Ça m’arrivent très souvent de rester bloquer, littéralement immobile, plusieurs heures par jour, à penser ou plutôt ruminer.
J’ai jamais su comment expliquer ça à ma psychiatre mais après des mois de recherche j’ai en fait compris que je suis pas le seul à vivre ça c’est un truc connu qui a même une page Wikipedia.
Je prends du valium mais j’ai pas l’impression que ça fonctionne, ou alors c’est un problème de tolérance.
J’ai d’autres médicaments anti-depresseurs et anti-psychotique mais c’est absolument de la merde même un flingue sous la tempe je reprendrais pas ces merdes.
Le seul truc qui marche étonnamment c’est le cannabis, ça me donne du « punch », pas physiquement parlant mais ça a la magie de me faire littéralement oublier en 5 minutes un truc sur lequel je tournais en rond pendant des heures dans ma tête.
Mais je peux pas demander du cannabis à ma psychiatre et de toute façon elle est inutile alors je m’achète mes médicaments moi-même.
J’ai pensé à la ritaline, c’est très cher donc j’aimerai avoir des avis, est-ce c’est ce qui ce fait de mieux pour stopper les paralysie d’analyse ?

TW/CW: mental health
You know this? https://antidepressantsortolkien.vercel.app/
And this? https://en.wikipedia.org/wiki/List_of_antidepressants
So, yeah.
Edit: sorted, removed duplicates, added Sildenafil, Taladafil, Ritalin.
Edit2: Vraylar instead of Vyvanse.

1. Agomelatine
2. Alnert
3. Ambivalon
4. Anafranil
5. Aripipraz
6. Asendin
7. Aurorix
8. Aventyl
9. Azaphen
10. Brantur
11. Brintellix
12. Caplyta
13. Catron
14. Celexa
15. Cipralex
16. Coaxil
17. Cymbalta
18. Desyrel
19. Drazine
20. Edronax
21. Elamol
22. Elavil
23. Eldepryl
24. Elepsin
25. Elontril
26. Elronon
27. Etonin
28. Evadyne
29. Exxua
30. Faverin
31. Fetzima
32. Galatur
33. Gamanil
34. Gepirone
35. Gerdaxyl
36. Inkazan
37. Insidon
38. Istonil
39. Ixel
40. Ketalar
41. Kinupril
42. Lomont
43. Lucelan
44. Ludiomil
45. Lurasidone
46. Lustral
47. Luvox
48. Maneon
49. Marplan
50. Melixeran
51. Merital
52. Metatone
53. Nardil
54. Niamid
55. Nogedal
56. Normud
57. Noveril
58. Pamelor
59. Parnate
60. Paxil
61. Pertofrane
62. Pirlindole
63. Pristiq
64. Prothiaden
65. Provigil
66. Remeron
67. Rexultin
68. Ritalin
69. Ruoxinlin
70. Safra
71. Sarafem
72. Savella
73. Seroquel
74. Seroxat
75. Serzone
76. Sinequan
77. Sintamil
78. Sildenafil
79. Solian
80. Spravato
81. Surmontil
82. Tadalafil
83. Tecipul
84. Timaxel
85. Tinoran
86. Tofranil
87. Tolvon
88. Trevilor
89. Upstene
90. Vagran
91. Valdoxan
92. Victoril
93. Viibryd
94. Vivactil
95. Vivalan
96. Vraylar
97. Zelapar
98. Zelmid
99. Zulresso
100. Zyprexa

Bonjour,
Si vous avez du mal à réfléchir à vitesse normale, si vous êtes tout le temps dans la lune, ou dans les vapes, vous avez peut-être une comorbidité appelée Sluggish Cognitive Tempo (Cognitive Disengagement Syndrome). C'est proche du TDAH à prédominance inattentive, mais il y a quelques différences. Il existe un subreddit anglophone dédié à ce trouble : https://www.reddit.com/SCT/
Je suis pas mal les messages qui y sont publiés, en général, les gens qui vont mieux ont eu de bons résultats soit avec de l'Elvanse, soit avec du Strattera, alors que la Ritaline semble peu efficace, à en lire les témoignages. Ce trouble est peu connu en France, et les recherches médicales sont récentes. Le CHU qui me suit pour mon TDAH ne connaissait pas ce trouble, c'est pour dire...
Les personnes affectées par ce trouble ont du mal à suivre les conversations de groupe à vitesse normale, à regarder un film, à lire un livre, et à suivre le rythme au travail. De grandes difficultés au quotidien, que ce soit sur le plan personnel que professionnel. On peut avoir un SCT et un TDAH, c'est d'ailleurs fréquent d'avoir un TDAH quand on a un SCT. Plus d'infos ici : https://en.wikipedia.org/wiki/Cognitive_disengagement_syndrome
Vous reconnaissez-vous dans ce trouble, proche du TDAH ?

So, taking advantage of the mod holiday - not that I’m breaking any rules on purpose I just use a lot of terms accidentally.
Note, not looking to talk religion or favor any religion.

Suspected early ADHDers:

Note, retrodiagnosis is not medically valid. We can’t evaluate these people in the flesh or know enough about their childhoods. But, don’t let anyone tell you adhd was invented or is a modern disorder. It is not.

Esau, brother of Jacob

• about 2000BC. That’s right, 4,000 years ago.
• Can be found in Judaism and Christianity plus Islamic exegesis (his brother and father feature in the Quran but not him directly).
• Source. Just one of many sources. Actually found Jewish, Christian, Muslim, and laic researchers hypothesizing this too. This article happens to be short and to the point.
• traded his birthright for a hot meal
• impulsive overall

Simon Peter, aka Peter the Apostle

• About 2000 years ago.
• Can be found in Christianity and Islamic tradition. Probably the most well respected suspected ADHDer of old.
• Source. - note this researcher has nothing to do with Dr. R Barclay as far as I know. Just happen to share a last name.
• impulsive and outspoken
• “remember to look after my sheep” - reminded 3 separate times as he was notoriously forgetful
• got incredibly amped up and excited, speaking at length or even forgetting where he was (as he walked off a boat once)

Earliest descriptions of adhd

Hippocrates or someone using his pen name wrote of a condition that looked like adhd. - about 400 bc. - The father(s) of medicine identified the condition well before video games or cell phones. - source
Two modern doctors first ID’d it in the 1700s - Melchior Adam Weikard - 1775 - Sir Alexander Chrichton - 1798 - Source
Woah. Ok, maybe it’s not a new thing.

First evidence-based medicinal treatments.

• 1936, FDA first approved an amphetamine for what’s today known as adhd.
• some of the most popular stimulants today (Ritalin, adderall) were approved in 1955 and 1960

So what?

This isn’t a failure of you, your parents, society, or technology. There’s a lot of ignorance about what adhd is and how much we know about treatment.
Some good resources? This sub, generally well moderated. Russell Barclay’s videos and books, the “How to ADHD” YouTube series tries to keep it evidence based, and a few other places.

Moin Leute,
eine Freundin meinte letztens zu mir (M27), dass ich wohl das Paradebeispiel für ADHS bin.
Meine Vorgeschichte:
ADHS (damals ADS) wurde mir schon in meiner Kindheit (2. oder 3. Klasse glaube ich) diagnostiziert. Mir wurde das damals dann natürlich so erklärt, dass ich mich einfach nur nicht gut konzentrieren kann. Kindgerecht halt. Ich hab dann Medikinet bis zur 7. Klasse genommen, hatte natürlich auch regelmäßige Besuche beim Facharzt und hatte irgendwann einfach nur keine Lust mehr Tabletten zu nehmen. Die Tablette hat damals für mich bedeutet, dass ich auch frühstücken muss und ich wollte einfach nur nicht mehr frühstücken müssen. Habe dann mit 16/17 nochmal auf eigenen Wunsch hin angefangen Ritalin zu nehmen, da ich mich in der Schule einfach nicht konzentrieren konnte. Das habe ich nach kurzer Zeit wieder gelassen, da meine Stimmung echt stark geschwankt hat.
Wie siehts heute aus?
Trotz Defizite habe ich vor einigen Jahren meine Ausbildung abgeschlossen und mache gerade eine Weiterqualifizierung auf Meisterebene, es funktioniert also. Die Fähigkeit mich einfach zu konzentrieren und Frontalunterricht zu lauschen besitze ich nach wie vor nicht, aber darum soll es auch nicht gehen.
Was möchte ich hier gerade mit dem Post aussagen?
Ich habe vor ca. einem halben Jahr einen Post von einem Verwandten zum Thema ADHS gesehen. Er hat dort ein paar Sachen angesprochen, in denen ich mich natürlich wiedererkannt habe. Ein paar Tage später habe ich mit meiner Freundin geredet, weil ich die Frage "an was denkst du gerade?" nicht ausstehen kann, weil ich immer an mehrere Sachen gleichzeitig denke. Es ist einfach ein Durcheinander, wo ich innerhalb von einer Sekunde beispielsweise sowohl an Currywurst, als auch ans Tanzen und an die Wäsche denke, es hängt einfach nichts davon zusammen. Sie meinte zu mir, dass sie das so definitiv nicht hat und andere Freunde, die ich am gleichen Abend gefragt habe, konnten das nicht bestätigen bis auf einen, der genauso wie ich ADHS hat. Ich habe daraufhin am nächsten Tag, obwohl ich gerade im Unterricht saß, mir einfach nur den Wikipedia-Artikel dazu durchgelesen und bin anschließend auf weitere Quellen und war ein wenig schockiert, was ADHS ja wirklich ist. Ich habe relativ viele dieser dort aufgeführten Symptome. Sei es, einfach keinen klaren Gedanken halten zu können, lästige Arbeiten teilweise wie gelähmt nicht ausführen zu können, ich schweife in Gesprächen teilweise ab, selbst wenn es wichtig werden könnte und einige Sachen mehr.
Irgendwann lernt man ja mit sowas umzugehen, sei es durch "Vorsichtsmaßnahmen" oder Routinen. Da ich zum Beispiel grundsätzlich vergesse zum Einkaufen den Pfand mit zunehmen und es Zuhause einfach überhand nimmt, trinke ich nur noch Wasser aus der Leitung, ich tippe mir erst auf alle Taschen bevor ich aus dem Haus gehe, um zu prüfen, ob ich alles dabei habe. Das ganze ging sehr früh auch schon so weit, dass ich quasi "automatisierte Antworten" habe. Selbst wenn ich in einem Gespräch nicht zuhöre, antwortet meine quasi leere Hülle angepasst auf die Situationen und vermittelt dem Gegenüber sogar glaubhaft, dass ich alles verstanden habe und aktiv zuhöre.
Ein Negativbeispiel von der Arbeit: Ich war in die Arbeit vertieft und ein mir Unterstellter wollte mir was erzählen. Ich habe laut ihm einfach nur gesagt: "Halt mal kurz die Fresse." und habe meinen Blick gar nicht von dem Monitor schweifen lassen. Irgendwann schaue ich zu ihm rüber und sehe nur, dass er mich erwartungsvoll anschaut. Ich habe ihn dann gefragt, was er denn möchte und er hat mir das dann erzählt, was gerade passiert ist. Bitte hatet mich nicht gleich nach dem Motto "wie kannst du nur so mit ihm reden", wir reden beide sehr rau miteinander, das ist unser Ding, jedoch hatte ich nach diesem Vorfall große Bedenken, wann mir das denn noch so passiert ist oder in welchen falschen Situationen mir sowas mal passieren könnte.
Das Ganze ging in anderer Hinsicht so weit, dass wenn mein Chef mir einen wichtigen Arbeitsauftrag gibt, ich das "automatisch annehme" und ihm nicht zuhöre, weil ich in meinem Kopf mich zu sehr darauf konzentriere, ihm zuzuhören. Also quasi meine Gedanken einfach nur sagen "Hör ihm zu, das ist wichtig! Lass dich jetzt nicht ablenken" anstatt das Gehörte zu verarbeiten und tatsächlich aufzunehmen.
Durch diese ganze Geschichte lernt man irgendwann einfach Sachen zu akzeptieren, um nicht einfach als doof zu gelten, vor allem wenn man selber in einer Vorgesetztenposition ist. Ich habe manchmal auch einfach viel Glück, dass sich die Sachen dann irgendwie regeln oder ich einfach geschickt darin bin, die Information nochmal zu erfragen oder auf anderem Wege zu besorgen.
Genauso habe ich es mein Leben lang einfach nur hingenommen, dass ich mich einfach nicht konzentrieren kann und es nichts weiter ist. Dass ich einfach komisch bin, dass ich wie gelähmt im Bett liege, wenn ich in 3 Stunden etwas vor habe, auf das ich nicht wirklich Lust habe oder ich einfach nicht für Ordnung sorgen kann. Ich wurde nicht selten gefragt, ob ich an Depressionen leide, weil ich nicht einmal für die einfachsten Sachen einen Antrieb habe. Dass ADHS für viele Sachen der Auslöser sein könnte, wäre mir nie bewusst gewesen. Alles was ich in meinem Leben aus der Gesellschaft mitbekommen habe waren Relativierungen und ein dauerhaftes Runterspielen der Symptome. Man ist ja nur der Faule und hat keine Lust, etc. Natürlich gab es keine Relativierung von meinen Eltern. Meine Mutter hat sich früher immer für mich stark gemacht, aber ich bin damals nur wie so ein "benommener Fisch" einfach mitgeschwommen und hab versucht das zu machen, was ich machen soll.
​
Allein für vieles was ich mache und vor allem wie ich es mache eine Lösung zu haben, hat mir echt geholfen weiter auf das Problem einzuwirken. Ich weiß jedoch nicht, wie ich mein Problem mit den "automatischen Antworten" wirklich wegbekommen soll, aber auch dafür finde ich bestimmt eine Lösung.
​
Sollte sich jemand wirklich meinen Text durchgelesen haben, vielen Dank. Die Masse ist nicht ohne. Ich wusste nun natürlich nicht welchen Flair ich hier nehmen könnte.

