My prescription was 30x 10mg of escitalopram - the generic, not brand-name Lexapro - for something like $87 the first time I got it. When I went for a first refill, something had changed with the insurance and the cost actually went up into the $100s. It also started coming in a slide-out card pack rather than a regular pill bottle like the first filling. I remember being rather frustrated that I was "paying more for a fancy package" as far as I could see. Neither was the pharmacist at Walmart very helpful, saying I "shouldn't take it if I don't need to". I probably should've told her off on that note.
I stopped after the third batch. Not only did I feel caffeinated, whenever I would yawn I'd feel something of a gag reflex coming. I didn't feel any less empty. Between the side effects and the price, it just didn't seem to be worth it anymore. If I have a shot at getting this medication legitimately for less than $10 then this might be the start of me being able to take care of myself... assuming I can afford the doctor's appointment to get a renewed script.
Okay I was actually wrong, I said Lexapro, but escitalopram hasn't gone down much yet since it only recently became generic. What I meant was citalopram, which my mom takes and was brand name Celexa. It is basically the same thing (you can read the respective wikipedia pages for more technical information), but it has been generic for years since it was patented earlier. God bless the pharmaceutical industry. But if it wasn't working for you after 3 months, it might be worth trying a different one instead, zoloft, paxil, and prozac are all cheap generics now. Obviously a doctor would be better qualified to determine that, but you can definitely get a cheap SSRI prescription from someone, even GPs can write them (and apparently they're giving them out like candy, if you believe the articles that come up on google).
I'm no expert on medication, but I'm wondering if I'm on the right kind of medication for my anxiety disorder.
I did a bit of reading about the different types of medication used to treat anxiety and have learned that they fall into 3 main groups: SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin Norepinephrine Reuptake Inhibitors) and Anxiolytics. So far I've been on Paxil and Zoloft, both SSRIs, and I've never tried anything else. Could it be that I need something other than an SSRI?
IANAD and anecdotes can be worthless, but when I was getting treated for depression and anxiety a few years ago, I was prescribed a SSRI (citalopram) because it was supposed to help with both. For me, it was actually a lot more effective at alleviating anxiety than depression.
Something worth considering if you have severe anxiety attacks with physical symptoms: An ex of mine was prescribed beta blockers to deal with his anxiety attacks, and he swore by them. They alleviate the physical symptoms (shaking, sweating, heart rate), which can apparently help some people a lot.
As we get better at detecting the organic causes of depression and anxiety and other mental illnesses, hopefully it will allow better targeted drug therapy.
This whole try this for a month cause it helps some people who claimed to have similar symptoms nonsense is kinda bullshit.
They moistly come out at night, moistly.
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CorehealerThe ApothecaryThe softer edge of the universe.Registered Userregular
I am seeing a school psychologist on Friday, after not having seen any kind of mental health professional for over a decade.
Honestly don't know what to expect, or what I would even want to get out of it, but I do feel like it certainly can't hurt more then continuing to deal with my myriad mental issues solo like I have been doing lately.
Antidepressants are not like Tylenol, something you pop when you feel the need. They are a daily (usually) medication that take time (around a month) to build up in one's system, and take effect. Most of the immediate effects people feel are just placebo reactions.
I say this not to reprimand you, but rather to indicate that, given what you posted, you likely did not take enough to know how they actually impacted your mood.
If cost is a problem, ask your doctor whether you can get the meds for free, or at a reduced price. When I was on Abilify, I filed some paperwork with Bristol-Myers Squibb, and they sent me free meds. Linky link to their page. Another option is sample packs, which your doctor likely receives.
Additionally, generic SSRIs are really cheap. Lexapro and Zoloft are less than $10 before insurance. I think the doctors just prescribe the brand stuff because it's new and expensive and possibly because they got a bunch of free stuff with logos. I was also originally prescribed a stupidly expensive one, I think it was Lexapro before it was generic, and there was Lexapro shit all over his office. But I asked him about it and he changed it to just citalopram. Later I switched to Zoloft and that has been great for me, although there are some side effects I could really do without. Obviously the older drugs don't work for everyone (the month I tried Prozac was horrible, and that was after being on Zoloft for years), but it's worth trying.
Also keep in mind that dosage can make a huge difference. For a long time I was on 50mg of Zoloft and I couldn't tell that much of a difference, and when I switched psychiatrists he increased it to 100mg. Then one day I suddenly realized I hadn't thought about killing myself in weeks, as opposed to several times a day. But last month I tried 150mg and that was just too much.
My prescription was 30x 10mg of escitalopram - the generic, not brand-name Lexapro - for something like $87 the first time I got it. When I went for a first refill, something had changed with the insurance and the cost actually went up into the $100s. It also started coming in a slide-out card pack rather than a regular pill bottle like the first filling. I remember being rather frustrated that I was "paying more for a fancy package" as far as I could see. Neither was the pharmacist at Walmart very helpful, saying I "shouldn't take it if I don't need to". I probably should've told her off on that note.
I stopped after the third batch. Not only did I feel caffeinated, whenever I would yawn I'd feel something of a gag reflex coming. I didn't feel any less empty. Between the side effects and the price, it just didn't seem to be worth it anymore. If I have a shot at getting this medication legitimately for less than $10 then this might be the start of me being able to take care of myself... assuming I can afford the doctor's appointment to get a renewed script.
Did you shop around at all? I've had generics quoted from Walmart in the 100+ range that cost me $20-something a month at Kroger/QFC (or $30-something at walgreens).
I'm no expert on medication, but I'm wondering if I'm on the right kind of medication for my anxiety disorder.
I did a bit of reading about the different types of medication used to treat anxiety and have learned that they fall into 3 main groups: SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin Norepinephrine Reuptake Inhibitors) and Anxiolytics. So far I've been on Paxil and Zoloft, both SSRIs, and I've never tried anything else. Could it be that I need something other than an SSRI?
Those are the major ones.
Tricyclics still see some use in people who don't respond to modern drugs, and very severe anxiety might still be rarely treated with barbiturates or antipsychotics. As Bliss mentioned, beta blockers also work in some people.
Frankly, most people don't find an SSRI that works for them on the first try, and trying 3-4 drugs before finding one that works is not that rare. Also consider that the effectiveness of an SSRI scales with the severity of your disorder - it is arguable that SSRIs do anything at all to people who have mild mood disorders.
