Imitrex 100mg 25mg

aybe someone can help me... I am 24yo and my pain isnt normal, i dont get these pain thrusts, i have constant pain for months. I got surgery done in december last year and had no pain for like 6 months. Since last week i am suffering from pain again and i dont know what to do. I am taking max. dose of carbamazepin 200mg, gabapentin 300mg and amitriptylin 25mg, also i take ibuprofen 800mg and tilidin 100mg, but the pain is still at a high level. Yesterday I took like 5000mg (not at once) of ibuprofen to lower the pain level and it worked for like 12 hours, but this is not a long time solution, cause my kidneys and stomach will fail at a certain point.
I am ready to try everything, from meds to sports/activities as diversion or some techniques to lower the pain.
PS: I also tried oxcarbazepin, oxycodon, pipamperone, quetiapin, physiotherapy and a fascia roller. And sorry for my bad grammar

im supposed to be 8 weeks on T as of yesterday. i missed last weeks shot, and i missed yesterdays shot. im doing intramuscular 100ml/mg in my thigh. my boyfriend helps me by actually sticking me, and i push the test. but last week i just couldn’t fucking do it, it was my 2nd 100mg shot and as the days went on i just felt worse and worse physically. my period came back on the 2nd or 3rd late day. i’ve tried everything. i even got shot blockers, the plastic thing. i tried icing it, i tried getting high out of my mind (which doesn’t even fucking work because i get so TERRIFIED i feel sober), i tried putting heating pad on the area beforehand. for my first 6 or so shots i would bite my knuckles really hard and then inject, but i have hypotension that is triggered by my anxiety (i got diagnosed with it specifically because i pass out when getting my blood drawn if i’m sitting up). so when i would push the test, i would almost faint.
i tried music, i tried watching videos of my cat, watching videos of my favorite internet cats. watching twitch streams, watching youtube videos, listening to my favorite songs. i NEED to do this fucking shot. my doses were 25mg first two weeks, 50mg 3rd and 4th weeks, and then 5th week 100mg. my body is missing out on 200mg of test and i can feel the effect it’s having on me . it’s not good.
weeks 1-6 were fine for the most part, i could get it done at least. me and my bf have spent at least 10 hours within the past two weeks trying to do my shot. i got close this time, after two hours. but he kept yapping while i was trying to get back to “base level” aka lock in and calm the fuck down, so i just couldn’t do it past a certain point. i get so terrified. i know it doesn’t hurt. i literally know what it feels like i just can’t fucking do it . i will tell him, “do it” and he will do the Z track with the shot blocker and as soon as he tells me when he’s about to stick me, this TERROR grips me and i have to tell him to stop because i start tweaking. im considering asking my mom if i can just go to her house and inject there so i can hold her hand , just to see if it would work (mind you i don’t even really talk to her ).
i cried this time because i feel so fucking stupid. im fucking up my own hormone levels because im being a pussy about a little metal stick. im not even afraid of needles, i just hate watching them go into skin so whenever my bf sticks me, i look away. now i just can’t do it. i need to do it tomorrow, i have a 30 minute window between me and my bf’s work shifts. please, does anyone have any advice? i am going to get an auto injector, if anyone has any good recs that work for IM thigh and 1ml syringes, please lmk.
has anyone felt the terror im speaking of? this is more than a mental block for me. i’ve tried thinking of it in every single way i can imagine. “you’re taking this shot so kitty doesn’t have to take it. kitty takes it well but it still hurts him, and i don’t want kitty to hurt.” “if you do this then you get to preform sexual act on my bf that i’ve yearned for” “if you don’t do this then your whole family dies” “if you do this then bf will give you mind boggling head as a reward” like I AM OUT OF MENTAL APPROACHES .
please please help me

I was just prescribed trt for the first time today by my endocrinologist and I’m starting at 1 pump of test gel aka 20.25mg/day. I understand that absorption rate is a big variable that plays a factor but is that generally equivalent to someone who is taking 100mg weekly via injection, or would it likely be a lot lower? Is there any benefit to the gel over injections besides not having to deal with needles?
I’ve been researching the gel and am a bit concerned about secondary exposure to my wife and/or kids but I could be overreacting about that a bit.
My doc also said the goal for my test was around 300 but that still seems too low, so we’ll see how things go for the next few months.
35m, test 182, free 5.4

100mg sertaline, 20mg doluxetine, 1.25mg ability and 0.5 clonezepam, anyone else out there on this combo, and how has it worked, tia