(Note: A previous version of this post was longer and I have archived it in PDF form here ^\post only; landscape)) and here ^\full page; portrait)), as well as a screenshot here.)
Hi, I'm Marc, nearing my 30s, living in Brazil, and bearer of some mental health conditions: Bipolar disorder type 2, ADHD, C-PTSD and Delayed Sleep Phase Disorder.
Finding an effective treatment for this set of conditions took me about ten years since I first sought treatment, and I eventually had success with one particular medication: an old antidepressant named phenelzine (Nardil), from the MAOI type - a class unknown by most, but which we talk a lot about at /MAOIs, where I have been a moderator since 2019.
Also part of my treatment scheme are Ritalin and Concerta, two forms of methylphenidate, a mainstain in the management of ADHD for children and adults.
For more background into the above, refer to these:

• My 10-year journey into bipolar 2 diagnosis and full remission with phenelzine (Nardil); and
• Correctly diagnosed myself with bipolar disorder after 8 years of being wrongly treated for refractory atypical MDD - full remission with an MAOI antidepressant (comment).

I've been unemployed since June last year, which was before finding out the successful treatment to my disorders, and have been waiting for the full payment of my sick insurance since then. At one point I made a short appearance on national television; the interview took place when I was at the verge of being evicted, which did happen not long after. For the past 2.5 months I'm ^\quite unhappily)) living in my hometown, in a small house provided by my relatives (as I'm an orphan from age 4), and my only income is a grant from the federal government of R$ 600.00 (equivalent to 122 USD at today's rate) per month, plus whatever my family members can help me with to go through the month. Buying Concerta alone takes me more than half of that (320.05 BRL or ~65 USD); and then there's also Ritalin, and a couple of other meds; and I need to maintain my two cats and three fancy rats. I love them, they love me, and were it not for them I would sure not be here today. Anyway, there remains nothing left to buy food and other stuff for me, which people do help me one way or another although I'm always in a bind.
There remains the problem of phenelzine, though. For an US-based citizen, it's not exactly expensive, at ~110 USD per month. For me, however, that becomes ~542.00 BRL, not including shipping, which I can usually get down to 44 USD (207 BRL), but once had to pay around 240 USD (1182 BRL). It's totally unrealistic for me to afford it right now. Thus far I have received many donations from people I offer support to as an independent psychopharmacologist, who happened to have leftovers and were willing to send'em to me. Others who benefit from my advice and are in a position to help actually do so. I used to get a few monetary donations that kept me running up until a few months back.
I'm currently under withdrawal from this drug - for the 4th time, mind you. It is an absolutely miserable experience each time, and incurs the risk of it not working again when you reintroduce it, as was the case with writer David Foster Wallace, who ended up taking his own life. That's also what happened to other folks especially during shortages that took place in 2019^\1)) and 2020^\2)), and even more recently; in fact, I actually knew one such person and had tried to help her. I fear the same fate, for reasons that are exposed in the longer post I wrote before.
Phenelzine is regarded by many as the most potent antidepressant in existence, and I exhausted other options before landing on it, so it's a last resource drug. Fortunately it works amazingly: makes me a happy, functional individual as long as I keep taking it regularly. I should mention it's also the gold standard for social anxiety, panic disorder, and trauma disorders, such as mine. It simply works great for me, in combination with the other drugs I take.
My plan is to launch a crowdfunding campaign to help me afford such a treatment for, say, 6 months, and if all goes well, at least one of three things will have happened: either it'll be manufactured in Brazil, something I'm directly involved with; and/or I'll have won my court case where I'm asking for the Minister of Health to fund my treatment; and (hopefully) I'll have recovered and well enough to accomplish my goal of moving overseas, to a location where I'm paid better and have no such difficulties accessing my meds.
By posting here, I'm asking for help for at least one month's worth of phenelzine, but preferably two, plus the cost of a telehealth consultation (at around 300 USD) with an US-based doctor so that I can order from an US pharmacy a brand that does, in fact, work for me. Alternatively, I can go without that and try and work around the bad-quality brand that I'm guaranteed to be able to get, from Canada, as some try and have success with, though it costs more. An alternative that would be better still, but I'm unsure of whether it's possible, is if someone can have a friendly doctor transcribe my Brazilian prescriptions so that US pharmacies will dispense them to me. I colleagues and relatives in the US who could manage the order filling and shipping for me.
The monthly cost for the items that are hard for me to afford are, in order of priority:

1. phenelzine: about 110 USD; +shipping -> about 154 USD
2. more phenelzine: (110 USD gets me 2.5 bottles, and it's much preferable to get original, sealed bottles. So, ideally, I'd get 3, 4 or even 5 bottles! Each bottle costs about 48 USD in the US, or up to 56 USD in Canada).
3. telehealth consultation: about 300 USD (if someone know of a lower price, or can arrange this part for me, please let me know.)
4. Concerta: about 65 USD
5. Ritalin: about 12.50 USD

Every time I run out of phenelzine, my entire life comes to a halt; a period of insane withdrawal symptoms ensue for over two weeks, and after that I remain mostly disabled. Upon reinstating the drug and reaching the target dose, it takes a little over three weeks for the effects to take place again. It's a very destructive cycle (and it's even neurodegenerative!), and the entire experience is so nightmarish that I sincerely do not believe I can withstand going through it even one more time. Running off Concerta or Ritalin is also bad and incapacitating, but not nearly as much, and I can get help locally with some effort and just go to a nearby pharmacy to get them. No need to import, and wait for over two weeks, that is, if Customs clearance goes well.
To wrap it up, I wish I'd had written this post much sooner. I've been in MUCH better shape, and I'm not proud of myself for letting things get to this stage again. It's been so much fighting against my brain and body but at least here it is, I've done it.
I'm accepting donations through Paypal, Venmo, and Remitly. Suggestions are most welcome. Thank you so much for reading, and please help spread the word if you can. When I do set up the crowdfunding page, I'll share it here.

I’ve been agonizing lately over how I act at work when I’m in the zone, literally gnawing at my pen (i have now twice had a blue pen leak in my mouth), chewing my nails or on my hair, rubbing my nose (because boogers are in there and i can FEEL THEM), or otherwise making a weird ass face because I feel so uncomfy that people are around me all the time. Lately I’ve been running out of my social battery very quickly too, so I’m worried I’m offending people because i am so unfocused just trying to pretend im working for long enough to pull it together. Does that make sense to anyone else?? It’s my first real, good office job that I enjoy and it pays decently well. I’ve actually gotten a $4 raise since I started 6 months ago, but I am so paranoid that theyre gonna find out i dick around & fire me. Its literally so hard to focus, i started taking ritalin again so i dont go on hour long wikipedia dives. The thing is, i work longer hours & i get things done pretty quickly when i am focused.
Can anyone else relate, & if so, any advice on how to get it together??!!