There's also cannabis. I'm not joking.
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
As we get better at detecting the organic causes of depression and anxiety and other mental illnesses, hopefully it will allow better targeted drug therapy.
This whole try this for a month cause it helps some people who claimed to have similar symptoms nonsense is kinda bullshit.
SSRIs are kind of targeted.
Prozac is widely considered to be the first designer drug. We knew that serotonin was implicated in depression as far back as the 1960s, and Julius Axelrod did most of his work investigating the reuptake cycle in the 60s as well. When David Wong discovered Prozac, he and his team were specifically looking at a family of chemicals suspected to interfere with the serotonin reuptake cycle.
The main problem is that nobody really knows how or why fiddling with serotonin improves mood.
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
As we get better at detecting the organic causes of depression and anxiety and other mental illnesses, hopefully it will allow better targeted drug therapy.
This whole try this for a month cause it helps some people who claimed to have similar symptoms nonsense is kinda bullshit.
SSRIs are kind of targeted.
Prozac is widely considered to be the first designer drug. We knew that serotonin was implicated in depression as far back as the 1960s, and Julius Axelrod did most of his work investigating the reuptake cycle in the 60s as well. When David Wong discovered Prozac, he and his team were specifically looking at a family of chemicals suspected to interfere with the serotonin reuptake cycle.
The main problem is that nobody really knows how or why fiddling with serotonin improves mood.
...aaannd MDMA continues to be a schedule 1 narcotic.
I meant more targeted in terms of patients it is likely to help. As the above post alludes to, it takes people a while to find an SSRI, or whatever, that works well for them.
I really need to see a doctor about my memory issues. Basically anything further back than a week ago is just a vague fog. I've been at this internship for three months now and I can't remember things I did or was taught during the first two. At least it's taught me to comment my code well, because I sure as hell won't remember why or how I did something by the time I go back to it later.
Didn't help when I went to see a psychologist either, since i'd just forget everything we had talked about the previous week by the time I go in for the next appointment.
I'm no expert on medication, but I'm wondering if I'm on the right kind of medication for my anxiety disorder.
I did a bit of reading about the different types of medication used to treat anxiety and have learned that they fall into 3 main groups: SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin Norepinephrine Reuptake Inhibitors) and Anxiolytics. So far I've been on Paxil and Zoloft, both SSRIs, and I've never tried anything else. Could it be that I need something other than an SSRI?
Not a doctor, anecdotes are lousy, etc. I noticed a difference between how SSRIs poked me, and how an SNRI poked me.
Not sure if it would make a difference for what's happening in your mind/brain, but they seem to poke my mind/brain in different ways.
I really need to see a doctor about my memory issues. Basically anything further back than a week ago is just a vague fog. I've been at this internship for three months now and I can't remember things I did or was taught during the first two. At least it's taught me to comment my code well, because I sure as hell won't remember why or how I did something by the time I go back to it later.
Didn't help when I went to see a psychologist either, since i'd just forget everything we had talked about the previous week by the time I go in for the next appointment.
Take notes.
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MorninglordI'm tired of being Batman,so today I'll be Owl.Registered Userregular
edited September 2014
I also struggle with memory issues. Memory retention requires attention, so...
I take notes for important things.
I also sometimes have to trust that I will have the same idea again in the same situation for complex issues.
I also put a lot of work into attempting to remember accurately as well as trying to focus properly when I really want to remember something, which has improved my memory a lot.
Habit is also very useful. I can't actually close the door to my flat anymore when I leave it solo without putting my hand in my pocket and finding my keys. I did this habitually after I first locked myself out when my girlfriend was out of town so even when I'm in a completely absent minded, totally distracted daze, I realise that for some reason I can't seem to close the door, I keep resisting it, as if... oh yes keys! Do I have them? *puts hand in pocket and finds them* And then I can close the door.
An example of that automatic checker in action.
Without knowing more context it's very difficult to say what the problem could be. I would definitely see someone though. Long term memory problems that serious are throwing up low key alarm bells. You should rule out medical issues at least.
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(PSN: Morninglord) (Steam: Morninglord) (WiiU: Morninglord22) I like to record and toss up a lot of random gaming videos here.
I'm no expert on medication, but I'm wondering if I'm on the right kind of medication for my anxiety disorder.
I did a bit of reading about the different types of medication used to treat anxiety and have learned that they fall into 3 main groups: SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin Norepinephrine Reuptake Inhibitors) and Anxiolytics. So far I've been on Paxil and Zoloft, both SSRIs, and I've never tried anything else. Could it be that I need something other than an SSRI?
Not a doctor, anecdotes are lousy, etc. I noticed a difference between how SSRIs poked me, and how an SNRI poked me.
Not sure if it would make a difference for what's happening in your mind/brain, but they seem to poke my mind/brain in different ways.
My subjective experience is that SNRIs cause more of an immediate boost in energy and confidence similar to certain notable recreational stimulants.
Which is congruent with the body of knowledge about norepinephrine.
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
the "no true scotch man" fallacy.
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MorninglordI'm tired of being Batman,so today I'll be Owl.Registered Userregular
My father rang up unexpectedly to visit since he's swinging by Sydney on his hols so my free day is going to be extremely busy. I wont be able to get to typing up that GAD thing till next weekend. I haven't forgotten!
(PSN: Morninglord) (Steam: Morninglord) (WiiU: Morninglord22) I like to record and toss up a lot of random gaming videos here.
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MortiousThe Nightmare BeginsMove to New ZealandRegistered Userregular
Auckland University's Youth 2000 surveys of about 8500 NZ high school students have found that teen binge-drinking has almost halved since 2001, drink-driving has dropped by a third, regular marijuana use has halved, cigarettes have almost disappeared,
violence and fighting have dropped by a third, and students staying away from school because of bullying have dwindled from 9.5 per cent in 2001 to 5.3 per cent in 2012.
...
Yet at the same time as all these improvements, the Youth 2000 high-school surveys have found escalating rates of self-harm. In 2012, 29 per cent of girls and 18 per cent of boys harmed themselves deliberately, up from 26 per cent and 16 per cent in 2007.
Nice to see a thread discussing this. One of my least favorite topics yet one of the few most important to me.
One huge new part of my own medical knowledge that my doctors unfortunately missed for about 8 years: Depression is not always a diagnosis, but sometimes merely a symptom.