Hello, everyone! It's been a while since I posted anything or even visited the sub. I do not visit the sub anymore as I collected all the information I needed long ago and staying on the sub only led to more thinking about flox. Focusing on other areas of life has been a great life hack for me! I have done a lot of positive things in the past half a year - I am starting my own business, been meeting new people and making a lot of new friends. Flox has changed me for the better.
I want to preface this by saying that I was probably the only person (or almost only as I've met maybe 1 or 2 other people on Reddit) who claimed flares from CoQ10. It actually flared me quite a lot — sometimes I could handle 100mg and sometimes even 30mg would lead to terrible pain. It was frightening to be one of the rarest cases in a pool of already rare cases, so, naturally, I tracked reactions to supplements extremely attentively (u/vadroqvertical won’t let me lie about that) and I have tried a lot (my cupboard is full of supplements — I spent around €3,500 on them in the span of 1.5 years). I will list reactions to supplements and the approximate timeline of when it happened:
— First of all, CoQ10/Ubiquinol flared me not so much 1 month out (tried 100mg ubiquinol multiple times) but it got worse as time went on to the point that April 2023 I could not even take 30mg without great pain. I tried it 1, 2, 3, 4, 5, 6, 8, 16 months out all without luck with varying doses flaring me to different extents. I will outline the reasons for it below;
— Vitamin E flared me a lot 2, 4, 6 and 8 months out. Never tried again. Tried 200-400 IU at a time. Due to poor GSH regeneration through Glutathione Reductase dependent upon B2 and NADPH;
— Benfothiamine flared me as well (doses 150mg-300mg/day). This is due to high sulphite and blockage of complex IV of the Electron Transport Chain in the mitochondria the reason for I will explain further. Thiamine is easily broken down by sulphite in the body and it is broken down into sulphite as well, which causes a negative loop reaction in people with high sulphite levels. Benfothiamine also caused me a severe allergic reaction (extreme anxiety and itching) that gladly did not require hospitalisation but was extremely scary and scarred me psychologically (likely high sulfocysteine activated NMDA receptors);
— Vitamin B6 increased my neuropathy when I got it. Likely due to poor B2 functional status. The problem I was also deficient in B6 and its supplementation led to great improvements in sleep quality once I could tolerate it. Note B6 is easily destroyed by sulphite just like B1;
— Riboflavin flared me (tried at 100mg, doses under 10mg never flared me). This is likely due to unmatched NADPH supply due to high sulphite load in the body (speculative);
— Astaxanthin greatly improved my physical health at 5-6 months out (proving that the core of my issues was solely ROS) but it caused reductive stress (NADH accumulation), which also caused pain, albeit the pain was a different kind and asta caused worsening neuropathy and visual snow. It accumulates in fat tissue, so stopping it was nice with ROS coming to a balance at about 10-12 days after discontinuation (after a loading dose of 36mg/daily for 3.5 weeks) but ROS then came back after it went out of the body further. I did not retry astaxanthin as I realised it caused me reductive stress and neurological issues;
— NAC helped me a damn lot. It was the best antioxidant for me. The problem is it depleted my molybdenum and copper and started giving me allergic reactions (low molybdenum + copper as well as blocked complex IV will lead to way higher sulphite generated from NAC);
— Did not feel much from vitamin D. I live in a very sunny country and tested at 51 (ref. Range 30+) without any supplements;
— Magnesium helped me a lot. #1 supplement;
— Calcium did not help me much in the beginning, actually, caused me heart palpitations. Was fine taking it after a few months;
— Potassium was a good supplement. I took 800mg/day for a while and it supported my muscle health;
— Important: vitamin B5 made me feel a lot better. It took my ROS down like crazy — I could feel normal muscles again, it removed my oxalate pain completely, too but for only a short while like 3-4h.
I have tried many more supplements that were phyto-supplements and such and none of them really helped me beside maybe some placebo effects. Some made me feel worse and were not worth it at all. I did not try anything mood-changing as I was not interested in it. To note, GABA supplement made me feel a little euphoric at first.
It is very relevant that I have been oxalate dumping since 27 Dec. 2023. The description of the experience can be found here: https://www.reddit.com/floxies/comments/1by0uh0/comment/kyma718/
Now, to the real question: why did CoQ10 flare me even at high nutrient status (just after flox). I have to stress that flares from CoQ10 were much less at the beginning of flox likely due to better nutrient status (it went from extremely terrible to slightly more extremely terrible while 6 months out it went from ‘eh’ to terrible).

1. First, I have to say that NAC made me worse long-term. How? Over a long period of time I was taking it and was not watching my copper levels (NAC increases metallothionein and causes poor copper absorption) and molybdenum levels (NAC raises generation of sulfite and it needs molybdenum to be detoxified). Some NAC formulations have molybdenum in them but I was not lucky to get one of those and, due to lack of knowledge, did not supplement any molybdenum. The result was high sulphite and from that high ROS (with a combo of benfo which further increased sulphite it caused me peripheral neuropathy at 5 months). Sulphite causes Fenton reactions when complex IV gets blocked up. H2S (a signalling molecule and a vasodilator) also needs to be detoxified by a CoQ-10 dependent enzyme and turned later into sulphite and then sulphate by molybdenum and complex IV (dependent on copper) and if it is not detoxified, it causes a complex IV blockage and starts Fenton reactions as well as electron leakage during production of ATP, causing ROS. This causes a negative feedback loop that was described in the linked article as follows:

«This can be explained as follows:
1) hydrogen sulfide inhibition of complex IV generates superoxide in the respiratory chain, which becomes hydrogen peroxide,
2) hydrogen sulfide reduces ferric iron to ferrous iron, which makes it release from storage in ferritin,
3) this increases Fenton reactions between free iron and hydrogen peroxide, which generate more dangerous reactive oxygen species like the hydroxyl radical,
4) all of this deplete glutathione,
5) since a major purpose of the trans-sulfuration pathway is to provide enough cysteine to make glutathione, glutathione depletion hyperactivates the trans-sulfuration pathway, leading to more cysteine availability, the excess of which is catabolized to sulfite by alternative reactions that do not produce hydrogen sulfide and therefore do not require CoQ10.»