This is an update/continuation/oversharing-info-dump of the post I made from 6 months ago. You were very supporting, but I am very much down again. I should be happy about my life, but I am afraid of burnout/more depression. I had a bout of that not long ago, that felt exactly like the first mega crash some years ago. Luckily it only lasted very short period of time.
The burnout feeling comes in waves that can knock me out, though not enough to topple me completely over at work, but enough that I have to take time staring into a wall when I get home. You know, where my kids and SO are, that all need me.
I can't have downtime like that, but I sometimes cant function without it. And it's costly on the family account. Especially when you have a kid with special needs.
I did start medication on Ritalin a month ago and your input was a part of that decision. The other part was that I thought I had a mega crash, so I pushed all the buttons and got started on medication. I dont want to go into that black hole again and get spaghettified.
On medication, I do feel that I have more energy, but the problems that I always had persist/haunt me. So besides having more energy, the only difference is, that I now have 20/20 vision on the diagnosis.
So when I fuck up, I know exactly why and which symptom happened.
In one way it's a relief, so I can try not being so hard on myself, but the consequences of my actions are still there. It's hard to be kind to yourself when you mess up or is so inefficient.
There's a reason I am hard on myself constantly. Because I f***ing needed to be, to push myself to where I'm at now. Through the concrete walls.
It's like having an open wound where you foot should be, but only realizing decades later, that this is why you had to run day and night to keep up. And it never healed. Now you body is older and cant sustain the wound.
These are the biggest problems ADHD causes for me:

• I sometimes cant follow a conversation or having to interrupt otherwise I'll forget.
• Agree on something with others, only to forget it 2 hours later.
• Bad memory.
• Work on something, then blink, and find myself out of a rabbit hole and 4 hours have passed. "F**k! I have x presentation tomorrow and now have 40 minutes to complete it".
• Mess up calendars appointments.
• Hard time finding internal information on email/teams/sharepoint/team website
• Tell others the wrong numbers on something (though that is the last thing I want)
• Write/talk out of a tangent
• Forget to or poorly update: time sheets, work calendar, private calendar, school calendar and messages, leave request tool for work, team vacation planning.

No wonder I felt like I had to work twice as hard as my peers since I started school in most classes. If I don't continue fighting, I will not be able to keep up. But I'm older, my body and brain is older, and this is when people with ADHD can burn out.
So I could drop down to helpdesk or find work where I use my hands, reduce my familys living standards, but I've actually worked such jobs before and guess what? They still require executive functioning. Organizing, planning, being able to remember conversations, managing own time, etc.
There are no jobs where I this wont require me to work harder than other people, unless I just let go completely and find an extremely simple job. But life with a diagnosis and a kid with a diagnosis is hard enough already. It will be even harder with a lot less money. No wonder no one in my family has a higher education.
I was actually about to post my frustrations of trying to battle ADHD with digital tools in /adhd, but I realized that since so many responded to the last post, maybe this is actually a better place for advice, since some both have ADHD and work in the (very broad) area as I.
I dont see myself as in any danger of being fired, but I realize just how much ADHD is costing for every person around me. Family, Work. Myself.
​
DIGITAL TOOLS for ADHD
What digital tools will help with ADHD and keep helping?
Throughout my life, I've used paper, Excel, Evernote, Onenote and now digital whiteboards.
Paper is great and I even made a system once. It's completely free form. However I end up with paper everywhere. Then I dont have my paper with me. Or the notes are unstructured.
Excel structures me, but is more suited to attack concrete problems rather than manage my brain.
In Onenote, I started out with a mega note and used the function for meeting notes. It worked for a time.
Then I made a system where I had a section for each month and a note for each week. It succumbed into me being stuck in the same month, but just adding notes at the bottom.
Miro clicks incredibly well with my brain. Then I zoom out and I see the chaos. I organize it, but I raw output so much, that the performance of the tool itself deteriorates (!) and eventually (my brains') chaos consumes the board. Notes and illustrations here and there, everywhere.
Zooming out is the image of ADHD! To such an extent that is scares me. There's SO MUCH information and it ends up a garbled mess. It sometimes work "in the now" or very short term. Additionally since I started using it, it's like I need to illustrate and note down everything now, which is time consuming. Sometimes it does happen that it serves as communication pieces, meeting agendas or processes, but it also takes up a huge amount of time to do them, and I feel like I need to contribute more in other places.
During conversations or meetings, I always tend to grab Notepad.exe to quickly note down if it becomes detailed, so I down forget. So whatever main tool I use, I have to remember to consolidate with Notepad.
Then there's calendar appointments. Of course I have a shared private calendar because we are a busy family. Then there's my work calendar. So those two need to be aligned. Then I need to align that with my team availability chart. And remember to register my timesheets. And remember to register my days off in another solution. I need to keep all those in check with my schools app, and check messages and the school calendar.
I was trying to find the one tool to rule them all, but I think ADHD is bound to chaotically drift me away from them.
What do you guys with ADHD do?
​
How do I prevent burnout. I'm so exhausted of this and there is just no end to it.

I'm not sure how much it matters which TCA you use. I've seen a couple different molecules mentioned. I see this:
https://en.wikipedia.org/wiki/Tricyclic_antidepressant

Tricyclic antidepressants (TCAs) are a class of medications that are used primarily as antidepressants, which is important for the management of depression. They are second-line drugs next to SSRIs. TCAs were discovered in the early 1950s and were marketed later in the decade.[1] They are named after their chemical structure, which contains three rings of atoms. Tetracyclic antidepressants (TeCAs), which contain four rings of atoms, are a closely related group of antidepressant compounds.

...

The TCAs were used in the past in the clinical treatment of ADHD,[11] though they are not typically used anymore, having been replaced by more effective agents with fewer side effects such as atomoxetine (Strattera, Tomoxetin) and stimulants like methylphenidate (Ritalin, Focalin, Concerta), and amphetamine (Adderall, Attentin, Dexedrine, Vyvanse). ADHD is thought to be caused by an insufficiency of dopamine and norepinephrine activity in the prefrontal cortex of the brain.[12] Most of the TCAs inhibit the reuptake of norepinephrine, though not dopamine, and as a result, they show some efficacy in remedying the disorder.[13] Notably, the TCAs are more effective in treating the behavioral aspects of ADHD than the cognitive deficits, as they help limit hyperactivity and impulsivity, but have little to no benefits on attention.[14]

Not sure how much debate there is over how TCAs compare to newer drugs in terms of efficacy and side-effect profile. But for those who've failed the newer drugs, you might imagine that TCAs are an attractive option.
I found this interesting:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4150853/

Antidepressant mechanisms of action remain shrouded in mystery, greatly hindering our ability to develop therapeutics which can fully treat patients suffering from depressive disorders. In an attempt to shed new light on this topic, we have undertaken a series of studies investigating actions of tricyclic antidepressant drugs (TCAs) at the α2A adrenergic receptor (AR), a centrally important receptor, dysregulation of which has been linked to depression. Our previous work established a particular TCA, desipramine, as an arrestin-biased α2AAR ligand driving receptor endocytosis and downregulation but not canonical heterotrimeric G protein-mediated signaling. The present work is aimed at broadening our understanding of how members of the TCA drug class act at the α2AAR, as we have selected the closely related but subtly different TCAs imipramine and amitriptyline for evaluation. Our data demonstrate that these drugs do also function as direct arrestin-biased α2AAR ligands. However, these data reveal differences in receptor affinity and in the extent/nature of arrestin recruitment to and endocytosis of α2AARs. Specifically, amitriptyline exhibits an approximately 14-fold stronger interaction with the receptor, is a weaker driver of arrestin recruitment, and preferentially recruits a different arrestin subtype. Extent of endocytosis is similar for all TCAs studied so far, and occurs in an arrestin-dependent manner, although imipramine uniquely retains a slight ability to drive α2AAR endocytosis in arrestin-null cells. These findings signify an important expansion of our mechanistic understanding of antidepressant pharmacology, and provide useful insights for future medicinal chemistry efforts.

This is me finally coming around to share my story. Brace yourselves, as it'll be a rather long read.