In my case, doctors were so concerned with my depression that patterns were ignored. Most victims of Major Depression experience 1-2 long, severe periods of depression a year. In my case, I was experiencing 4-6 cases a year. Notably, it was worse in Winters, and I experience mild, hours-long periods of mania 4 times a year. Finally, a doctor took a comprehensive list of family medical history. Lo and behold- family history of Thyroid issues and Bipolarism.
Current science doesn't have any evidence for Major Depression being hereditary (they thought I was depressed since my father and uncle were). Thyroid issues, which manifest as Bipolarism, however, are hereditary. Blood tests confirmed diagnosis. It's part of a growing field known as "Bi-polar Type II" and "Bi-polar NOS (Not Otherwise Specified)." The key difference between these and Bipolar Type I is that periods of mania are severely muted, sometimes nonexistent, and periods of depression last slightly longer.
Ultra problem though is that anti-depressant medications are terrible at treating Bipolar, and sometimes can exacerbate issues. Finally got on Thyroid related treatments, and last two years have been going much, much better.
And, if anyone is interested, anecdotal experiences with medications over the years:
Prozac - Made my chest hurt.
Wellbutrin - Gave me the shakes.
Seroquel - Terrible Mouth Dryness, makes you super drowsy.
Lexapro/Escitalopram - This stuff does weird ass things to your libido. Was like viagra to me. Hated it.
Abilify - Didn't have any problems (but wasn't proper for my diagnosis)
Gabapentin - Good at reducing anxiety on a 1-3 hour scale. Too much makes you feel drunk - had to be careful with dosage.
Oxcarbazepine - Makes your joints hurt. Goes away after first month.
Dawn Therapy - Super worth it. Many insurance companies are starting to cover this if you can get your doctor to prescribe it under SAD diagnosis. I use a Philips lamp myself. Ramps up light over 40-minute period prior to waking up, to simulate dawn. Can also double as a low-power Light Box for Light Therapy. These lamps are $150 though, so hard to purchase out-of-pocket.
Suffice it to say, my advice is to always get a couple of opinions. Depression can have a lot of causes, which aren't always the go-to "Major Depression." Also, whenever possible, see specialists. Half the reason for my poor early diagnoses was that I was at bottom-of-the-barrel doctors in University or Emergency clinics, and not with private-practice or hospital doctors who had the time to really investigate. (Unfortunately, these are more expensive as well, which I sympathize with people on).
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MorninglordI'm tired of being Batman,so today I'll be Owl.Registered Userregular
Yes, if you aren't responding well to treatments, seek more and expert help.
Just an extra tip: Do not under any circumstance think "Guess I can't be helped then" and bugger off into the vast wilds of untreated whatever the fuck is going on with your head.
That way, literally, lies madness.
(PSN: Morninglord) (Steam: Morninglord) (WiiU: Morninglord22) I like to record and toss up a lot of random gaming videos here.
I'm no expert on medication, but I'm wondering if I'm on the right kind of medication for my anxiety disorder.
I did a bit of reading about the different types of medication used to treat anxiety and have learned that they fall into 3 main groups: SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin Norepinephrine Reuptake Inhibitors) and Anxiolytics. So far I've been on Paxil and Zoloft, both SSRIs, and I've never tried anything else. Could it be that I need something other than an SSRI?
Not a doctor, anecdotes are lousy, etc. I noticed a difference between how SSRIs poked me, and how an SNRI poked me.
Not sure if it would make a difference for what's happening in your mind/brain, but they seem to poke my mind/brain in different ways.
My subjective experience is that SNRIs cause more of an immediate boost in energy and confidence similar to certain notable recreational stimulants.
Which is congruent with the body of knowledge about norepinephrine.
Wait, what?
Ok, a quick googling indicates that SNRIs work kinda-sorta like Cocaine and Amphetamines. Is that what you were talking about?
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MorninglordI'm tired of being Batman,so today I'll be Owl.Registered Userregular
edited September 2014
He might mean coffee as well.
Caffeine stimulates norepinephrine production.
The only problem with caffeine is its extremely short half life and its extreme side effects in high doses. Long term and short term.
Caffeine works similarly enough to dexamphetamine that I take coffee as a medicinal supplement to my regular medication.
A lot less than I used to. It'll give me serious insomnia if I have a coffee too late in the afternoon.
Like, during one of my "off the medications" periods, where I was trying to live without them, I was trying to do a really hard assignment, and I found that coffee gave me bursts of the same effectiveness as dexamphetamines....
Lets just say I drank way too much goddam coffee over 24 hours and leave it at that.
Of note, I was very much in the grip of my past serious anxiety issues back then.
Stay the fuck away from caffeine if you have anxiety issues.
I was so freaked out that whole time period is still a notable flashbulb memory a decade later.
Morninglord on
(PSN: Morninglord) (Steam: Morninglord) (WiiU: Morninglord22) I like to record and toss up a lot of random gaming videos here.
I'm no expert on medication, but I'm wondering if I'm on the right kind of medication for my anxiety disorder.
I did a bit of reading about the different types of medication used to treat anxiety and have learned that they fall into 3 main groups: SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin Norepinephrine Reuptake Inhibitors) and Anxiolytics. So far I've been on Paxil and Zoloft, both SSRIs, and I've never tried anything else. Could it be that I need something other than an SSRI?
Not a doctor, anecdotes are lousy, etc. I noticed a difference between how SSRIs poked me, and how an SNRI poked me.
Not sure if it would make a difference for what's happening in your mind/brain, but they seem to poke my mind/brain in different ways.
My subjective experience is that SNRIs cause more of an immediate boost in energy and confidence similar to certain notable recreational stimulants.
Which is congruent with the body of knowledge about norepinephrine.
Wait, what?
Ok, a quick googling indicates that SNRIs work kinda-sorta like Cocaine and Amphetamines. Is that what you were talking about?
Those are notable recreational stimulants, yes.
And by "immediate" I mean "within the first couple of days," not "in five minutes."
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
the "no true scotch man" fallacy.
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MorninglordI'm tired of being Batman,so today I'll be Owl.Registered Userregular
edited September 2014
It's like muscular strength really.
Lift five kilos 20 times four times a day you get a benefit. You'll hurt like hell for the first week, but then you'll get stronger.
Try to lift two hundred all at once without any preparation and you'll tear something. You can also do permanent damage. And you wont get any stronger.
