
It's been 10 years since I've been struggling mostly because I was misdiagnosed with majpr depression.
I lost my only sibling not too long ago too. I've been trying to understand how people with bipolar 2 manage with full time work, having family, friends and hobbies etc. Is it possible to put depression in remission? Or will we always have to deal with some degree of depression? It makes life impossible with those monthly occurrences and I'm wondering if it's as good as it's going to get?

I'm not sure if this is the single best subreddit to post this but am posting several places.. Anyways, I have an almost 14 year old boston terrier. He has suspected sundowners as he gets very agitated and barks in the evening, worse than the day. He also has general anxiety. He also has atypical cushings. He is reactive to other animals and aggressive towards them. He recently had cervical surgery for a herniated disk. That is important because he started trazadone during the pre and post surgery. Prior to his disc issues he was taking: 100mg gabapentin as needed for pain or as a sedative 0.5 mg of Xanax as needed (usually evening) 15mg Selegiline every day Mitotane one day a week for cushings melatonin and lignans every day for cushings
Pre and post surgery he was one a heck ton of pain meds and other things. They added the trazadone to keep him calm. Now that he is mostly pain free he is not on the pain meds. We brought up with primary what we can do to keep him calm since he can't have as much activity out of risk of re-injury. They suggested adding Prozac.
Their current recommendation is to do: Prozac 10mg once a day Selegiline 15mg once a day Xanax 0.5 mg every 6-8 hours
They also said I could give trazodone on a situational basis. This seems like a lot? He would also continue the meds for cushings. I hear of serotonin syndrome and I don't know how common it is. I have been hesitant to start the Prozac because Trazadone has seemed to work the best but I know it may not be the best long term. BUT, he is almost 14 and he has never shown his age as much as he has the last few months, but it's not time, yet. I've had that discussion with multiple doctors. They always say he looks so good for his age. I've heard Prozac can take a long time to work and can make things worse before they get better. We've been through hell the past few months and I am scared.
Because of his reactivity and risk of injury we don't go for "normal walks". I have a treadmill that we walk on. I have a fenced in yard for going potty and roaming around. We just have to be careful for neighbor dogs making noise and or bunnies/squirrels. He can't play with most toys because he gets aggressive with them. What I have done is kongs and other puzzle toys with peanut butter and treats but he gets them all so quickly and just barks and barks. I can't give unlimited pb and treats! Does anyone have ideas on ways to stimulate him that are safe and not food motivated?? Any advice, experience on these meds and issues? I'm not saying my vet is wrong, I'm just exploring options and looking at others experiences. I'm worried the prozac is too long of a process for where he is. The agitation and barking in the evening has been a lot after what we've been through recently.

I'm not sure if this is the single best subreddit to post this but upon google search the medications I searched for came up here a lot. Anyways, I have an almost 14 year old boston terrier. He is most definitely reactive. He has a whole host of other issues as well. He has suspected sundowners as he gets very agitated and barks in the evening, worse than the day. He also has general anxiety. He also has atypical cushings. He recently had cervical surgery for a herniated disk. That is important because he started trazadone during the pre and post surgery. Prior to his disc issues he was taking: 100mg gabapentin as needed for pain or as a sedative 0.5 mg of Xanax as needed (usually evening) 15mg Selegiline every day Mitotane one day a week for cushings melatonin and lignans every day for cushings
Pre and post surgery he was one a heck ton of pain meds and other things. They added the trazadone to keep him calm. Now that he is mostly pain free he is not on the pain meds. We brought up with primary what we can do to keep him calm since he can't have as much activity out of risk of re-injury. They suggested adding Prozac. Their current recommendation is to do: Prozac 10mg once a day Selegiline 15mg once a day Xanax 0.5 mg every 6-8 hours
They also said I could give trazodone on a situational basis. This seems like a lot? He would also continue the meds for cushings. I hear of serotonin syndrome and I don't know how common it is. I have been hesitant to start the Prozac because Trazadone has seemed to work the best but I know it may not be the best long term. BUT, he is almost 14 and he has never shown his age as much as he has the last few months. I've heard Prozac can take a long time to work and can make things worse before they get better. We've been through hell the past few months and I am scared.
Because of his reactivity and risk of injury we don't go for "normal walks". I have a treadmill that we walk on. I have a fenced in yard for going potty and roaming around. We just have to be careful for neighbor dogs making noise and or bunnies/squirrels. He can't play with most toys because he gets aggressive with them. What I have done is kongs and other puzzle toys with peanut butter and treats but he gets them all so quickly and just barks and barks. I can't give unlimited pb and treats!

I am currently 31 years old, 6'4", and weigh 295 lbs. I've lost 47 lbs in the last 6 months through exercise and improved diet. Six months ago, I started taking Strattera for ADHD, gradually increasing the dose to 100mg per day. About 1.5 years ago, I was diagnosed with gout and have since been taking 300-450mg of allopurinol daily to control my uric acid levels. Recently, I discovered that my testosterone levels were low and began treatment with 100mg of testosterone per month, which has now been adjusted to 100mg every two weeks.
 
I had routine blood work done to monitor my condition and received the results this morning. My glucose level was 51 mg/dL, taken at 8:45 AM after fasting for about 12-14 hours; my previous result four months ago was 87 mg/dL. As far as I know, I don't have diabetes and have never had any related concerns. Reading about low glucose levels potentially indicating liver or kidney issues is alarming. I am awaiting feedback from my doctor and looking for any additional insights.