Backstory

I'm Marc (name's actually Marcelo, but the nickname is how I go by and have been for over a decade) and I'm 29. My parents died in a car crash when I was 4; relatives took me and my sister and we were subjected to abuse, mainly psychological. When I was 14 my sister married I went on to live with her, and eventually that came to be a somewhat of abusive and traumatic experience in its own ways as well.
In mid-2012, when I was 18 and working my first formal job, I went to a neurologist with complaints of persistent headache and an unbelievable degree of daytime sleepiness along with hypersomnia. No matter how much sleep I got, it was never enough; that constant feeling of sleep-deprivation sapped my energy and motivation and, in addition, probably due to napping during the day, I was having multiple episodes of sleep paralysis. After requesting some brain imaging and related exams, with no relevant findings, I was left with a prescription for citalopram, which I bought at the pharmacy on my way home. It was totally confusing for me later on when, upon reading the package insert, I found it was an antidepressant. That made little sense to me at first, but considering I had been avoiding leaving home and/or doing things I previously enjoyed due to my symptoms, it made sense to me to make an appointment with a psychiatrist. Only then I was taught about depression and its forms, was formally diagnosed, and left with a script for bupropion. A totally different experience than simply leaving the doctor's office with a prescription with zero explanation about it.
The trial with bupropion went rather terrible: excessive anxiety, jitteriness, tachycardia, worsening of tinnitus. A month and a half later, I decided to quit it and it crossed my mind to try the citalopram I had at home. A rapid and noticeable improvement ensued, and I continued taking it for some 2 - 2.5 years. Eventually, it pooped-out and would no longer work at all, despite dosage adjustments or whatever other tricks we experimented with.
That was the beginning of a LONG saga. I'll post a full list of drugs that I've tried along the years in a comment under this thread.
At the end of 2015 I visited a new doctor, hoping to break the cycle of trialling one SSRI after another as that made little sense to me (and I know many of you can relate). This doctor upgraded my diagnosis to "treatment-resistant depression" (TRD), also called refractory depression, another concept most of you guys who've come to this sub are familiar with. He put me on mirtazapine and venlafaxine, later replaced by desvenlafaxine - per my request, and we augmented with modafinil, a drug that had previously been partially successful for my depression as it was comprised essentially of neurovegetative symptoms.
I remained on this regimen for just under 2 years, when, bringing up once again a long suspicion of ADHD, I got a diagnosis for that and was prescribed lisdexamfetamine (Vyvanse) to take instead of modafinil (he also put me on fluoxetine in place of desvenlafaxine).
The response to all of the drugs mentioned in the previous paragraph was rather inconsistent. They all seemed to work fine, even great for some time, and then their effect vanished - many times this was linked to stressful life events, but not always. Lisdexamfetamine in particular was noteworthy for turning my life around in the beginning, and then bringing about unparalleled anxiety a few weeks in, even worse than bupropion years back. In 2018, having moved to a new city and now under the care of yet another doctor, I eventually replaced it with methylphenidate/MPH (Ritalin) and that went much better for the ADHD symptoms in isolation - not for depression.
At some point in 2019, I came to further re/define my depression as atypical. That led me to do some serious research into MAOIs, and among other sources, this post from the Slate Star Codex in particular motivated me to try and find a psychiatrist that would be willing to put me on one. I wanted to try phenelzine/PLZ (Nardil), but soon found that it was not sold in my country. Importing was not an option at the time as it'd be prohibitively expensive, and so I asked for tranylcypromine/TCP (Parnate) instead. With some resistance, he actually prescribed it for me, although not in my first visit. And that was the beginning of Long Saga: Part II.
TCP appeared to kick in for me since the very first day, and I quickly became more active, motivated, and hedonic. My memory was back, and so was my will to live. My brain seemed to be back to its full capacity once again. I came back to enjoying old hobbies, such as volunteer programming, and playing the guitar. Sleep, however, was an issue. I had been on mirtazapine and methylphenidate (Concerta) right before initiating TCP, and decided to taper down the mirtazapine, feeling it was making me restless and worsening my tinnitus.
A sad fun addendum. After quickly checking the Drugs.com online interaction checker, he doctor had me sign a waiver that I were instructed to stop both mirtazapine and MPH before initiating TCP. I tried to argue that it was not needed, but he held his view. Even sending him some material from Gillman and Stahl, and some papers I collected here wasn't enough. Since I was the patient and felt in position to take the risk, I went on without discontinuing either drug. Coming back to the next visit, he felt personally disrespected, angry even; dismissed me as his patient, and was quite convinced I risked death by continuing to not follow his advice.
It appears that, to this day, I still seem pretty much alive!
I remained on TCP for some two years (until August 2021) and that was a very erratic timespan. My response to it wasn't consistent at all - i.e. I kept cycling between periods of "very well" or "normal" and periods of depression, often severely disabling, with major cognitive impairment. Fair attempts at adjusting the dose were made, from 10-20mg up to 40mg a day, and augments such as NAC, lithium, clonidine, nortriptyline, mirtazapine, and others were tested. It just would not stabilize; nothing seemed to settle things down.
Then, at some point mid-2020, I came across the notion of the "'mood spectrum" or bipolar spectrum, and upon assessing my family history, past treatment responses and other details, it became clear to me that what I had was not, in fact, "unipolar" TRD (or, in formal terminology, Major Depressive Disorder), but some form of bipolar disorder instead. At the same time I was assigned a new doctor and voiced my hypothesis; being familiar with the concept, he agreed with me and we began steering my treatment in that direction.
By now it's fully figured out, btw. I have: Bipolar disorder (BD) type 2, with atypical features (i), with mixed features (ii), with rapid cycling (iii), without psychotic features (iv), and with anxious symptoms (v).
This symptomatology, and variations thereof, happen to be, by the way, what I find many patients who are formally diagnosed with "depression and anxiety" and are treatment-resistant actually have. I've been practicing as a volunteer independent psychopharmacologist for some time now, helping people around (in a similar fashion to Dr. Gillman), and this framework has helped many people I came to know and assist.
Just for completeness, my other diagnoses are: ADHD-combined; C-PTSD (owing not only to my childhood history, but also to going through some traumatic/abusive relationship experiences of various forms, such as prolonged ghosting - to give just one example - and, probably chiefly among all, due to facing severe financial shortcomings as an adult, all while dealing with the onset of bipolarity); and finally, delayed sleep phase disorder, a condition that often comes hand in hand with ADHD (and sometimes BD). These were all findings/diagnoses of my own, later to be validated and addressed by doctors of course.
A final note before we go ahead: Looking back now, it's clear to me that the rapid and marked response I had to citalopram in 2012, as well as with lisdexamfetamine in 2017, and then with TCP in 2019, were all clearly hypomanic episodes. Also, the anxiety, agitation and unease induced by many drugs such as bupropion, venlafaxine, sertraline and fluoxetine, and the ocasional impulsiveness with modafinil, among many other signs, were mixed episodes, as were instances of abnormal irritability during treatment with TCP (and escitalopram before that). So, these were all features of BD.
I remember bringing a concern to my first psychiatrist back in 2012, who dismissed bipolarity; this repeated in the years ahead as I asked at least two other doctors what their thoughts were about my problematic response to classic antidepressants. Even when I asked for lithium, all I got was a low dose indication, as an augment to my antidepressant, instead of standard doses for BD.
This had me convinced to the point that, right before going to the new doctor to try and get TCP, lamotrigine had been suggested to me by another doc, but having read that "Lamotrigine for Major Depressive Disorder Is Inappropriate", I didn't take her seriously nor I bothered getting it at the pharmacy.
Finally, I arrived at this sub in late 2019, and got to exchange knowledge and experiences with great folks. I also soon became a moderator here and got to participate in the MAOI WhatsApp group. This put me in touch with really great people, and by last year (2022) I decided to run a small crowdfunding among some colleagues to finally be able to try phenelzine.
One awesome silent benefactor, whose actual name, age and gender I still don't know to this day, was kind enough to donate me a couple of bottles of Nardil from Lupin, brought to my country by a friend of mine who happened to be visiting the US at the time by coincidence.

Reaching remission

Prior to starting PLZ, I had been on lamotrigine 125mg plus valproate ("VLP" / Depakote ER generic) 500mg, and MPH (Concerta + Ritalin), with ocasional mixed episodes and rare "pure" anxiety manifestations, which I controlled with olanzapine and diazepam, respectively. Do note that I was no longer on TCP; having ascertained it kept me on rapid mood cycling in a manner similar to the one described here, and noticing I was as good as, if not better, on the two anticonvulsants/mood stabilizers alone.
When getting the first bottles of Nardil, I started at 60mg (4 tablets) and was able to do away with the valproate in the same day.
Its effect over anxiety was immediate. I was calm, tranquil, laid back. My voice was different, and people noticed it. I did experience a significant level of dissociation, although it was not really unpleasant and I was still able to function and talk to people and so on. I reported that in my thread Anyone find they no longer need ADHD stimulants after starting phenelzine?. That subsided within a week, thankfully.
I soon began taking quetiapine/QTP (Seroquel) - 50mg at night - and it helped a lot with sleep, while also reducing the occurrence of mixed states. Its potential excessive daytime sleepiness was offset by lamotrigine, which I dialed down to 100mg in divided doses. I played with dosages a bit (how to distribute drug doses along the day) and ended up finding what seemed to be ideal regimen.
Precisely two weeks later, I increased the dosage to 75mg (5 tablets) and, by entering week 3, I was depression-free. The feeling of experiencing actual "normality" was exciting. It was a different experience than that of TCP - I didn't feel under the effect of some drug, it was just a "normal" sensation. The lifting of depression brought about by PLZ was clean and transparent. My memory and cognition were once again brilliant. I was able to process information quickly and efficiently; answer questions, and make decisions. My sleep schedule became stable. I cherished playing around with my pets (two cats, two fancy rats at the time) and once again, came back to old hobbies, such as soldering and fixing electronics and playing music in the computer. I came back to walking outside everyday, to get some daylight, able to pay attention to traffic, look people in the eye and compliment them, and to be overall mindful of my surroundings.
In fact, writing all this reminds me of the film Limitless (2011), whose protagonist's life is turned around after taking an experimental revolutionary drug. The irony is that, in my case, such a revolution resulted from a drug that was approved six decades ago!
People sometimes say that when they first begin taking phenelzine (or other MAOIs) they go through a sort of "almost hypomanic" phase. Let me just take a moment to state that I don't like this description, as there is no such a thing as "almost hypomanic" IMO and it confuses people. Now, how do I know this wasn't all hypomania? First off, I was still sleeping my usual, healthy 9 hours straight. This alone discards the [hypo]mania hypothesis. Furthermore, I had great emotional control, and wasn't impulsive at all in terms of spending money and managing my time - quite the contrary, actually.
This period of awesomeness went on until I ran out of the phenelzine from Lupin, and had to replace it with the Erfa stock I had bought. For those who don't know, Erfa is the distributor for Pfizer phenelzine (manufactured in the US) in Canada. Some people suspected that, but as the bottle seal is Pfizer's, that's how I know for sure. It's the exact same drug. Folks report it to be less effective, for reasons mainly related to its inactive ingredients and also its coating. In my case, however, that was the least of the problems, as my parcel arrived in a bad condition: partially degraded, smelling like phenylacetic acid, probably due to heat exposure during shipping.Turns out the pharmacy I bought it from didn't ship to Brazil; I had to ask a cousin who lives in the US to get it for me at his address and then post it through USPS.
From the day as I replace my PLZ from Lupin to Erfa, a significant relapse ensued. The potency of the medicine was greatly diminished and I was pretty much bedridden during that period. But, about two months later, another very kind friend I made was able to donate me more bottles of Lupin, and when that arrived, it once again took me three weeks for the full antidepressant effect to kick in and I was again fine and well, or mostly anyway.
Another, longer relapse came by when I switched brands of quetiapine, at around October last year - I used to buy it from the pharmacy, from a trusted manufacturer, but due to strenous financial difficulties, being unemployed since June because of my seriously aggravated health situation back then and having been denied social insurance, I applied for a government program that provides some essential medications for free. The brand is, however, less effective than the one I had been buying and my mental health worsened without me realizing. It wasn't until 3 or so months later that, upon checking notes, I figured that must have been the cause of this second relapse and, being able to purchase some QTP from the previous brand with the help of another great friend, I quickly became better again. This was a dark period, during which I re-experienced previous trauma ^\C-PTSD flashbacks and reinforcement)) due to money issues and relationship frustrations. Oftentimes these left me paralyzed and hopeless, I slept on the floor some nights, and resorted to paracetamol/acetaminophen to ease the emotional pain (look it up if curious - it really works).
Anyway, with the original regimen restored, I was doing alright again, even despite changing from Lupin to Greenstone phenelzine, until I eventually ran out of it. The surrogate protocol I devised, based on TCP 25mg, didn't go well at all: I found the hard way that going up to 50mg was needed. 120 pills of vigabatrin ended up costing me a lot, and didn't do much in terms of approximating PLZ's anxiolytic efficacy. At any rate, though, when I ran out of my first package, unable to purchase another, I presented to the ER with absence seizures and had my first ever (and only, I hope!) panic attack. So thankful I wasn't alone at home.A few days later, I found that valproate (divalproex, 500mg) gave a better effect than vigabatrin.
The combination (TCP, olanzapine, valproate, quetiapine, methylphenidate) allowed me to survive until I got a couple more bottles of Greenstone Nardil sent me by another colleague. I use "survive" here because it was quite a hell-ish experience, of which I have little recall of. My brain was at like 20-30% or so. To make matters worse I had to endure some rather harsh events such as an eviction order and the loss of one of my beloved fancy rats, Lentil. When Nardil arrived, though I did a hot swap (from 50mg TCP to 75mg PLZ) and, thankfully, this time around it actually kicked in faster.
To make an addendum, this time I maintained the valproate, but only half a pill (that's effectively 250mg) (and yes, I know Depakote ER pills aren't supposed to be cut) and found this pretty much erradicated any occurrence of mixed episodes, further increasing the potent anxiolitic effect that Nardil provides at low to moderate (but not high) doses. Valproate is a GABA-T inhibitor much as phenelzine's metabolite phenylethylidenehydrazine/PEH. PEH is formed in the gut but this depends on some free MAO to be available there, which is why a person taking 90mg of PLZ won't have the same anti-anxiety potency as someone at 60mg (who, in turn, will have a lower antidepressant effect).
And by the way, this is what's behind the difference in effect among manufacturers. Lupin's coating is much more gastro-resistant than PfizeErfa. This causes less of PLZ to reach the gut, as a larger portion of it is metabolized in the stomach into phenethylamine/PEA.
And we arrive at now. I'm once again out of phenelzine, it'll be a month by next Friday (July 7). I prepared by keeping some TCP around and when the time came I jumped to it at 50mg. Took me a couple of weeks to figure out an ideal dose distribution through the day as well as how much olanzapine I should take it with. The fact that I also ran out of Concerta 3 days later and had to endure a week taking multiple doses of Ritalin through the day to try and mimic it didn't help also. (That was sorted eventually.) Right now I'm back to the surrogate protocol, and find myself in a sort of chicken-and-egg problem: I'm unable to work without Nardil as I'm not functioning well, and I can't purchase Nardil as I'm not working and don't have the money for it. In fact, my Parnate will run out this week as well and I still don't have the funds to buy more. But that's another beast entirely.
And there we have it. A remarkable response to phenelzine (in combination with other drugs, which I shall detail separately) after 10 years of severe, disabling bipolar depression that has destroyed so much in my life and held me down so hard. I can't access it right now due to cost $$ but am confident to figure out a way soon. I'm pleading for the federal government to assist me with it, it's a court battle - so far not favorable to me due to an "expert" report that's 31 pages of BS and the supposed "expert" is not even a neuro/psychiatry specialist - she's an... acupuncturist! (!!!).
Now that I know that it's possible to live fully, instead of just surviving as I've been doing all these years, and had a fair glimpse into how a happy and fulfilling life can be, I no longer indulge in thoughts of "letting go" as I did so many times in the past (and here too, I know many of you relate). I will find a way through and get back to my optimal treatment scheme again. I'm confident I will accomplish the things in life I've longed for since way back, and more. If you read my account this far into and it resonates with you, I like to think that you, too, will be made whole again as much as me somehow... if not more!
P.s.: I'll be adding two posts below this and, of course, I'll be happy to answer any questions you have.
P.s. 2: This is day 2 since I've been functioning somewhat decently. I actually began writing this over a week ago!
[Edit] P.s. 3: Forgot to mention. Atypical depression has this pervasive symptom called "sensitivity to interpersonal rejection", and, contrary to all other symptoms, it doesn't fade much or go away even during remission in most cases. It does, however, with phenelzine. In my case anyway. It's the one and only drug to ever have that effect on me, which is why I think it's so singular.