That's the difference between recreational drugs and the milder stuff used to treat people.
Only it's always two hundred more weight than you can normally lift.
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(PSN: Morninglord) (Steam: Morninglord) (WiiU: Morninglord22) I like to record and toss up a lot of random gaming videos here.
A psychologist I was forced to see in school mentioned that he had been trying to find an old PC-game, so a few years later when I found a copy for sale online, I looked up his email-address and sent him the link.
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JuliusCaptain of Serenityon my shipRegistered Userregular
Psychiatrists rarely enquire about caffeine intake when assessing patients. This may lead to a failure to identify caffeine-related problems and offer appropriate interventions. Excessive caffeine ingestion leads to symptoms that overlap with those of many psychiatric disorders. Caffeine is implicated in the exacerbation of anxiety and sleep disorders, and people with eating disorders often misuse it. It antagonises adenosine receptors, which may potentiate dopaminergic activity and exacerbate psychosis. In psychiatric in-patients, caffeine has been found to increase anxiety, hostility and psychotic symptoms. Assessment of caffeine intake should form part of routine psychiatric assessment and should be carried out before prescribing hypnotics. Gradual reduction in intake or gradual substitution with caffeine-free alternatives is probably preferable to abrupt cessation. Decaffeinated beverages should be provided on psychiatric wards.
Whatever you do don't go cold turkey if you've got mental health issues. Gradually reduce. 1 less cup a day. Or make yourself a special mix of caffeinated/decaff, and slowly reduce the amount of caffeinated as time goes on.
Particularly if you are also on any other drugs that mess with brain chemistry. The rebound will be ridiculous if you go cold turkey.
If you suffer from insomnia try to make sure your last cup is before 3pm.
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(PSN: Morninglord) (Steam: Morninglord) (WiiU: Morninglord22) I like to record and toss up a lot of random gaming videos here.
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JuliusCaptain of Serenityon my shipRegistered Userregular
Psychiatrists rarely enquire about caffeine intake when assessing patients. This may lead to a failure to identify caffeine-related problems and offer appropriate interventions. Excessive caffeine ingestion leads to symptoms that overlap with those of many psychiatric disorders. Caffeine is implicated in the exacerbation of anxiety and sleep disorders, and people with eating disorders often misuse it. It antagonises adenosine receptors, which may potentiate dopaminergic activity and exacerbate psychosis. In psychiatric in-patients, caffeine has been found to increase anxiety, hostility and psychotic symptoms. Assessment of caffeine intake should form part of routine psychiatric assessment and should be carried out before prescribing hypnotics. Gradual reduction in intake or gradual substitution with caffeine-free alternatives is probably preferable to abrupt cessation. Decaffeinated beverages should be provided on psychiatric wards.
Whatever you do don't go cold turkey if you've got mental health issues. Gradually reduce.
Oh yeah going cold turkey is not an option for me. I'm trying to quit drinking and smoking (and weed) so throwing another one on the pile is probably not a good idea anyway but thanks for pointing out that caffeine might also be an issue. I wanted to cut down on my caffeine anyway but knowing it is bad for other stuff besides health and general unrelaxed-ness gives me another good reason to do it.
I had some chest pain and anxiety today and it made me super glad to be off the benzos, for about a year now (or thereabouts). The equivalent of 30-40 mg Valium every single day was too damn much and for way too long-term a time period.
Don't be that guy who goes onto the internet to diagnose yourself, but the flip side is that it's still good to be educated about what you're putting in your body before you do it.
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MorninglordI'm tired of being Batman,so today I'll be Owl.Registered Userregular
Psychiatrists rarely enquire about caffeine intake when assessing patients. This may lead to a failure to identify caffeine-related problems and offer appropriate interventions. Excessive caffeine ingestion leads to symptoms that overlap with those of many psychiatric disorders. Caffeine is implicated in the exacerbation of anxiety and sleep disorders, and people with eating disorders often misuse it. It antagonises adenosine receptors, which may potentiate dopaminergic activity and exacerbate psychosis. In psychiatric in-patients, caffeine has been found to increase anxiety, hostility and psychotic symptoms. Assessment of caffeine intake should form part of routine psychiatric assessment and should be carried out before prescribing hypnotics. Gradual reduction in intake or gradual substitution with caffeine-free alternatives is probably preferable to abrupt cessation. Decaffeinated beverages should be provided on psychiatric wards.
Whatever you do don't go cold turkey if you've got mental health issues. Gradually reduce.
Oh yeah going cold turkey is not an option for me. I'm trying to quit drinking and smoking (and weed) so throwing another one on the pile is probably not a good idea anyway but thanks for pointing out that caffeine might also be an issue. I wanted to cut down on my caffeine anyway but knowing it is bad for other stuff besides health and general unrelaxed-ness gives me another good reason to do it.
If you are feeling anxious but feel like you need a cup to concentrate, just make one and sip it a bit, then see how it effects you. If your concentration doesn't improve much and your anxiety goes up, you don't need one, it's just habit telling you "I can't concentrate = caffeine". So don't drink the rest of it, because it's your high stress level that is causing the concentration problems. The best state of mind for concentration is a middle ground, too low or too high and it affects your concentration in slightly different but equally dysfunctional ways.
In that case you are better off taking a few minutes to calm down a bit and see if that helps.
That's how I monitor my intake under stressful conditions.
Morninglord on
(PSN: Morninglord) (Steam: Morninglord) (WiiU: Morninglord22) I like to record and toss up a lot of random gaming videos here.
I'm no expert on medication, but I'm wondering if I'm on the right kind of medication for my anxiety disorder.
I did a bit of reading about the different types of medication used to treat anxiety and have learned that they fall into 3 main groups: SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin Norepinephrine Reuptake Inhibitors) and Anxiolytics. So far I've been on Paxil and Zoloft, both SSRIs, and I've never tried anything else. Could it be that I need something other than an SSRI?
Lots of SSRIs have anti anxiety as a side effect but it's not their primary function. Anti-anxiety drugs are pretty much their own family entirely.
As I understand it, people self-assess themselves as more efficient at completing tasks on caffeine, but objective observation shows that they're going faster and messier--any gains made are lost fixing what they screwed up.
Personally, I've replaced my ridiculous intake of coffee and diet soda (2 pots and two liters) with half-caff coffee and various low/no-caffeine sodas.