1. In the article linked below, you will see that CoQ-10 protects against reactive oxygen species mainly due to improving hydrogen sulphide clearance (H2S). Therefore, CoQ-10 deficiency did not cause much ROS in complexes I and II but mainly produced issues in Complex III (where sulphite detoxification starts) and complex IV (where the last electrons are delivered during the sulphite-sulphate reaction). Excerpt: «In human cells with CoQ10 synthesis defects from the same study, CoQ10 protected against reactive oxygen species, but suppressing the enzyme that uses CoQ10 to clear hydrogen sulfide abolished this effect. This shows that the reactive oxygen species were coming from poor hydrogen sulfide clearance.»

Considering this, and oh my god, finding this article was like god sent it to me: my CoQ10 flares were coming from poor hydrogen sulphide clearance. At that point there were multiple reasons this could be happening:

1. Cellular CoQ-10 deficiency;
   
2. Manganese toxicity;
   
3. Copper deficiency;
   
4. Molybdenum deficiency;
   
5. SUOX (enzyme which converts sulphite to sulphate) or another genetic impairment;
   
6. Blockage of complex IV by something else.
   

I checked my molybdenum and copper transporting genes, SUOX using DBSNP and my AncestryDNA.txt file, and they were all good (Yes, I know Ancestry does not do a full genomic profile but it still had the main SNPs for that.). I also checked my manganese transporter genes and seemed I was homozygous for an important one but fine with others. It is really hard to estimate how that might affect you IRL, perhaps that would require a real genetic counsellor (or lots of hours spent ruminating again). I also did not think I had any genetic issue since I was very very healthy all my life and had 0 pain or health issues before flox occurred (I have extremely healthy young looking parents that drink, smoke and do whatever they want and have 0 consequences to their health as well).
I took some tests, for example: Genova NutrEval at ~6 months out, full nutrient blood test panel at ~11 months out (abstained for 35 days from any supplements at all, even vitamins and tested literally everything, paid around €1,200) and my CoQ10 levels at both of those occurrences were at 1 & 1.07 in absence of supplementation with ref. Range 0.8-1.4, so it was definitely not low. That way I eliminated #1 and #5. While I was not entirely sure whether genetic issues had to do anything with it, I decided to pretend like they didn’t, since I had to try out other solutions before jumping to the most complex one. I took a lot of molybdenum, so molybdenum deficiency was not at the table for me. In this way I was left with #2, #3 and #6. In the full blood panel, my manganese was slightly high (20.1 with ref. Range <~18) and the SNP people were talking about that caused them manganese toxicity was homozygous for me, so I definitely considered it but manganese when supplemented made me a feel a lot better, actually (mentally, not physically), so I was also likely deficient in it. For now, I just avoid it in supplemental doses but I do not avoid foods containing it. Besides, I do not have iron overload genes that could contribute to manganese toxicity.
I could not take copper because it would lead to high ROS immediately (due to complex IV blockage the reasons for which I will outline further). Considering manganese was likely deficient and not superfluous, I discarded reason #2 and reason #3 could not be fixed by copper, so it was definitely not only copper deficiency but either another factor or another factor coupled with copper deficiency. I was stuck for a long time until I found another article from the same author about B12 and B9 helping to detoxify oxalate. As I said before all this explanation, I have been oxalate dumping throughout the whole process (already 4 months). I should note I was oxalate dumping even before I got floxed (I likely had oxalate overload to my appendix surgery — this is proven by inflamed mesenteric lymph nodes confirmed by 3 MRIs — Sally Norton has the same case of over-absorption in her book) and that is how I actually got the E. Coli they gave me Cipro for (oxalate crystals create a good environment for it in the urinary tract lol) and how I got floxed (I went full circle, lmao). When I was floxed, I was not oxalate dumping for at least a year likely because my body was not in the state to handle the dumping process but it was still affecting me as I will outline further. First of all, I want to say that biotin actually promoted dumping for me as said in the article and not relieved it like it is said in Sally Norton’s book (I am not sure if there is a genetic variation to this). The proposed mechanism of oxalate detoxification in the article is as follows:
«Recall my proposed two-step detoxification process:

1. Pyruvate carboxylase [biotin-dependent] converts oxalate to formate.
   
2. Formate is joined to tetrahydrofolate to enter the methylation cycle, be used for the synthesis of purines or DNA, or be converted to carbon dioxide and exhaled in the breath.»
   