Diagnosed ADD around age 10. Started on Ritalin, moved around to Concerta, I think a couple others (can’t remember) before landing on Focalin around age 15.
I’ve never really felt like it “worked” or “clicked” for me. Sometimes it feels like it helped a little but the helpful effects were always lost in a sea of really bad effects.

1. Instead of focusing on one thing, I’d hyperfocus on a million things, go off on Wikipedia rabbit holes, etc and get distracted and hyper focused on everything but my work.
2. Brief periods of euphoria and motivation followed by HORRIBLE anxiety, heart racing, zombie moods, and just feeling like I was “tweaking”, horrible comedown and all.
3. On Focalin, I have a complete inability to function socially. Complete loss of creativity. Just feel overanxious and tweaky and skittish

It provided maybe a little benefit but it was extremely inconsistent and the overall net effect was neutral or even negative. I’d stop taking it for long periods because it was such a rough experience.
I read stories about people taking medication and “being able to focus for 8-12 hours” and “feeling calmed down” etc and I’ve suspected for a while now that my medication may not be doing everything it should.
My issues are defined by an inability to focus but also a lack of motivation or spark or whatever. It’s a long complex story but I tend to zone out and daydream a lot. I can focus for brief periods but I burn out extremely quickly and can’t focus after that.
I’m not a dumb person, I took and passed two bar exams, each on the first try (different states) without the use of any medication but I think to function at the level that is required to have a productive career (sitting and being productive 8-10 hours a day, 5-6 days a week) I need something more to be at my best consistently.
I was considering Vyvanse or Adderall (had previously discussed Vyvanse with my doctor, who has been treating me for almost 20 years) but couldn’t afford Vyvanse when we last discussed.

This article contains a lot of film stills. For a fully illustrated version please click here - https://filmofileshideout.com/archives/sorry-but-i-love-orgy-of-the-dead/ Orgy Of The Dead is trashy, offensive, and downright stupid, but I love it. It was written by Ed Wood, so you know it had to be bad, or had to be bad in a good way, or good in a bad way? I can’t tell the difference anymore. It’s a movie and it is very entertaining. The plot is pretty straightforward. A nice white couple crashes their car during a full moon and end up stranded in a graveyard. They are kidnapped by the Wolf Man and the Mummy and forced to watch an evil ritual through half a dozen fog machines on full blast. It could happen to anyone. The ritual is overseen by a female vampire and some dude who looks like the no-neck narrator from The Rocky Horror Picture Show. Actually, the dude is played by none other than Jeron Criswell King AKA The Amazing Criswell. He played the lead alien in Wood’s Plan 9 From Outer Space, but with a slightly different hairdo. According to Wikipedia, Criswell (1907 - 1982) “was an American psychic known for wildly inaccurate predictions.” How inaccurate you ask? He was Mae West’s personal psychic, and he told her that she would one day become the president of the United States. He claimed that he grew up sleeping in a coffin and that he never spoke until he was four. If you’re interested, he left behind several books and recordings of his predictions. The Amazing Criswell and the low-rent Vampira (the real Vampira wanted nothing to do with the film) sit in front of a couple of stone columns, watching a series of women do interpretive stripteases designed to illustrate their sins. Criswell’s character turns out to be the devil. There’s no red skin or horns, but he does have a silk cape and a Colonel Sanders Kentucky Fried Chicken tie. He judges each striptease, and if he is not pleased by their performance, the souls of the dancers are damned. If he is pleased, I’m not sure what happens. The premise is, of course, just a loose framework to justify a series of bad stripteases, but Stephen C. Apostolof, the director, and Mr. Wood were committed to it, and the result is… I don’t know what it is, but it's enjoyable. The female vampire announces the first stripper and out walks a white woman in brownface, dressed like a Native American. Faux Vampira explains that this woman “died in flames and all her lovers died in flames.” After being introduced, the woman begins a striptease interpretation of the genocide her people suffered. Actually, to be more accurate, it is a white actress performing a minstrel-like parody of the genocide her own ancestors committed while she simultaneously debases herself through the objectification of her body. Is that punching up or down? While she sways in the fog and wiggles her bottom to remind us of the Trail of Tears, Indian drums and chants play in the background. Then, to place the offensive cherry on this nasty, little sundae, Apostolof overdubs an echoey chorus of men singing “Heya ho, heya ho” over and over again. After the sexy Manifest Destiny routine is over, a woman appears who I assume is/was a prostitute. Vampira introduces her thusly, “One who prowls the lonely streets at night is bound to prowl them in eternity.” I didn’t know they had lonely streets in eternity, or prostitutes for that matter. Anyway, our “street prowler” flirts with a biology-classroom-skeleton for a while and then disappears back into the stone mausoleum from whence she came. I’m not going to go through each sordid dance, but there are a few others worth mentioning, in particular the golden girl! This poor woman was obsessed with gold in life, and so is given a golden shower, of coins, while she does her dance. Then, two beefy fellas dump her in a cauldron of boiling gold, but instead of her body being horribly disfiguring, the molten metal just forms a shiny sheen over her skin and she is then carried back to her mausoleum and sealed back up. Pat Barrington is the actress who performs the golden dance, but Barrington also plays the horrified Shirley standing on the sidelines. You would never guess Barrington played both roles because Apostolof was clever enough to have her switch wigs. This results in some kind of Lacanian, meta-psychoanalytic, post-structuralist metaphor of a woman watching herself do a striptease that horrifies her. You know how cerebral Wood can get. The next young lady is dressed in a cat costume with a window cut out of the front for her breasts. The devil explains to Vampira that, “A pussycat is born to be whipped.” Take note, all you pet owners. This, of course, means that we get to watch her being whipped while we listen to some very upbeat lounge jazz. There is a Spanish dancer, a Hawaiian-looking “native girl”, a very happy-looking murdered bride, and more. None of the strippers remove their bottoms, but some use flesh-colored G-strings to simulate nudity. All the while, we keep cutting away to Shirley and Bob watching in horror. There is some occasional “dialogue”, if you want to call it that, (To be recited as if you were a second grader zonked out on a double dose of Ritalin) Shirley: “I’m frightened, I’m so frightened.” Bob: “Hold on just a little longer, Shirley.” Shirley: “Be careful, oh please, be careful. We’ll never get out of here alive. I know it. I just feel it.” Bob: “You do?” Shirley: “Yes, I feel it in my bones.” Bob: “You’re talking nonsense.” Shirley: “Oh no, I’m not.” (The absence of exclamation points is intentional.) The stripteases are way too long, and some are performed without much enthusiasm, but the sheer ridiculousness of it all carries you through. Each dance is cross-cut with assorted reaction shots of the onlookers, although it’s hard to tell how the werewolf and mummy are reacting under their cheap rubber masks. In a movie as superficial as this one is, there is little or no thought given to the subtext being presented. The movie is an excuse to look at naked ladies, but there is definitely some moralism about women, sin, and sex. Orgy of the Dead sets up a kind of Greek Chorus where each woman's striptease/trial is commented on by Bob, Shirley, The Devil, Vampira, the Mummy, and the Werewolf. I guess that’s pretty close to what Ancient Greek choruses were originally composed of. Each woman is made to "repent" for her sins by pleasing the sexual whims of The Devil. It isn't really repentance, it's more like reveling in their misdeeds, but it is a kind of reckoning. The devil wants them to fully indulge in their own destruction. If they please him, he will spare them from damnation, but surely, they will not be sent to heaven. Maybe they will go to the devil’s harem, or some horrible purgatory like New Jersey. Bob and Shirley embody white-bread society’s disapproval of the strippers and their sins, but as the audience, we are encouraged to align ourselves with The Devil. We are here for the same reason he is. If Bob and Shirley had their way, the ritual would be stopped and the movie ruined. The result is the same old double-bind that women have found themselves in for centuries. It is the dissonant directive telling them to be sexual, while simultaneously reproaching them for it. There is, however, something deeper underlying this bind. At its heart is a core belief that women are inferior to men. God made Adam with his own hands, Eve is just an offshoot made from a piece of the primary original. Women are not only seen as “less than”, but they are obligated to make up for their deficiencies. These stripteases are performed as payment for the debt they incurred by being born female. What we have in Orgy of The Dead is a tribunal overseeing the punishment of women by Satan. Satan is the audience’s entry point, but we are not meant to entirely identify with him. It is really the mummy and the werewolf that are our proxies. They stand on the sideline, cracking jokes and gaping at the spectacle, waiting to see what comes next. In a choice between prudish white citizen or lustful evil demon, we are given a middle ground. We can be a cursed, but horny lycanthrope, or a rotting, but horny specter of the undead. Next time you are in a theater, look around and see who is who.