There was a time in my life that I drank 4+ pots of full-caffeine coffee, 6+ cups of black tea, and a two-liter of soda each day. That was, coincidentally I'm sure, the time in my life that I slept with the lights on and had to check under my bed and in my closet before I slept for roaches, spiders...and monsters. But it was the only way I could get shit done, because I have super severe ADHD and it wasn't getting treated at the time (because I was too depressed courtesy of undiagnosed bipolar disorder to seek treatment for that or anything else).
As far as medications go, I'm a big fan of them for treatment...but personally ended up in the unfortunate position of having bipolar disorder and ADHD and a doctor that didn't believe a person could have both. And also wouldn't believe me when I said that my manias were extremely rare, and benign when they did occur--she more or less told me I was a ticking bomb, destined to go crazier and crazier as I got older. So I got Lamictal for the bipolar, which helped a little but still left me depressed more often than I wasn't, and Strattera for the ADHD (because it's not a stimulant), which helped a little but had side-effects severe enough that I stopped taking it (clumsiness, messing up words spoken aloud and typed, and sexual problems).
For extra insult, I was on Adderall for my ADHD for years before I was diagnosed bipolar, and never had trouble with it provoking manias. The doctor told me that was 'unlikely' and that she 'wasn't going to believe me without documentation' when I relayed this to her.
So I stopped going to the doctor, since she was the only one I could go to for free and I was super broke, stopped taking my prescription drugs and started taking St. John's Wart. I'm depressed less often than not now, and with that out of the way I've been able to figure out strategies for dealing with my ADHD problems.
Despite my troubles, I still strongly advocate seeking help from medical professionals and going through the medicine dance even if it sucks at times. God knows I will as soon as I can see a doctor that I can stomach.
edit: And that wasn't the first bad doctor experience I had. My doctor before that one, I left because she told me that I'd hit the maximum effective dose of lamictal already at 250 mg (my mother was only stable at 400) and that people with Asperger's couldn't learn to read basic body language no matter how hard they tried. Guess you get what you pay for, when you're using free services in a small Southern town? Admittedly I'm sort of a horrid mess of issues, probably a bit more difficult to deal with than what they usually deal with.
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MorninglordI'm tired of being Batman,so today I'll be Owl.Registered Userregular
As I understand it, people self-assess themselves as more efficient at completing tasks on caffeine, but objective observation shows that they're going faster and messier--any gains made are lost fixing what they screwed up.
It's going to vary across the population like any other drug.
It'll also vary based on how much you drink regularly, the task you are doing, what your current personal circumstances are (not falling asleep is automatically going to result in more work done. It might not be efficient work, but it is work.)
I'm really not surprised that when already running at max efficiency people don't need coffee.
How many millions of years evolution prior to the discovery and widespread distribution of coffee across the world? Yeah.
We don't need it, at all.
It sure is handy in some situations.
And in others, not so much.
Like all things, moderation is best.
Morninglord on
(PSN: Morninglord) (Steam: Morninglord) (WiiU: Morninglord22) I like to record and toss up a lot of random gaming videos here.
As I understand it, people self-assess themselves as more efficient at completing tasks on caffeine, but objective observation shows that they're going faster and messier--any gains made are lost fixing what they screwed up.
It's going to vary across the population like any other drug.
It'll also vary based on how much you drink regularly, the task you are doing, what your current personal circumstances are (not falling asleep is automatically going to result in more work done. It might not be efficient work, but it is work.)
I'm really not surprised that when already running at max efficiency people don't need coffee.
How many millions of years evolution prior to the discovery and widespread distribution of coffee across the world? Yeah.
We don't need it, at all.
We also didn't have completely bullshit schedules and bright lights to screw things up even more.
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MorninglordI'm tired of being Batman,so today I'll be Owl.Registered Userregular
edited September 2014
Efficiency =/= staying awake.
He's talking about, say, a mid morning coffee when you are well rested and healthy.
Morninglord on
(PSN: Morninglord) (Steam: Morninglord) (WiiU: Morninglord22) I like to record and toss up a lot of random gaming videos here.
I would like to share an experience I just had this past month relating to mental heath, because it has been really eye opening.
Story:
In early September, I randomly almost passed out on the train to work. This has never happened to me before outside of situations involving heat and exercise. I went to the doctor and they checked out my heart and blood, they found no problems and I thought relatively little of it. The next friday, I experienced a full blown panic attack after feeling a strange sort of snapping sensation in the right side of my head, followed by a numbness. At the time, I thought I was having a stroke or seizure, and was of the opinion that I was either dying or losing my mind. My chest got tight and I felt like I was going to lose consciousness.
After calling the doctor's office and describing what was going on, my fiance drove me to the hospital, where they checked my vitals, etc very quickly and again found no issues with my heart or blood. After a few hours I finally saw a doctor, by that point I was feeling better but still has the strange sensation on the right side of my head. I spoke with the doctor and described my symptoms. He eventually asked me, "Did you have a sense of impending doom?" and I'm really glad he asked that, because I said "Yes!" at which point he told me I had had a panic attack and gave me an IV of fluids and an injection of Ativan (a benzo). Prior to this, I had never experienced a panic attack while sober (I had only had one ever before). I have no history of severe anxiety, and had never taken any anti-anxiety medication.
The next day I felt groggy but generally OK. I figured staying up all night in the hospital will do that to you (not to mention being injected with Ativan). The strange feeling on the side of my head persisted, though. The day after that I felt AWFUL. Like really shaky and just massively out of it. Long story short, for the next two weeks I had several ups and downs that included tremors (my teeth would chatter and my chest and arm would twitch for ~2 minutes), fatigue, dizziness, mild paresthesia, anxiety, and one full blown migraine (no pain, but I was disoriented and photosensitive for an entire evening and my head felt like it was cramped up).
My tremors steadily got better (each episode was weaker than the previous) and I'm finally feeling a lot better. Throughout all of this, my doctor assured me it was stress, a virus, or something otherwise undiagnosable. They did check for Lyme and did a precautionary MRI, all of which came back looking fine. My vitals were always fine, and I passed a basic neuro.
Story TL/DR: My nerves/brain temporarily freaked out, causing a panic attack, tremors, a migraine, and a bunch of crazy symptoms including heavy anxiety for a period of ~2-3 weeks. Doctors have no idea why.