This are also very important words: «There may be more regulation layered on top of this to prevent excessive formate accumulation. It would certainly be preferable to have oxalate crystals cause pain or disrupt the skin than to have formate accumulate beyond the capacity to clear it.» This is why I felt best when dumping. Could eat anything, drink beer, even smoked weed once without issue. Another time though I got too brave, smoked a lot of weed and got a very bad ‘relapse’ but recovered quickly from it. The next morning when using a towel after a shower I had the same pain I used to have 2.5 months out from Cipro (which was extremely bad and took me back 14 months in memories) while before I smoked weed that second time I had almost 0 tendon pain in my daily life apart from oxalate [Here I thought maybe I and DrHungry share similar issues then? He also had an extreme (same in intensity relatively to his flox journey) flare from weed and is also using a lot of sulphur-based antioxidants still. Could such weed flares be related to complex IV dysfunction and/or impaired sulphite clearance?]. In either case, I felt best when dumping, probably because my body was able to regulate formate accumulation and ROS production greatly reduced at those times.
I was sitting outside with my parents and their friends, researching my flox issue when I read these lines: «Formate accumulation is the principle mechanism of methanol toxicity. Part of its toxicity is driven by inhibiting cytochrome oxidase, complex IV of the mitochondrial respiratory chain, which would inhibit the clearance of sulfite and hydrogen sulfide and block the production of ATP.» It finally clicked. It was honestly one of the best moments in my life when I realised. I made the connection between great improvement from B5, formate accumulation, issues with copper supplementation, general ROS improvement and oxalate everything together. Suddenly, my whole flox journey became crystal clear to me.
B5 is mainly used in the body to create Coenzyme A. An intermediate molecule in the production of CoA is called 4’-phosphopantethine and is used in the enzyme 10-methyltetrahydrofolate dehydrogenase (high formate will pair with THF and form 10-MTHF in the attempt of the body to detoxify formate). This enzyme converts 10-MTHF back to THF and creates NADPH in the process which is used by Glutathione Reductase to regenerate Glutathione. Hence, high-dose B5 led to a lot of those reactions occurring and me feeling a big relief from ROS AND OXALATE, so oxalate is indeed detoxified into formate by biotin-dependent pyruvate carboxylase.
Okay, so theory is very interesting but what is theory if it has no proof? When I read it, I realised I finally cracked my flox but I had to get real proof.
Just a few weeks before this, I drank some wine and got nerve damage (likely from high sulphites in it, again, duh — while this was a terrible experience, it played a role in me getting closer to the solution of my issues). Beer caused me no issues, could drink 10 or more bottles in one sitting, eat a lot of rice with no issue. Before, I had only numb hands and top of feet. After the wine, I had burning up to the knee and burning in palms and behind my shoulders. I got fed up with this, I just decided to methylate the fuck out of my nerves and eat copper not in supplements but from calamari (very high in copper but low in vit A, so no toxicity risk like from liver). At that time, I was dumping and my ROS was not too high. I started consuming around 200g protein per day, eating a lot of copper 3-4mg/day and my nerves really healed a lot. To the point they even became normal after 3-4 days. My vision became brighter, it was absolutely crazy. I was also supplementing 150mg molybdenum/day. After a week of that, though, I started getting ROS back and it was very bad ROS, like almost a year ago when I had low molybdenum and copper from a lot of NAC use. That confirmed my suspicion that my issue was indeed sulphite. Eating almost anything caused ROS for me, dumping stopped since the body had no free reducing agents (NADPH) to support sulphate-producing enzymes (oxalate is transported on sulphate transporters, so it literally could not drive out of the cell because it had no car lol). As you understand, high ROS prevents a lot of enzymes from working and here it causes, as you have probably understood, a negative feedback loop.
So, back to the proof. Since I realised that my issue is probably formate, I just decided to take high-dose B5 again (did not add any high dose B2, B1 or other B vitamins, just took my usual B complex with food). It really helped me a lot, again. I felt almost normal. Then, it caused me some pain but I felt how I was getting better and the next day I took it in the day, then in the evening I ate around 80g carbs and took double the dose of B complex (my B complex has low doses: 10mg B1, 10mg B2, 25mg B3, 20mg B5, 5mg B6, 100mcg B7, 100mcg B9, 50mcg B12) instead of adding a lot of B5 and boom, no pain and oxalate dumping restarted quite more strongly than it even used to be before megadosing protein. So I was in pain for at least 2 weeks dying from ROS and then 2 days of B5 and suddenly I was normal again? It felt like paradise. The next day, I went out with my friends. I was a little nervous since we were going to eat out and we ordered 600g of carbonara (the portions here were huge there). I ate it all at once with 2x my light B complex and guess what happened? NO PAIN, just oxalate dumping. I finally realised that I was right and detoxified formate unloaded my complex IV, allowed sulphate transporters to be created, reduced ROS production from food and suddenly I felt like a normal human being (except the dumping part). I recently retried CoQ10 — no flare. Likely before formate got recreated a lot because I was dumping a lot (if you read my comment, you will understand).
I am not megadosing B5 right now but just stuck to 80-100mg B5 per day, so 4x my light B complex as my B6 tolerance improved a lot. Why I am not megadosing B5 is because oxalate likely blocks conversion of vitamin B2 into its active forms as I at ~11 months out when I did full-testing in the absence of supplementation 35 pre-testing had high molybdenum, iodine, (almost above the ref. Range (113 with ref. Range <120) selenium and very high B2 even though I was cellularly deficient according to Genova NutrEval (at 356 with ref. Range <295).
Hence, we can understand what happened to me from the beginning:

1. Oxalate overload led to formate overload as oxalate is converted to formate through the action of biotin-dependent pyruvate carboxylase;
   
2. Formate overload led to complex IV blockage, high ROS and high sulphite, which also leads to high ROS and also leads to complex IV blockage (negative feedback loop);
   
3. High sulphite destroys vitamins B1&B6 as said in the beginning, which caused endogenous production of oxalate to skyrocket (you can read about this if you google, this information is very available);
   
4. Hence sulphate transporters also got impaired, oxalate detoxification in the form of physical crystals also halted, which led to even higher overload;
   
5. This led to higher formate, this led to even more ROS.
   

Mega-dosing B vitamins and especially B5 and B9 led to formate detoxification and the ability of my body to detoxify oxalate. This improved me a lot and it definitely feels like it will inevitably lead to my recovery. I feel good now, I still have some remaining neuropathy but it’s minimal and I know what to avoid to not make it worse and how to improve it quickly if I need to. I have no OS from beer, coffee or food. Also, I am dumping a lot right now. You can ask me all kinds of questions that you want and I will try to answer them to my best ability since I know what it is like to be floxed and I will help anyone who is in the same situation. I am only 22 years old and this experience led to me rethinking my whole life. I plan to become an extremely rich person to be able to fund biochemical research in the future and will focus specifically on floxed individuals and I will help floxed people first. I will try to reach my goals as fast as possible, I promise.
I hope this post does not get removed by moderators. If there is anything to moderate, change, or add, I will be happy to do that. All I say here is very attentively selected and fact-checked either from external sources or personal experience. I do not lie and have no motivation to do so. I am only trying to share my knowledge and to help realise others flox is not unbeatable and can be understood and solved — it all depends on individual factors.
Linked articles:
Manganese Toxicity Is a CoQ10 Deficiency
https://chrismasterjohnphd.substack.com/p/manganese-toxicity-is-a-coq10-deficiency
CoQ10 Deficiency Is Sulfur Toxicity
https://chrismasterjohnphd.substa2ck.com/p/coq10-deficiency-is-sulfur-toxicity?utm_source=profile&utm_medium=reader
10-Formyltetrahydrofolate dehydrogenase
https://lpi.oregonstate.edu/mic/vitamins/pantothenic-acid#formyltetrahydrofolate-dehydrogenase
Can Biotin Help Detoxify Oxalate?
https://chrismasterjohnphd.substack.com/p/can-biotin-help-detoxify-oxalate
Can B12 and Folate Help Detoxify Oxalate?
https://chrismasterjohnphd.substack.com/p/can-b12-and-folate-help-detoxify

Morning - optimum nutrition multivitamin -5g creatine - 500mg krill oil -370mg black seed oil complex ( black seed, beat root, turmeric, apple cider vinegar, honey, pomegranate juice powder) -Alpha GPC 150mg -Caffeine 150 mg -L-theanine 100mg - N-acetyl-L-tyrosine 100mg
Post workout -5g creatine -5g BCAA (2500mg l-leucine, 1250mg l-isoleucine, 1250mg l-valine)
Before Bed - L-theanine 200mg - shoden ashwaganada 120mg -gaba 50mg -magnisum glycinate 100mg -apigenin 25mg
Quitting nicotine and wanted to deal with sleeplessness and brain fog. Also recovering from a nasty rotator cuff injury so wanted to work my way back into my supplements after not taking them for a while, besides my multivitamin. Took a T-test last year was on the higher end so if anything here could be detrimental to that let me know.
Thanks in advance.

Groot (6 years old, male, nurtered, minpin, 15.95 lbs) had his annual check up today and the vet heard a significant murmur. She recommended x-ray and echo. Groot gets very anxious so they sedated him and took the x-ray, his heart is enlarged - she said 11? - and he has fuzziness that could be fluid. The only symptom we've noticed is he sometimes coughs/gags in the morning.
He's on 10mg prozac (going on 6+ years for this dose), 100mg gabapentin*2/day.
He'll now be starting vetmedin 2.5mg every evening, 1.25mg every morning and furosemide 20 every 12 hours.
He's on royal canin urinary, so I guess we'll have to change that. A dietitian will be calling me to discuss food.
Vet diagnosed him with congestive heart failure. I asked prognosis and she said a few years. What am I realistically expecting? Should we proceed with an echo?
Groot is reactive, and a mess most days so going to the vet is great. I just want him to be comfortable and we definitely haven't noticed any changes in energy etc. he gained 1lb since his last check up.