Hello,
I'm not looking for specific medication recommendations to be clear. I'm just inbetween psychiatrists, and it's a 3 month wait until I can see one, so I'm just wondering if anyone else has ADHD was not helped by the usual prescribed stimulants, and what were the next steps you (and presumably your Doctor) took..
I have ADHD-PI (PI being Predominantly inactive) - not sure how officially recognized that subtype of ADHD is, most people I've talked to have never heard of it, but I don't get out much or bring it up much at all either. It has a Wikipedia page, so I guess that's something:

The 'predominantly inattentive subtype' is similar to the other presentations of ADHD except that it is characterized primarily by problems with inattention or a deficit of sustained attention, such as procrastination, hesitation, and forgetfulness. It differs in having fewer or no typical symptoms of hyperactivity or impulsiveness. Lethargy and fatigue are sometimes reported, but ADHD-PI is a separate condition from the proposed cluster of symptoms known as sluggish cognitive tempo (SCT).

So basically, I don't experience any hyperactivity or impulsiveness, but it's still super difficult to sustain focus on certain things, which for me is primarily anything to do with learning, or just reading a book. Like if I try and watch a YouTube video to try and learn about something or how to do something, there's no way I can stay focused on it. Or if I try to read a book, primarily non-fiction, it's nearly impossible, and I don't retain the information long if I am able to get through it, just reading the words, but not soaking any of it up, retaining little to no information. Learning has always been tough for me (36/m).
Primarily I (36/M) have been prescribed Adderall, but have also been on Ritalin, neither of which have helped me with ability to focus or sustain attention. I am also always tired, so that's pretty much the only reason I have been taking stimulants for so long, despite them not helping me focus at all. They also help some with treatment resistant depression.
I do through short spurts (1-3 days) of angeirritability, as well as phases of obsessive anxiety, which are awful.
But I don't know how to treat my inability to sustain attention on things (again, primarily things to do with trying to learn something, perhaps it's more of a learning disability kind of thing, or it's ADHD-PI and a learning disability compounded on one another.
Sorry this post is so long! I do that a lot. Apparently I don't have much of an issue sustaining my attention on making posts that are too long.

Informed consent is a principle in medical ethics and medical law, that a patient must have sufficient information and understanding before making decisions about their medical care.
Pertinent information may include risks and benefits of treatments, alternative treatments, the patient's role in treatment, and their right to refuse treatment. In most systems, healthcare providers have a legal and ethical responsibility to ensure that a patient's consent is informed.
Treatment of ADHD by way of methylphenidate has led to legal actions, including malpractice suits regarding informed consent, inadequate information on side effects and misdiagnosis in the USA.
Medical Council of India Guidelines
To standardize the practice of obtaining informed consent, the Medical Council of India (MCI) has laid down guidelines that are issued as regulations in which consent is required to be taken in writing before performing an operation.
The MCI guidelines are applicable to operations and do not cover other treatments.
For other treatments, the following may be noted as general guidelines:

1. For routine types of treatment, implied consent would suffice
2. For detailed types of treatment, ideally express oral consent may be needed
3. For complex types of treatment, written express consent is required

Legal Expert Opinion
The most extensive guidance on informed consent can be found in judicial precedents on the matter. Jurisprudence pertaining to medical negligence and the nature of consent required from patients, before carrying out any medical procedure, has been laid down by the Indian Supreme Court in a seminal judgment on the subject. Broadly these principles are as follows:
A doctor must give a patient adequate information for him/her to understand the various aspects of the proposed treatment, as given below, so that he/she can take a call on the treatment. This would consist of the following:
i. the nature and procedure of the treatment; ii. its purpose and benefits; iii. its likely effects and complications; iv. any alternatives, if available; v. an outline of the substantial risks; and vi. adverse consequences of refusing the treatment.
Such ‘adequate information’ need not include remote or theoretical risks, rare complications, and possible results of a hypothetical negligent surgery.
Further, the consent obtained by the doctor from the patient before commencing a treatment (including surgery) should be real and valid, which means that: (a) the patient should have the capacity and competence to consent; (b) consent should be voluntary; and (c) consent should be on the basis of adequate information, concerning the nature of the treatment procedure, so that he/ she knows what the consent is for.
Medical treatment cannot be provided by doctors and hospitals without informed consent. However, subjective discretion of the attending doctor comes up quite often given the regulatory framework surrounding consent.
Need for Advocacy
Based on my personal experience and also from reading reports in patient support groups, the practice of taking informed consent for adult ADHD treatment in India is non-existent.
Patients aren’t told about side effects and contraindications and have to rely on drug pamphlets or the Internet to inform themselves.
Advocacy Focus

1. MCI needs to include drug treatments apart from surgery and be specific about which drug classifications require informed consent. As an example of good practice, see the informed consent form for MPH and for ATX atomoxetine that an American state requires.
2. The laws around informed consent in medicine need to be made more stringent and remove doctor discretion, in favour of personal autonomy.

Disclaimer: The various medication available for adult ADHD have benefits and side effects both. In most cases, the benefits outweigh the side effects. However, patients need to be informed about both and need to discuss treatment plans in detail with their doctors.
Sources:
Methylphenidate Wiki
Informed Consent Wiki
Consent and medical treatment: The legal paradigm in India
Consent in Healthcare: Outline, Gaps and Conundrum (Part 1)
Consent in Healthcare: Outline, Gaps and Conundrum (Part 2)

So here I am listening to Mengele Pt 2 while my Ritalin kicks in thinking about the words Robert used to describe Mengele's almost transcendental decision to broaden his education beyond dentistry when I start hearing something familiar. The words Robert used, I'm not sure which reference he's drawing from (or quoting from) around 5-6 minutes in but it really, really sounds like the sort of thing that a college kid who just started taking a recreational dose of amphetamines would say. I say this as a man who had to self medicate (pretty irresponsibly, tbh) on and off for a decade, dabbling with the whole spectrum of amphetamines. Robert describes how Mengele's friend awakened in him a curiosity and interest in a wide range of scientific matters; I suggest, what if it wasn't his friend, but the drug that had just begun to drip into German society in the 30s, amphetamine.
So, the timeline here is a little wonky but close enough that I think its an interesting idea nonetheless. Amphetamines had been first synthesized in Germany in 1887 but people didn't realize it would turn you into a living God until it was rediscovered in the USA in 1927 and entered the American market in 1934. It arrived in Germany formally as Pervitin, this time as the more potent methamphetamine, in 1938, available to the general public, and also just in time for the Battle of France. This means its formal introduction to Germany would be quite late for this theory of mine, but I was unable to find anything about unofficial use prior to Pervitin. Before '38 it was already fairly well established in the US, could some American Benzedrine have crossed the Atlantic and made it into the hands of a curious German PhD student who felt stuck in his educational direction? [This isn't a rhetorical question].
Mengele (I believe it's actually pronounced, "Man-jelly") would have been 23 in 1934, and 24 when he earned his PhD in Anthropology. Kind of tough to imagine speed making it to him in just one year after its introduction in the US. But again, I don't think impossible. One possibility is that the narrative Robert related about Mengele's inspiration was constructed post-hoc, that Mengele began taking amphetamine at a more reasonable later date and had some transcendental binge that he, knowingly or not, moved to his time at college for a simpler narrative about how he became the person he became. Or perhaps, black market, or gray market, speed was in Germany for the mid-thirties; perhaps he had early access to it due to his studies in medicine; or perhaps (most disappointingly), he just had a friend who gave him some really unfortunate, yet inspiring, advice.
I'm not a historian of any sort (well I am a Geologist, an Earth historian, but our methodologies are pretty different) nor am I familiar with Mengele's biography beyond this series and basic high school shit. Was Mengele Straight Edge? Does he relate some other first experience with speed? Is it impossible for amphetamine to have had a place in the black market in Germany in the mid-30s? Tell me what you think!

Note: Not a biologist, just have spent quite a bit of time trying to figure things out.
There's a theory called the Yerkes-Dodson law that says that performance can go down if arousal is either too low or too high, i.e. performance is maximized at a moderate amount of arousal. Stimulants are largely said to work by increasing arousal (norepinephrine and dopamine) in the brain. People with ADHD are often to said to be low in these neurotransmitters, so the stimulants would bring them to the middle.
So SCT is often looked at as a subtype of ADHD that is worsened by stimulants. This is very important since the vast majority of people with ADHD see significant relief with stimulants. What appears to work for a good amount of SCT patients is Strattera or very low doses of Ritalin-type drugs. The thing is about both of these drugs is that they appear to reduce the amount of tonic norepinephrine in the brain. (study on low dose methylphenidate's actions)
This is where the biology gets a lot more tricky and I'm only able to give a guess. From my understanding, a phasic release of norepinephrine (release in response to an event) is what causes us to pay attention. Tonic norepinephrine is the constant release and a high amount of this (from chronic stress) leads to daydreaming & fatigue. Furthermore, a higher amount of tonic norepinephrine makes it harder for a phasic response to overwhelm it and allow one to focus.
Is it possible that by reducing the amount of norepinephrine flowing constantly and making the phasic bursts more significant, Strattera and low-dose Ritalin give relief to many SCT-like symptoms? And that the usual method of treatment by stimulants is damaging since many SCT patients might already be high in norepinephrine?
Anyone more knowledgeable about the science, feel free to correct any misunderstandings I have!

