↑ comment by Nick_Roy ·
2015-03-10T13:58:12.950Z · LW(p) · GW(p)
Two Disclaimers: First, I am not a doctor. Second, beware of other-optimizing. This advice is working well for me, but it may not work well for others.
The depression became obvious and major enough that I was forced to take action to stop it. The rationalizations had run dry, so I fully realized in both System 1 and System 2 that I was not "unmotivated", I was mentally ill. Years of life hacks and half-assed lifestyle interventions had accomplished some, but not enough, so it was time for medications, which I had previously feared due to bad experiences with bupropion years earlier.
The constraints in my investigation: something effective for major depressive disorder in both the short-term to fight what I was then feeling and in the long-term to prevent relapse, non-serious side effects, anxiolytic properties, as there is comorbid OCD and social anxiety disorder (SA, also this is why I chose medications before psychotherapy), and a reasonable price. Tianeptine met these constraints, with the nice bonus of plausibly being a cognitive enhancer.
Within six weeks of use, the tianeptine decreased the depression such that it was time to focus on the next most serious drag on my productivity and happiness: OCD. Not being majorly depressed allowed me to develop exercise and meditation habits that reduced the OCD down to a similarly manageable level. The anxiolytic effects of the tianeptine and the reduced stress of not being seriously depressed probably also helped.
The depression and OCD were still there and still a nuisance, but they had become minor enough that it was time to continue prioritizing elsewhere. By then tianeptine's anxiolytic properties had faded to mildness due to tolerance, though it has continued to be effective as an antidepressant that at least does not increase anxiety, which was my primary issue with bupropion.
Next on the list was either SA or an uncontrollable sleep cycle, both being about equally problematic. I chose to address the sleep cycle first because modafinil immediately came to mind as a plausible treatment, plus we've all heard of its reputation as an anti-akratic. In hindsight, I should have thought about this more thoroughly before leaping into it. Availability bias at work. Anxiety is an uncommon side effect, but I decided to take the risk. In hindsight, I ought to have realized that for people already dealing with multiple anxiety disorders, that anxiety side effect probably becomes a lot more more common. A statistics fail on my part.
So, I tried modafinil to control my sleep cycle and reduce akrasia, and instead I produced the unshakable certainty that unnamed, unseen monsters were out to get me. Whoops. Looks like my suspicion was correct that I have subclinical generalized anxiety disorder, because the modafinil had exacerbated it to unacceptable levels. The stress of experiencing this also triggered a depression relapse, so I then took myself off the modafinil. Soon enough I recovered to where I had been before trying it.
This leads me to the present. Now I am faced again with the choice of confronting either the sleep cycle problem, SA, or both. My System 1 is wary of fighting the sleep cycle again just yet after being burned last time, so SA it is. I have already taken the edge off, because of social skills training I started months ago and because of the interventions I've taken against OCD, but it is still serious enough to pursue a pharmacological solution.
First on my To Be Scrutinized list is kratom, as I have already been taking theanine for years now. I will investigate effectiveness, safety, cost, and personal fit. Whatever I try, I will also attempt exposure therapy alongside the anxiolytic effects of a medication. If I am successful, I will next have another go at fixing the sleep cycle, then I will either consider my options regarding the notoriously untreatable fact that I am on the autistic spectrum, or else move on to address the much decreased but still niggling depression and OCD.
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