Please, for the love of all that is good on Earth, how do I stop this from happening?
I just spent 30 minutes ensuring my patient could get primidone so that she would not go into a withdrawal seizure. Her insurance almost refused it regardless! She is 9 days early for her refill and I effectively doubled the dose (obviously with a slow titration) because I saw her last week.
Nearly all of the medications I prescribe start at low dosages and increase slowly using the lowest dosage formulation to fine tune my treatment. I am constantly notified that patients are requesting early refills because they are increasing as I've recommended. I do not know at the start if the patient will stay at the starter dose or have moved to a significantly higher dose by the 1 month mark.
I have to call pharmacies and then insurance companies to tell them I am increasing the medications. Even then, they will refuse to cover the medications due to a quantity limit. I'm talking about cheap medicines that I'll often just have patients pick up via GoodRx.
I'll give examples:

• Increasing TCAs for headaches/migraines. I start nortriptyline 25mg qHS and increase by 1 tab as tolerated every 1-6 weeks (patient preference) up to 100mg qHS.
• Increasing propranolol or primidone for tremors. My patient today was at 200mg qHS (50mg tabs) and I wanted to slowly push her up to 250mg BID to complete the medication trial. Jokes on them! Now she has to get 900 tablets to get a full 90 day supply to ensure insurance does not refuse an early refill, and for all I know she will not tolerate ANY morning dosage. I have plenty of patients who start at propranolol IR 20mg daily and increase slowly up to 60mg BID.
• Increasing Sinemet IR from 0.5 tab BID up to 3 tabs TID (in select patients) over the span of months. Pharmacies often refuse the order but I cannot write out how to increase this medication in 150 characters or less (hint, I use a medication chart and print it out for them).
• Increasing risperidone for my Huntington's patients from 0.5mg qHS up to 5mg BID. I had a poor refugee family that did not speak English lose valuable time with their loved one before insurance refused to cover the 0.5mg tablets due to quantity limits. I called the company who directed me to Optum who directed me to her insurance who directed me back to Optum. I faxed a request for insurance approval and NEVER heard back!

It does not reliably work to:

• Order more pills than what would be the daily dosage per month at the starter dose.
• Write in the prescription itself that the medication is being increased.
• Reorder an entirely new prescription using the same lower dosage just before 1 month later as we are still increasing the medication.

Can any pharmacists, MDs, or, heaven forbid, insurance rats help a young physician trying to navigate this field of shit? What is the fool-proof way to stop having to haggle for my patients?

Hi! a few weeks ago I posted here telling how bad I felt and how I wanted to give up on life, that Zoloft was not for me, and that's how I felt at that moment. Since then my doctor started lowering my dose from 100mg to 25mg and it has been incredible, I have been on the new dose for a little over two weeks and I can finally say that I feel better. I no longer have s*icidal thoughts, or the desire to hurt myself, The anxiety has finally subsided. Obviously some days are better than others but I finally feel like it works for me. Anyway, all this is to tell you not to give up, this is a little slow but it works, in any case it is best to consult with your doctor if you feel very bad, maybe like in my case your dose is wrong, but I assure you that there is something that works for you ✨

deleted my original post because I couldn't edit my title...
Link to images below
https://imgur.com/a/hives-3vmKfSu
Species: Dog
Age: 3
Sex/Neuter status: M/neutered
Breed: Coonhound
Body weight: 70
History: We got him a little less than a year ago. Vet has prescribed Trazadone/Gabapentin for reactivity in stressful situations. We have successfully used these meds 2x in the past 6 months without issue. I am also pretty sure he was receiving these meds while in the shelter. Or at least, trazadone.
Clinical signs: Hives - was given a dose of 1 Gabapentin 600mg and 3 Trazadone 100mg yesterday 6:30am. Was fine all day - normal response to meds - sleepy and drowsy. Was maybe a little itchy at bedtime (10pm), woke up this morning at about 6am with hives all over his body. No other symptoms except occasional itchiness. Mood and energy and appetite was normal otherwise. Went down a little over the course of 2.5hrs, but most were still noticeable. Gave Benadryl (2.5 25mg tablets) and Hives reduced a bit within the hour. I had to leave for work at that point. Husband said he was sleeping but still looked a bit bumpy when he left around 11am
Duration: not sure - perhaps at some point over night to present time
Your general location: MA
Links to test results, vet reports, X-rays etc.
Wondering if this is a typical reaction to these meds - especially after multiple uses without issue, or if we could be looking at an allergy or reaction to something else. I understand that both these meds CAN cause hives - but wouldn't the most likely so so within a few hours of ingestion?
Does it warrant a vet appointment if he has responded to benadryl? Thanks for the help.