Both of these guys are quintessential mass-murderers of their gens imho
Mcveigh was cold and calculating, and sought revenge against those whom he thought had wronged him. He was left holding the bag, as it were, for the real bad guys, according to many. He was ruthless and effective in his pursuit of due recompense against the ATF for those they murdered at Waco and Ruby Ridge. He was a man with a mission. He executed it. And for this, he was murdered. A quintessential Gen X life trajectory imho. Highest income in any given year was probably $15k. 6'0.5.
Mcveigh's Legacy: The FBI stopped messing with gun nuts. Guns have never been more legal. Final assessment: Success
Klebold was another story. He was a wannabe. He wasn't even in the trenchcoat mafia. He had skills at Engineering, and was Tall, but nobody cared. The Clique system had spoken and he knew he would be a failure his entire life. He did what he had to do, or tried to rather. He tried blowing up his school, and failed. Plan B: Shoot up the school. He got a friend of his, Eric Harris, killed along the way. I have much less sympathy for Klebold than Mcveigh. Klebold's great war was on the 32X (Doom). His great depression was treated with SSRIs and exacerbated by Ritalin probably.
Klebold's Legacy: Video game retailers clamped down on sales to minors. The 32X faded into the sunset. Doom's legacy was tarnished for a long time, resulting in people mistakenly thinking that Goldeneye 007 was superior. His mom milked her murderer's son notoriety for financial gain. Final assessment: Complete failure, just like his generation.
Gen X wins this round. Discuss.

Due to long waiting time for Psychiatrist appointment in Germany I got really tired and got the diagnosis in my home country which confirmed ADHD.
My country doctor prescribed stimulant- Methylphenidate(Concerta/Ritalin) and I am thinking of bringing enough till the time I get the Psychiatrist's appointment here and diagnosis done.
Since, Methylphenidate is listed as narcotics. https://de.wikipedia.org/wiki/Liste_von_Betäubungsmitteln_nach_dem_Betäubungsmittelgesetz
Therefore, the question arises that is it legal to bring this medicine in Germany with my country doctor's prescription only? I did a lot of research and finally found the following link mentioning I can bring medicine a maximum for 3 months but I should have multilingual certificate specifying all the required details. https://www.zoll.de/EN/Private-individuals/Travel/Entering-Germany/Restrictions/Medicinal-products-and-narcotics/medicinal-products-and-narcotics_node.html
Is this all or do I have to do take additional steps?
Please guide me as I don't want to do the wrong thing unknowingly.
I also found the following link but it mainly talks about taking medicine outside Germany https://www.bfarm.de/EN/Federal-Opium-Agency/Narcotic-drugs/Travelling-with-narcotic-drugs/_node.html
Thanks in advance

There seems to be a question/push-back on this sub surrounding bupropion being a CNS stimulant. Personally, I think it's important to have accurate info. I understand that when you google "is Wellbutrin a stimulant," the first result is "no". This is because Wellbutrin is mainly prescribed and marketed as an antidepressant; they're just differentiating it from potent, first-line stimulant meds, like Adderall (amphetamine). Bupropion is also an NDRI--as is Ritalin, which is a well known stimulant. Some people misuse bupropion, which is incredibly dangerous, and is something we should be aware of. Below are links to both scientific articles and Wiki pages (which have sources, use them if you're in doubt) that support what I'm saying:
First, bupropion is a substituted cathinone (scroll down to "see also," you'll find bupropion):

Cathinone /ˈkæθɪnoʊn/ (also known as benzoylethanamine, or β-keto-amphetamine) is a monoamine alkaloid found in the shrub Catha edulis (khat) and is chemically similar to ephedrine, cathine, methcathinone and other amphetamines. https://en.wikipedia.org/wiki/Cathinone

From the bupropion Wiki:

Bupropion acts as a norepinephrine–dopamine reuptake inhibitor and a nicotinic receptor antagonist.[3] However, its effects on dopamine are weak.[17][18][19][20][21] Chemically, bupropion is an aminoketone that belongs to the class of substituted cathinones and more generally that of substituted amphetamines. https://en.wikipedia.org/wiki/Bupropion

From an article on Pubmed:

Bupropion is a weakly potent central nervous system (CNS) stimulant that is marketed. . . as an antidepressant. https://pubmed.ncbi.nlm.nih.gov/12044800/

From an article in Nature:

Bupropion is an antidepressant with stimulant properties. https://www.nature.com/articles/1300979

From the prescribing info:

Bupropion produces dose-related central nervous system (CNS) stimulant effects in animals, as evidenced by increased locomotor activity, increased rates of responding in various schedule-controlled operant behavior tasks, and, at high doses, induction of mild stereotyped behavior.

[https://www.accessdata.fda.gov/drugsatfda\_docs/label/2007/018644s036lbl.pdf](https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/018644s036lbl.pdf)
The dangers of abuse:

Doctors are warning that an antidepressant sold under such names as Wellbutrin, as well as a smoking cessation drug called Zyban, is increasingly being abused by drug users – with often fatal results.

https://www.ctvnews.ca/health/health-headlines/doctors-warn-of-potentially-fatal-abuse-of-wellbutrin-antidepressant-1.1383282
Again, I just think it's important to have accurate info. Just the other day, someone made a post about a streetname for Wellbutrin, and the comments went nuts about how the person was an idiot, and so forth. It doesn't change anything about the medication; that "stimulant phase" goes away pretty quickly for most of us, and then around 6 weeks in, the antidepressant effects fully kick in.
TL; DR: Wellbutrin is a milder CNS stimulant.

After 53 years on this earth, and (correctly) diagnosed with BPAD, Aspergers, Dysphoric Mania, General Anxiety, and mood disorders caused by severe hypothyroidism, I was diagnosed recently with ADHD. The first time I took Ritalin, the change was immediate, and incredibly striking.I was so happy, but after a week it seemed to fade away. My doctor titrated me, and got to a good level.
In the past couple of weeks, I began noticing evening anxiety, with dread. I cannot go back to the days of being nervous and worrying about meaningless things. It occurred to me, though, I had my TV blaring, music playing, I was reading my Kindle, and surfing Reddit, Imgur, Twitter and Wikipedia.
So I shut everything off, and just sat there. I mean, before I could not just sit idly. The last week, I gave myself 1 hour Reddit (or less), then 1 hour (or less) Imgur, and scheduled time for reading, and TV. I cannot believe how well I can handle this “normal” leisure time.
I’ve even been able to schedule my meds on time, 5X per day. Most importantly, what was my biggest dread, I take my evening meds, and go to sleep on time. I used to sit all evening, constantly worrying about having to go to sleep on time.
I hope this is the medication stabilizing, and that I will be able to “be normal” like this. Any advice from people with experience?

Introduction
I don’t really know where to start this with, but…yeah.
For those of you who don’t know, Weezer is an American rock band formed in 1992, initially consisting of lead singer Rivers Cuomo, guitarist Brian Bell (who replaced Jason Cropper in the band’s inception), drummer Patrick Wilson, and bassist Matt Sharp. After the release of a collection of demos called The Kitchen Tapes in 1992, Weezer burst onto the scene with their first self-titled album, or the Blue Album (now that the also self-titled Green/Red/White/Teal/Black Albums exist) in May 1994.
Featuring phenomenal guitar work paired with bright, clean production courtesy of The Cars’ Ric Ocasek as producer and major promotion in the form of Spike Jonze directing the music video for lead single ‘Undone - The Sweater Song’ and the video for ‘Buddy Holly’ being prepackaged on the Windows 95 CD-ROM, the Blue Album was universally praised upon its release, being regarded as one of the best albums of the 1990s and remaining as Weezer’s best-selling record ever.
Despite this, the explosive success of the Blue Album was met with a lot of mixed feelings from Rivers as it later went platinum a year after its release. This ended up giving him a self-proclaimed inferiority complex about the music he was writing being too simplistic, and he strove to write more intense, complex music for Weezer’s next effort.
Songs From The Black Hole
Drawing from this goal alongside opera pieces like Aida, Andrew Lloyd Webber’s concept album Jesus Christ Superstar and Les Miserables for inspiration, Rivers decided to write a sci-fi rock opera as an analogy for his life on tour and relationships at the time, which would eventually be titled Songs From The Black Hole. Envisioned as a collection of continuous tracks ending with a coda of overlapping vocals from previous songs accompanying a reprisal of the album’s main musical themes, STFBH also carried an overarching story of space travelers aboard the spaceship Betsy II in the year 2126, culminating with the disillusionment of the travelers’ captain Jonas at the end of the ship’s journey and having Jonas wishing to return to simpler times.
While the characters planned to be voiced by Rivers, Brian, Matt and longtime collaborator Karl Koch alongside several guests like The Dambuilders’ Joan Wasser, recording of the album proved to be unproductive and a majority of the demos were eventually shelved, though the songs ‘Tired Of Sex’, ‘Getchoo’, and ‘No Other One’ would still find their way onto what would actually end up being Weezer’s sophomore album.
The (Madama) Butterfly Effect
During the early stages of making Songs From The Black Hole, Rivers underwent surgery to correct one of his legs being shorter than the other since birth, which was also accompanied by painful physiotherapy sessions. At the same time, he applied to Harvard for studying classical composition, detailing his disillusionment with the lifestyle of a rock star as part of his application letter only to find himself becoming lonelier and more isolated in college, which also led to Rivers’ songwriting becoming darker and more serious. Over time, Songs From The Black Hole was abandoned entirely as Rivers moved away from the more irreverent elements of SFTBH and focused on a new concept for an album loosely based on Giacomo Puccini’s opera Madama Butterfly, which would later go on to become Pinkerton, Weezer’s second album that released in 1996.
For context, Pinkerton was named after Madama Butterfly’s character of BF Pinkerton, a US naval officer who leaves his Japanese wife (the titular Butterfly) and child for a woman in America which drove the former to suicide in the play, with Rivers comparing his image of an “asshole American sailor” to a touring rock frontman.
Being self-produced and featuring a significantly distorted, more abrasive sound compared to the Blue Album, Pinkerton also featured deeply personal lyrics about Rivers’ loneliness, frustrations with relationships sexual or otherwise, and shades of his questionable-at-best views on women at the time (‘Across The Sea’ having Rivers fantasize about a letter from an 18-year-old Japanese fangirl with the lyric “I wonder how you touch yourself” directed at said girl) as a self-proclaimed uncomfortable self-portrait of himself.
In a statement to Weezer’s fan club on July 10th, 1996, Rivers wrote:

There are some lyrics on the album that you might think are mean or sexist. I will feel genuinely bad if anyone feels hurt by my lyrics but I really wanted these songs to be an exploration of my "dark side" -- all the parts of myself that I was either afraid or embarrassed to think about before. So there's some pretty nasty stuff on the there. You may be more willing to forgive the mean lyrics if you see them as passing low points in a larger story. And this album really is a story: the story of the last 2 years of my life. And as you're probably well aware, these have been two very weird years.