So here's what I've realized:
Medical science still knows very little about issues like this. I have spoken to several people (including family members) with anxiety issues and migraines who have spent DECADES trying to get them figured out. They've found stuff that works, and stuff that doesn't, but all of them agree that the root cause is extremely nebulous. The science of the brain has an amazing amount of unexplored ground to cover.
I also have a new respect for anyone who struggles with these issues. I now know the difference between "feeling worried" and intense anxiety. It is like fighting your shadow self, and your shadow self fights dirty. The symptoms are not mental, they are biological. You feel sick when you are not, and the feeling isn't an illusion you can just wipe away. Your brain is actually making you feel sick (at least I think).
I have a few theories about what happened, but they will always just be theories. That aspect of it is extremely frustrating. I will always wonder "Was I actually sick or was it all in my head?" The only things I know with relative certainty are that I had a panic attack, and I had a migraine. Everything else, the dizziness, the light headness, the weird sensations on the right side of my head, the paresthesia, the tremors, I'll never really know if sometimes was doing that to me or if my body was doing that to itself.
IanatorGaze upon my works, ye mightyand facepalm.Registered Userregular
Here I am, having finally decided to do major research on depression - as part of a paper in school, no less!
Here I am, going through the library's online material on depression, and my brain is shutting down trying to find some sort of peer-reviewed reference on the definition of "clinical depression" and just seizing up at the wall of stuff before my eyes.
Here I am, almost in tears at the thought that, less than halfway into the semester, in less than three hours I will have blown off any ability for me to get anything better than a C in this class.
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Just start at the DSMV and then pick a half dozen studies from a variety of specific areas that show it is a myopic shallow unscientific description of an arbitrary cluster of symptoms, at the 3/4ths mark describe how the limitations of our current clinical science lacks better tools that could be reasonably applied, and conclude with well it's what we got until we get better science, and support a call to action with recent science/social(increased awareness and treatment)/political(Obama's brain science initiative thingy) developments that signal a silver lining.
Your prof will love it.
It tells a good story, you get to hit on most of the fields of behavioral science, and question the standard practice of psychology while reaffirming it.
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They moistly come out at night, moistly.
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MorninglordI'm tired of being Batman,so today I'll be Owl.Registered Userregular
edited September 2014
It'll work. I always got the best grades for sub fields I was particularly critical of.
A good report has you set something up and then survive everything you can possibly think of to throw at it, then conclude with "Well, it lived. Good enough for now. But here's how we could do better."
Morninglord on
(PSN: Morninglord) (Steam: Morninglord) (WiiU: Morninglord22) I like to record and toss up a lot of random gaming videos here.
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IANAD and anecdotes can be worthless, but when I was getting treated for depression and anxiety a few years ago, I was prescribed a SSRI (citalopram) because it was supposed to help with both. For me, it was actually a lot more effective at alleviating anxiety than depression.
Something worth considering if you have severe anxiety attacks with physical symptoms: An ex of mine was prescribed beta blockers to deal with his anxiety attacks, and he swore by them. They alleviate the physical symptoms (shaking, sweating, heart rate), which can apparently help some people a lot.
This whole try this for a month cause it helps some people who claimed to have similar symptoms nonsense is kinda bullshit.
Honestly don't know what to expect, or what I would even want to get out of it, but I do feel like it certainly can't hurt more then continuing to deal with my myriad mental issues solo like I have been doing lately.
Did you shop around at all? I've had generics quoted from Walmart in the 100+ range that cost me $20-something a month at Kroger/QFC (or $30-something at walgreens).
Those are the major ones.
Tricyclics still see some use in people who don't respond to modern drugs, and very severe anxiety might still be rarely treated with barbiturates or antipsychotics. As Bliss mentioned, beta blockers also work in some people.
Frankly, most people don't find an SSRI that works for them on the first try, and trying 3-4 drugs before finding one that works is not that rare. Also consider that the effectiveness of an SSRI scales with the severity of your disorder - it is arguable that SSRIs do anything at all to people who have mild mood disorders.
There's also cannabis. I'm not joking.
the "no true scotch man" fallacy.
SSRIs are kind of targeted.
Prozac is widely considered to be the first designer drug. We knew that serotonin was implicated in depression as far back as the 1960s, and Julius Axelrod did most of his work investigating the reuptake cycle in the 60s as well. When David Wong discovered Prozac, he and his team were specifically looking at a family of chemicals suspected to interfere with the serotonin reuptake cycle.
The main problem is that nobody really knows how or why fiddling with serotonin improves mood.
the "no true scotch man" fallacy.
...aaannd MDMA continues to be a schedule 1 narcotic.
I meant more targeted in terms of patients it is likely to help. As the above post alludes to, it takes people a while to find an SSRI, or whatever, that works well for them.
Didn't help when I went to see a psychologist either, since i'd just forget everything we had talked about the previous week by the time I go in for the next appointment.
Not a doctor, anecdotes are lousy, etc. I noticed a difference between how SSRIs poked me, and how an SNRI poked me.
Not sure if it would make a difference for what's happening in your mind/brain, but they seem to poke my mind/brain in different ways.
Take notes.
I take notes for important things.
I also sometimes have to trust that I will have the same idea again in the same situation for complex issues.
I also put a lot of work into attempting to remember accurately as well as trying to focus properly when I really want to remember something, which has improved my memory a lot.
Habit is also very useful. I can't actually close the door to my flat anymore when I leave it solo without putting my hand in my pocket and finding my keys. I did this habitually after I first locked myself out when my girlfriend was out of town so even when I'm in a completely absent minded, totally distracted daze, I realise that for some reason I can't seem to close the door, I keep resisting it, as if... oh yes keys! Do I have them? *puts hand in pocket and finds them* And then I can close the door.
An example of that automatic checker in action.
Without knowing more context it's very difficult to say what the problem could be. I would definitely see someone though. Long term memory problems that serious are throwing up low key alarm bells. You should rule out medical issues at least.
My subjective experience is that SNRIs cause more of an immediate boost in energy and confidence similar to certain notable recreational stimulants.
Which is congruent with the body of knowledge about norepinephrine.
the "no true scotch man" fallacy.
It’s not a very important country most of the time
http://steamcommunity.com/id/mortious
One huge new part of my own medical knowledge that my doctors unfortunately missed for about 8 years: Depression is not always a diagnosis, but sometimes merely a symptom.