Hello there,
two questions but sort of related.
What is the max dosage a day? 100mg?
I take 50mg and if I have to redose I go for 25mg. would 50+50 be too much? Why? (I don't have side effects).
Second:
Does anyone take different dosages for different occasions? For instance, last night I was gonna have pizza at home with my wife and mother in law. I knew we would drink beewine. I took 50mg 90 minutes before and had one stout beer and two small glasses of wine. Was happy about it!
buuuuut on saturday I have a BBQ of long time friends that we usually get super wasted (but I wanna avoid it this time). So I considered 75mg straight away and then redose with 25mg or go for 50+50.
(In case it matters i'm 8 weeks in TMS with no result in terms of number of drinks, but i'm being compliant and patient).

I (25F) started on 25mg of lamictal 8 weeks ago after being diagnosed with bipolar 2 and ADHD. This was the first time I have EVER taken medication in my life, and I was scared. Psych decided to medicate the bipolar and hold off to see if ADHD symptoms improved before trying anything for that since my manic/depressive episodes were the real killer for me. After two weeks I bumped up to 50mg, then two weeks later 100mg, and now I’m holding steady at 150mg feeling better than ever. I seriously can’t believe how much better I feel with next to no symptoms. Having battled an eating disorder that has cycled with my bipolar for the last 13 years, exercise addiction, body dysmorphia and bouts of psychosis that caused many severe acts of self-harm, I feel like I’m meeting myself for the first time and have been set free.
Don’t get me wrong - Everyday isn’t perfect, I still have really hard moments. But it’s absolutely nothing compared to my previous day to day reality. With the help of therapy and other self-exploratory activities such as journaling, reading, and art, I actually feel capable of observing my feelings and dissecting them to better understand them, whereas before my one and only option was to act on whatever loud emotion I was experiencing which led to very destructive behavior.
If you’re struggling and are looking for reviews and experiences with lamictal, I can tell you that my experience has been life changing. I encourage you to give it a try if it’s been recommended to you by a professional, and I truly hope you have a successful experience like i did.

I’ve been on Sertraline for 3-4 years now? It’s been so long that I can’t remember but started at 25mg for a couple weeks, went to 50mg for + a year until I decided to go up to 75mg for my anxiety. I currently feel really sad because of a situation that happened at work & life in general I say feel because I am not too sure why I am sad but my body feels tense, anxious, jittery and hard to focus but my mind is blank?
It’s not important but I called my doctor to increase my meds to 100mg. The lower doses were doing good for me but I just dont feel my best and i also feel like it’s not only affecting me but the people around me.

I came here when I was in a really dark place. And I read a comment that “people rarely come back to share their success after panic disorder is gone” so I wanted to share. December 2022, I was working in the ER at a local hospital. I was just standing there and had my first panic attack. Little did I know, they would get worse & be an everyday thing. I was anxious, crying, scared to goto work. I tried a psychiatrist who prescribed me bipolar meds. Didn’t help made me worse so I was scared to take anything else. December 2023 I had 2 major panic attacks while working in the er. I had to be seen both times. I was diagnosed with panic disorder. I was so bad I took 5 months off of work and could not leave the house (major agoraphobia). I started taking Zoloft dec 20th. It made me worse. I started on 25mg. Few weeks later upped my dose to 50mg. Worked for 3 weeks around January and I was back to panicking. Went to the dr she upped to to 100mg. I am about 2 months panic free. I just started my first week of my new career at ford motor company (3 days in). I never thought I would be myself again. Zoloft works on the right dose and with the right time

My husband is currently experiencing fairly severe zoloft withdrawal symptoms, and I'd love to hear your suggestions for how to best support him.
For some background, he started taking zoloft about two and a half years ago to help with his anxiety and depression. He has dealt with anxiety (without depression) for almost a decade. He started at 25mg, then up to 50, then 100mg. After he'd been taking it for a year, we met, fell in love, got pregnant, got married, then lost the baby, all in about 7 months. As a bit of an aside, after the baby, I was taking zoloft for about a month, but stopped (cold turkey) after a series of unbearable nightmares.
He started tapering down about 2.5 months ago under the direction of his doctor. He went from 100 down to 50 for three weeks, then 25 for three weeks, then 25 every other day for three weeks, now he's off. I think he stopped completely about a week ago.
For the last several days, he has been experiencing severe mood swings (mostly swinging between okay/happy to incredibly sad and crying), chills, trembling, diarrhea, loss of appetite, nausea, vomiting (as well as what you could call retching or dry-heaving), and a return of his anxiety (worse than it's ever been according to him).
He has messaged his doctor, and we are waiting to hear what she says. I feel like she dropped the ball a bit because she originally said she was going to prescribe him something else to help transition off, but that didn't end up happening.
Please let me know how I can help him. Right now, I am just trying to reassure him that he is okay, that I'm here, not going anywhere, etc. We went to Kaiser urgent care yesterday, and they ran all kinds of tests that came back normal, so I've been reassuring him with that information as well. He can be a bit of a hypochondriac, so he's been taking his temperature and checking his oxygen levels a bunch. I want nothing more than for him to be happy and well, and I will do anything to help him, so please help me do that.