In short, imagine Kanye dropping Yeezus following The College Dropout or The Beatles releasing Revolver right after Please Please Me, and you’ve pretty much got a good impression of the drastic shift that going from the Blue Album to Pinkerton was.
So how did this go over with listeners?
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Not particularly well.
Upon its release, Pinkerton ended up underperforming commercially, having sold only 47,000 copies on its first week. Fan reception wasn’t much better either, with Rolling Stone readers naming Pinkerton as the third worst album of 1996, and many listeners ended up feeling put off by the deeply personal and/or sexual nature of the lyrics. This took a major toll on Rivers’ mental health, with him later describing the fallout around Pinkerton as “like getting really drunk at a party and spilling your guts in front of everyone[…]and then waking up the next morning and realizing what a complete fool you made of yourself”, given the confessional nature of the record.
Hiatus
During the last leg of the tour for Pinkerton, twin sisters Mykel and Carli Allan died in a car crash in mid-1997. As the founders of Weezer’s official fan club in the ‘90s, they had served as liaisons between fans and the band and were pretty much known as Weezer’s two biggest fans at the time - the Blue Album deluxe track ‘Mykel & Carli’ was even written in the two’s honor. Their deaths were another factor that lead to Rivers and Weezer going on hiatus, and after the touring for Pinkerton ended, Matt Sharp ended up leaving Weezer in 1998 after growing further from the band and founding The Rentals, with the Weezer fan club ceasing to exist between their hiatus and the greater portion of Weezer fans migrating to the then-emerging Internet.
Rivers would go back to Harvard and start recording some demos with Brian and Patrick in 1998, but those sessions proved to be unproductive and resulted in Patrick leaving for Portland shortly after. As a result of these compounding tolls on his mental health, Rivers would then lapse into a depressive state after moving to an apartment in California, painting the walls and ceiling of his bedroom black while covering his windows with fiberglass and black sheets to block out light.
Back On Track
However, in early 2000, Weezer was given a high-paying offer to play the Summer Sonic Festival in Japan later that year, with rehearsals and performances under the alias Goat Punishment in the months leading up to the event rejuvenating the band’s members. After replacing Matt Sharp with Mikey Welsh as their bassist, Rivers also began production for Weezer’s third (and second self-titled) album. The band also brought back Ric Ocasek for production, in part due to the commercial failure of Pinkerton’s brasher sound and Geffen Records refusing to let them self-produce again for that reason.
On top of the aforementioned production choices, this was around the time that Rivers had a marked shift towards writing simpler, less personal songs and lyrics starting with the hundreds he wrote between 1999 and then, many of which remained as demos that the band narrowed down during production. Rivers ended up referring to said songs as "very intentionally not about me - not about what was going on in my life, at least in a conscious way.”, while record executives at Geffen ended up forcing several songs on the album to be discarded, which ended up streamlining the album even more. Even the artwork for the now-nicknamed Green Album was meant to call back to Weezer’s debut, and, by similar logic, veer as far away from Pinkerton as possible in all fronts. Essentially, the Green Album was meant to be an antithesis to the abrasive sounds and at times uncomfortably personal lyrics of Pinkerton (as this image kindly sums up), which Rivers reasoned would go over well with listeners…unless the unthinkable happened, right?
The Unthinkable Happens
That’s right, it turned out that…people started liking Pinkerton. As in *really* liking it.
During Weezer’s hiatus, the growth of their online fanbase and a general critical reevaluation of Pinkerton led to Pinkerton amassing a cult following and being considered Weezer’s best work of all time, something that quite a few fans still echo today. During the turn of the 2000s, Rivers hated this shift in popular and critical opinion, referring to the rabid fanbase around Pinkerton as “the most painful thing in my life these days” and calling Pinkerton itself “sick in a diseased sort of way”, which arguably spurred the course-correcting direction of the Green Album further.
As a result, the Green Album, despite its generally positive reception, slightly polarized fans and critics over its ‘return to form’ sound for the band, with detractors of the album pointing out its departure from Pinkerton’s style or the almost simplistic extent that its songs were condensed to. However, it was still commercially successful, especially more than how Pinkerton fared, being certified Platinum and selling 1.6 million copies in the US. The Green Album also enjoyed modest radio success with its single ‘Photograph’ alongside bigger hits like ‘Hash Pipe’ and perhaps most prominently, ‘Island In The Sun’, and these successes helped play at least some part in heightening Rivers’ confidence and softening his views towards Pinkerton over time.
The former ego boost, however, would be quite apparent immediately after the Green Album.
A Minor Tangent
It was also at this time that after touring for the Green Album, Mikey Welsh suffered a breakdown from drug usage, the physical and mental duress of touring and undiagnosed mental health problems like bipolar disorder, before being checked into a psychiatric hospital and leaving Weezer. He was replaced by Scott Shriner as Weezer’s bassist ever since, and after retiring from music to focus on his art career for several years, Mikey died from a presumed heroin-induced heart attack in 2011.
Maladroit, or How Rivers Learned To Stop Worrying And Took Advice From Fans
In part due to getting cockier after the Green Album’s success, Rivers pretty much threw caution to the wind for making Weezer’s fourth album, firing the band’s management and starting efforts for self-funding the albums. Among these snap decisions was Rivers’ idea of including fans in the creative process and taking their general input, which notably showed in the album title of ‘Maladroit’ that was contributed by fans.
In retrospect, Weezer’s fans naming the album the French word for “clumsy” proved to be rather ironic, given how much of the other fan interactions during production went over pretty awkwardly, to say the least.
While the band would release demos to the public via their own website, Rivers would also talk with fans under the username ‘Ace’, on a forum called the Rivers Correspondence Board for getting feedback on the current works in progress. However, the divide between Rivers favoring the band’s newer and future output and the many diehard Blue/Pinkerton fans who frequented the Correspondence Board quickly proved to be tenuous, leading to Rivers repeatedly arguing with fans over the direction that Maladroit was taking, and in one particularly infamous moment for the Weezer fandom, calling the universally praised Blue Album closer ‘Only In Dreams’ “GAY!GAY!GAY! DISNEYGAY!” compared to the WIPs for Maladroit.

if only you guys gave newer songs half the gay allowance you gave the old ones you'd love them.
i can't tell you the courage it takes to sing these lines every night.

This was basically Rivers at his most antagonistic towards the band’s fanbase, referring to them as “little bitches” in an interview that year and having a number of lyrics on Maladroit being about his dissatisfaction with the fanbase’s relationship and attitude towards him, namely in the song ‘Space Rock’. Regardless, the album’s liner notes ended up giving special thanks for Weezer’s fans upon the release of Maladroit, and was generally received well by audiences and critics, with some calling it one of the more underrated Weezer albums in the following years mostly because of it being more obscure in the general eye.
Said antagonism was also a partial consequence of Rivers’ drug use around the time, which went as far back as taking painkillers for his leg surgery and taking drugs since the Green Album, having written ‘Hash Pipe’ and Maladroit’s ‘Dope Nose’ consecutively in several hours under the effects of Ritalin. The nadir of Rivers’ drug use was arguably during the Maladroit tour in August 2002, where Rivers, having taken painkillers before opening an act in Osaka, saw Buddhist-themed decorations emblazoned with swastikas in an intoxicated haze and yelled “Heil Hitler, motherfucker” during their intro. Rivers would later swear off drugs and got clean soon after, but it remained an unsavory incident that he regretted.
What Happened Next
Throughout the production of the band’s fifth album Make Believe, Rivers would also start vipassana meditation after being encouraged to do so by producer Rick Rubin, which ended up influencing much of the production on that album and leading to Rivers mellowing out considerably in the years following his many inflammatory incidents with the Weezer fanbase in the making of Maladroit, alongside his mental health issues that led to and followed Pinkerton. Although Make Believe would start the trend of more thoroughly mixed critical and fan reception to Weezer’s output in general, it also remains Weezer’s highest-charting album and pretty much marked Rivers’ personal life taking a turn for the better, returning to Harvard to complete his education and getting married to longtime friend Kyoko Ito in 2006.
Wrap-Up
Weezer are still going to this day, with the third part of their 4-EP ‘SZNZ’ series having released just recently, Rivers providing vocal features regularly alongside the occasional solo song, as well as Patrick and Brian having their own bands as side projects. While fan expectations over their music direction have been a topic they’ve flip-flopped on throughout the years, taking a strong do-what-we-want stance with songs like “Pork & Beans” and sometimes swinging the other way with “Back To The Shack” pretty much being a promise to return to Weezer’s roots after the mixed-to-negative reception of previous albums like Raditude, Rivers’ dynamic with the band’s fanbase has certainly improved over the time since, what with being willing to cover Toto’s ‘Africa’ after fan requests on Twitter and just having some of the funniest memes from a band themselves. Hell, even the Weezer Fan Club was revived after the release of 2014’s Everything Will Be Alright In The End, with other venues of fan interaction like their official Discord server going strong as well.
In conclusion, although Weezer’s music remains with its share of major ups and downs alike to the point that many fans name the only consistent trait of their discography being its inconsistency, their real-world low points are all but long past them, with Rivers and the band being all the better for it.
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This was the first time I’ve tried to make as extensive of a writeup as this and I ended up enjoying it quite a bit, with the main sources I looked from being Weezerpedia and the Wikipedia entries for the 4 albums in question. I’d also recommend Zeepsterd’s ‘Keeping It Weezer’ videos for covering the similar span of events here and MarcButEvil’s Weezer videos if you want to learn more about Weezer’s general history or going deeper into other albums like Make Believe or the White Album. Thanks for reading!