In my case, doctors were so concerned with my depression that patterns were ignored. Most victims of Major Depression experience 1-2 long, severe periods of depression a year. In my case, I was experiencing 4-6 cases a year. Notably, it was worse in Winters, and I experience mild, hours-long periods of mania 4 times a year. Finally, a doctor took a comprehensive list of family medical history. Lo and behold- family history of Thyroid issues and Bipolarism.
Current science doesn't have any evidence for Major Depression being hereditary (they thought I was depressed since my father and uncle were). Thyroid issues, which manifest as Bipolarism, however, are hereditary. Blood tests confirmed diagnosis. It's part of a growing field known as "Bi-polar Type II" and "Bi-polar NOS (Not Otherwise Specified)." The key difference between these and Bipolar Type I is that periods of mania are severely muted, sometimes nonexistent, and periods of depression last slightly longer.
Ultra problem though is that anti-depressant medications are terrible at treating Bipolar, and sometimes can exacerbate issues. Finally got on Thyroid related treatments, and last two years have been going much, much better.
And, if anyone is interested, anecdotal experiences with medications over the years:
Wellbutrin - Gave me the shakes.
Seroquel - Terrible Mouth Dryness, makes you super drowsy.
Lexapro/Escitalopram - This stuff does weird ass things to your libido. Was like viagra to me. Hated it.
Abilify - Didn't have any problems (but wasn't proper for my diagnosis)
Gabapentin - Good at reducing anxiety on a 1-3 hour scale. Too much makes you feel drunk - had to be careful with dosage.
Oxcarbazepine - Makes your joints hurt. Goes away after first month.
Dawn Therapy - Super worth it. Many insurance companies are starting to cover this if you can get your doctor to prescribe it under SAD diagnosis. I use a Philips lamp myself. Ramps up light over 40-minute period prior to waking up, to simulate dawn. Can also double as a low-power Light Box for Light Therapy. These lamps are $150 though, so hard to purchase out-of-pocket.
Suffice it to say, my advice is to always get a couple of opinions. Depression can have a lot of causes, which aren't always the go-to "Major Depression." Also, whenever possible, see specialists. Half the reason for my poor early diagnoses was that I was at bottom-of-the-barrel doctors in University or Emergency clinics, and not with private-practice or hospital doctors who had the time to really investigate. (Unfortunately, these are more expensive as well, which I sympathize with people on).
Just an extra tip: Do not under any circumstance think "Guess I can't be helped then" and bugger off into the vast wilds of untreated whatever the fuck is going on with your head.
That way, literally, lies madness.
Wait, what?
Ok, a quick googling indicates that SNRIs work kinda-sorta like Cocaine and Amphetamines. Is that what you were talking about?
Caffeine stimulates norepinephrine production.
The only problem with caffeine is its extremely short half life and its extreme side effects in high doses. Long term and short term.
Caffeine works similarly enough to dexamphetamine that I take coffee as a medicinal supplement to my regular medication.
A lot less than I used to. It'll give me serious insomnia if I have a coffee too late in the afternoon.
Like, during one of my "off the medications" periods, where I was trying to live without them, I was trying to do a really hard assignment, and I found that coffee gave me bursts of the same effectiveness as dexamphetamines....
Lets just say I drank way too much goddam coffee over 24 hours and leave it at that.
Of note, I was very much in the grip of my past serious anxiety issues back then.
Stay the fuck away from caffeine if you have anxiety issues.
I was so freaked out that whole time period is still a notable flashbulb memory a decade later.
Those are notable recreational stimulants, yes.
And by "immediate" I mean "within the first couple of days," not "in five minutes."
the "no true scotch man" fallacy.
Lift five kilos 20 times four times a day you get a benefit. You'll hurt like hell for the first week, but then you'll get stronger.
Try to lift two hundred all at once without any preparation and you'll tear something. You can also do permanent damage. And you wont get any stronger.
That's the difference between recreational drugs and the milder stuff used to treat people.
Only it's always two hundred more weight than you can normally lift.
Oh...hmmm...
http://apt.rcpsych.org/content/11/6/432.full
Whatever you do don't go cold turkey if you've got mental health issues. Gradually reduce. 1 less cup a day. Or make yourself a special mix of caffeinated/decaff, and slowly reduce the amount of caffeinated as time goes on.
Particularly if you are also on any other drugs that mess with brain chemistry. The rebound will be ridiculous if you go cold turkey.
If you suffer from insomnia try to make sure your last cup is before 3pm.
Oh yeah going cold turkey is not an option for me. I'm trying to quit drinking and smoking (and weed) so throwing another one on the pile is probably not a good idea anyway but thanks for pointing out that caffeine might also be an issue. I wanted to cut down on my caffeine anyway but knowing it is bad for other stuff besides health and general unrelaxed-ness gives me another good reason to do it.
Don't be that guy who goes onto the internet to diagnose yourself, but the flip side is that it's still good to be educated about what you're putting in your body before you do it.
If you are feeling anxious but feel like you need a cup to concentrate, just make one and sip it a bit, then see how it effects you. If your concentration doesn't improve much and your anxiety goes up, you don't need one, it's just habit telling you "I can't concentrate = caffeine". So don't drink the rest of it, because it's your high stress level that is causing the concentration problems. The best state of mind for concentration is a middle ground, too low or too high and it affects your concentration in slightly different but equally dysfunctional ways.
In that case you are better off taking a few minutes to calm down a bit and see if that helps.
That's how I monitor my intake under stressful conditions.
Lots of SSRIs have anti anxiety as a side effect but it's not their primary function. Anti-anxiety drugs are pretty much their own family entirely.
Personally, I've replaced my ridiculous intake of coffee and diet soda (2 pots and two liters) with half-caff coffee and various low/no-caffeine sodas.
There was a time in my life that I drank 4+ pots of full-caffeine coffee, 6+ cups of black tea, and a two-liter of soda each day. That was, coincidentally I'm sure, the time in my life that I slept with the lights on and had to check under my bed and in my closet before I slept for roaches, spiders...and monsters. But it was the only way I could get shit done, because I have super severe ADHD and it wasn't getting treated at the time (because I was too depressed courtesy of undiagnosed bipolar disorder to seek treatment for that or anything else).