I need reassurance, I'm scared.
Hi, so I have been on lamotrigine since 2019, I recently upped my dose at the beginning of this year to 300mg, I have been on zoloft for about a year and I am on 100mg. I recently start seeing a new psychiatrist, and she wanted to up my medication. She wants to slowly raise my lamotringe so she gave me 50mg to slowly raise it. She also gave me seroquel 25mg to get me out of psychosis.
I am terrified of upping my doses and started new medications. I have been rescheduling my appointments over and over again telling myself I will start the medications since I was supposed to meet back in 2 weeks. I have always been scared of medications that make you sleepy and I know seroquel can do that. I just don't want to be basically sedated where I can't get out of bed if my daughter needs me at night. The lamotrigine when I went to go pick it up at the pharmacy the pharmacist was awfully rude and decided to scare me telling me that she didn't wanna give me the medication. She said I could develop a very serious rash, and I can actually end up having a seizure if I miss a dose.
I am absolutely terrified to start these new medications, I just need some reassurance. I hope I get some replies.. I'm desperate I want to get better, but this is something I have always struggled with.

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’ve been on 125mg for about 6 weeks now, and didn’t notice a change in my mood compared to 100mg. Because it is causing me a lot of stomach issues and no significant change mood wise, I’m going back to 100mg, which didn’t upset my stomach at all. Is going down 25mg going to cause withdrawal symptoms? And how severe if so? I’m going on a trip in 2 days and worried about doing the change right away

Hey all, I am hetero c677t and suffer from panic and ocd. I tested my b12, folate, and homocysteine levels and they came back as: B12 671 pg/ml Folate 19.4 ng/ml Homocysteine 12.5 umol/L
I take a methylated b complex, fish oil, magnesium, trace minerals, d3 and k2 daily. I also add 10g of collagen peptides to my coffee in the morning for glycine. I am also on 100mg zoloft. My diet is extremely clean, I barely drink alcohol, maybe once a month, eat lean proteins, whole grains, kefir, greek yogurt, fruits, vegetables, healthy fats (evoo, nuts, alot of avocado), lots of fruits and vegetables, eggs a few days a week, and zero processed sugars, foods, sodas. I drink coconut water, electrolytes and water.
I take walks 1-2 times a day, do zone 2 cardio 3 days a week, zone 5 cardio 1 day a week, and light strength training 2 days a week.
Any idea why my folate is high, b12 in normal range but my homocysteine would be as high as it is? The methyl b-complex I take has 200mcg of methylfolate, 250mcg methyl b12, 25mg b6 p5p and 25mg riboflavin r5p. Ideally, I want to get it under 10, preferably 9. My D3 levels are 61.5 ng/ml. A1C and cholesterol both have no issues.
Most all people I see on here have LOW folate and/or B12...but why would my folate be high and b12 normal and still have homocysteine issues? Is the methylfolate not being absorbed?
Below is some info on my various SNPs:
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https://preview.redd.it/3nvscqsgxe0d1.png?width=1462&format=png&auto=webp&s=a3ab02c87a91bd8e14e3fa73292e6454898fa12f

I’ve been on Zoloft for a month (25mg for 8 days and 50mg for the rest). I’m primarily taking it for social anxiety, not depression. So far, my overall anxiety has gotten better, but for social anxiety the benefits have been minimal. My doctor said I should consider upping to 100mg, but I’m not sure I really want to go back to square one and wait for a month for it to work again. I also know it can take up to 6-8 weeks for it to fully work, just wanted to see if anyone has experiences or opinions on this. Thanks!

Hello! I'm 32 (F) as a teenager I didn't really struggle with acne but starting my mid 20s I started to break out more consistently. I got on Spironolactone 100mg to start off with and after a few months it started to cause abnormal bleeding in between my periods which is very not normal for me. My derm recommended I go see my OBGYN who said that 100mg is more than she likes people to start off on and if I wanted to stay on Spiro I would need to incorporate birth control, and I said no. That's too much stuff for me. Acne later came back worse, I saw OBGYN who recommended we start back up on 25mg and see if that helps my skin with no bleeding side effects. And viola! It was perfect. It cleared up my skin with little to no side effects ( I experienced mild dizziness frequently but nothing severe) after two years of clear skin and taking Spironolactone I decided to start taking it every other day so I could get off and see how my skin reacted.
I hate the idea of being on a hormonal acne medication long term, as Spironolactone only works while taking it, unlike acutane. Once I got off, my skin stayed clear without the medication for a year or more, after that my hormonal acne returned, not as bad as before, but I have consistent break outs, hyperpigmentation all of the time etc... the severity of the break outs has lessened but my point being, hormonal acne may be something I will just have to deal with until my body decides to regulate itself. OR I can choose to be in a long term medication.
I've come to accept my acne more. That maybe I'm just someone who doesn't have clear skin and that's just something I have to accept. I have beautiful, healthy skin, people always think I'm 10 years younger than I am, but I also have acne. I've decided that you can have acne and still have beautiful and healthy skin. And if the severity of the breakouts became too much to deal with, I'd have to weigh my options of trying acutane or getting back on a low dose of Spiro. But for now, I'm just trying to embrace my imperfect skin.