As far as medications go, I'm a big fan of them for treatment...but personally ended up in the unfortunate position of having bipolar disorder and ADHD and a doctor that didn't believe a person could have both. And also wouldn't believe me when I said that my manias were extremely rare, and benign when they did occur--she more or less told me I was a ticking bomb, destined to go crazier and crazier as I got older. So I got Lamictal for the bipolar, which helped a little but still left me depressed more often than I wasn't, and Strattera for the ADHD (because it's not a stimulant), which helped a little but had side-effects severe enough that I stopped taking it (clumsiness, messing up words spoken aloud and typed, and sexual problems).
For extra insult, I was on Adderall for my ADHD for years before I was diagnosed bipolar, and never had trouble with it provoking manias. The doctor told me that was 'unlikely' and that she 'wasn't going to believe me without documentation' when I relayed this to her.
So I stopped going to the doctor, since she was the only one I could go to for free and I was super broke, stopped taking my prescription drugs and started taking St. John's Wart. I'm depressed less often than not now, and with that out of the way I've been able to figure out strategies for dealing with my ADHD problems.
Despite my troubles, I still strongly advocate seeking help from medical professionals and going through the medicine dance even if it sucks at times. God knows I will as soon as I can see a doctor that I can stomach.
edit: And that wasn't the first bad doctor experience I had. My doctor before that one, I left because she told me that I'd hit the maximum effective dose of lamictal already at 250 mg (my mother was only stable at 400) and that people with Asperger's couldn't learn to read basic body language no matter how hard they tried. Guess you get what you pay for, when you're using free services in a small Southern town? Admittedly I'm sort of a horrid mess of issues, probably a bit more difficult to deal with than what they usually deal with.
It's going to vary across the population like any other drug.
It'll also vary based on how much you drink regularly, the task you are doing, what your current personal circumstances are (not falling asleep is automatically going to result in more work done. It might not be efficient work, but it is work.)
I'm really not surprised that when already running at max efficiency people don't need coffee.
How many millions of years evolution prior to the discovery and widespread distribution of coffee across the world? Yeah.
We don't need it, at all.
It sure is handy in some situations.
And in others, not so much.
Like all things, moderation is best.
He's talking about, say, a mid morning coffee when you are well rested and healthy.
Story:
In early September, I randomly almost passed out on the train to work. This has never happened to me before outside of situations involving heat and exercise. I went to the doctor and they checked out my heart and blood, they found no problems and I thought relatively little of it. The next friday, I experienced a full blown panic attack after feeling a strange sort of snapping sensation in the right side of my head, followed by a numbness. At the time, I thought I was having a stroke or seizure, and was of the opinion that I was either dying or losing my mind. My chest got tight and I felt like I was going to lose consciousness.
After calling the doctor's office and describing what was going on, my fiance drove me to the hospital, where they checked my vitals, etc very quickly and again found no issues with my heart or blood. After a few hours I finally saw a doctor, by that point I was feeling better but still has the strange sensation on the right side of my head. I spoke with the doctor and described my symptoms. He eventually asked me, "Did you have a sense of impending doom?" and I'm really glad he asked that, because I said "Yes!" at which point he told me I had had a panic attack and gave me an IV of fluids and an injection of Ativan (a benzo). Prior to this, I had never experienced a panic attack while sober (I had only had one ever before). I have no history of severe anxiety, and had never taken any anti-anxiety medication.
The next day I felt groggy but generally OK. I figured staying up all night in the hospital will do that to you (not to mention being injected with Ativan). The strange feeling on the side of my head persisted, though. The day after that I felt AWFUL. Like really shaky and just massively out of it. Long story short, for the next two weeks I had several ups and downs that included tremors (my teeth would chatter and my chest and arm would twitch for ~2 minutes), fatigue, dizziness, mild paresthesia, anxiety, and one full blown migraine (no pain, but I was disoriented and photosensitive for an entire evening and my head felt like it was cramped up).
My tremors steadily got better (each episode was weaker than the previous) and I'm finally feeling a lot better. Throughout all of this, my doctor assured me it was stress, a virus, or something otherwise undiagnosable. They did check for Lyme and did a precautionary MRI, all of which came back looking fine. My vitals were always fine, and I passed a basic neuro.
Story TL/DR: My nerves/brain temporarily freaked out, causing a panic attack, tremors, a migraine, and a bunch of crazy symptoms including heavy anxiety for a period of ~2-3 weeks. Doctors have no idea why.
So here's what I've realized:
Medical science still knows very little about issues like this. I have spoken to several people (including family members) with anxiety issues and migraines who have spent DECADES trying to get them figured out. They've found stuff that works, and stuff that doesn't, but all of them agree that the root cause is extremely nebulous. The science of the brain has an amazing amount of unexplored ground to cover.
I also have a new respect for anyone who struggles with these issues. I now know the difference between "feeling worried" and intense anxiety. It is like fighting your shadow self, and your shadow self fights dirty. The symptoms are not mental, they are biological. You feel sick when you are not, and the feeling isn't an illusion you can just wipe away. Your brain is actually making you feel sick (at least I think).
I have a few theories about what happened, but they will always just be theories. That aspect of it is extremely frustrating. I will always wonder "Was I actually sick or was it all in my head?" The only things I know with relative certainty are that I had a panic attack, and I had a migraine. Everything else, the dizziness, the light headness, the weird sensations on the right side of my head, the paresthesia, the tremors, I'll never really know if sometimes was doing that to me or if my body was doing that to itself.
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Here I am, going through the library's online material on depression, and my brain is shutting down trying to find some sort of peer-reviewed reference on the definition of "clinical depression" and just seizing up at the wall of stuff before my eyes.
Here I am, almost in tears at the thought that, less than halfway into the semester, in less than three hours I will have blown off any ability for me to get anything better than a C in this class.
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Just start at the DSMV and then pick a half dozen studies from a variety of specific areas that show it is a myopic shallow unscientific description of an arbitrary cluster of symptoms, at the 3/4ths mark describe how the limitations of our current clinical science lacks better tools that could be reasonably applied, and conclude with well it's what we got until we get better science, and support a call to action with recent science/social(increased awareness and treatment)/political(Obama's brain science initiative thingy) developments that signal a silver lining.
Your prof will love it.
It tells a good story, you get to hit on most of the fields of behavioral science, and question the standard practice of psychology while reaffirming it.
A good report has you set something up and then survive everything you can possibly think of to throw at it, then conclude with "Well, it lived. Good enough for now. But here's how we could do better."