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#depression or just dopamine withdrawal?
tempest-loupnoir · 1 year
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tikki-tok · 1 year
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Whenever the depression chooses to rear its ugly head, it always shows up with a briefcase full of yearning that I DID NOT ASK FOR like NO bitch you will NOT cope with the stress of doing the dishes by dreaming of men you will DO THOSE DAMN DISHES
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foreveranevilregal · 2 years
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I’m tired. I’m broken. I’m lonely. I’m depressed and hopeless. I’m sorry I can’t be what you all want and crank out thousands of words of writing on demand without wanting anything in return. Maybe I overestimated myself or got a big head from when I had tons of notes. That’s my fault. I should be more aware that I’m not actually good at writing and don’t deserve anything. Once again, I’m sorry.
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eternal-echoes · 1 month
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“Could you imagine getting into a massive car accident on the free-way, sustaining a few broken ribs and a concussion, and telling the paramedics:
Don't worry about me. I'm fine. The hospital doesn't need to know, and they would just blame me for driving too fast. Besides, I can't stand needles and they're just going to prick me with an IV and injections of pain medicine. I can heal on my own.
Would you survive? Perhaps. But you would heal more quickly if you showed your wounds to the physician. The same could be said of the girl who has suffered the trauma of sexual abuse yet plans to heal alone in silence. The hospital exists for a reason, and so do family, friends, and counselors.
From a scientific perspective, it's interesting to note what happens in the mind of young women who suffer abuse. Researchers from the University of Texas Southwestern Medical School discovered that traumatic intimidation through abuse and violence leads to high levels of stress that trigger excessive levels of brain-derived neurotrophic factor (BDNF) to be released in the brain. When this happens, certain genes in the brain are turned on, causing the victim of abuse to experience social withdrawal, depression, fearfulness, an increased tendency toward addictive behaviors, and a decreased ability to enjoy intimacy in the future.1
If you have been sexually abused and are experiencing these consequences, you are normal. But take a step in faith and find an adult in whom you can confide. It can be a family member, relative, teacher, counselor, youth minister, pastor, or anyone who is trustworthy and loving. If you can't think of whom to tell, pray to God that He will show you the right person.”
-Jason and Crystalina Evert, How to Find Your Soulmate Without Losing Your Soul
1 Oliver Berton et al., “Essential Role of BDNF in Mesolimbic Dopamine Pathway in Social Defeat Stress,” Science 311 (February 2006), 864-868; McIlhaney and Bush, Hooked, 85.
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somewhat-sanguine · 9 months
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no narcotics in my brain can make this go away (anhedonia)
I don’t quite remember what it feels like to experience pleasure anymore. My dopamine receptors are shot. Everything I feel, besides sadness, is blunted and muted but at the same time almost indescribable. Like a vicious swirling of emotion inside my mind, brief instances of happiness fade so fast and my brain feels like worms squirming on the sidewalk in the summer heat. What’s worse, perhaps, is the immense wave of loneliness I feel mixed with tinges of shame. I don’t quite remember much at all anymore, the last decade or so of my life is a blur because of drugs and alcohol…and yet I crave those things so much. My baseline levels of dopamine are so fucked the only thing that elevates them is a few swigs of vodka or a few lines of coke. I sat down to write a poem, but because of the brain fog (I am only three days sober), I feel as though I am unable to write anything cohesive, meaningful, and most of all poetic. I look back at my old poetry and feel envy… I feel distant from the work I used to put my heart and soul into.
I am tired. Oh so tired. How much easier it would be to poison myself and my brain again…but I have to keep that little voice inside of myself alive, the voice that whispers “You are more than this, there must be more to life than this.”
I wish I could laugh and smile. I wish I had someone to just…even just play a video game with. I’ve thought about joining some random servers or an online game to try to connect to people, but I inevitably begin to feel as though I am a burden to everyone I attempt to connect with. I have not yet figured out if that’s the post-withdrawal depression talking, or if it’s actually true. 
I know I push people away, I know I ignore people, and I’m not sure if that’s in correlation with how much of a burden I feel I am or if I push them away before they can leave me. 
What’s wrong with me? 
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consult-sherlockholmes · 11 months
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How is the withdrawal? Do you feel better? I'm so sorry you have to go through all this again. :/ At least @consultjohnwatson isn't mad at you.
Technically it’s not withdrawal. Withdrawal only happens when you are dependent on a drug after chronic usage. After months of use your body gets used to the presence of the drug, changing its neurochemical homeostasis to adapt to the constant presence of the drug. This is also how tolerance develops, your body tries to adapt to the increased amount of certain neurotransmitters, downregulating receptors, so you need more and more of a drug to feel the same effect. Tolerance and dependence are often closely linked. And when you then remove the drug to which your brain has adapted to, your body’s homeostasis gets disturbed, resulting in horrible painful torturous withdrawal. Your body basically starts fighting the changed state, after it got used to the drugs presence, readapting, only that this readaption is a very painful process. 
However I did not use for months before, thank you very much for your faith in me, so it can’t be withdrawal. I only received a single dosage, so the current effects are based on a rebound or crash after the high, any aftereffetcs of harmful additives, and hangover. The massive neurotransmitter release during a high can then cause the user to feel the exact opposite effects of the drugs afterwards, for example exhaustion, depression and pain after stimulant use. The brain needs to readjust those neurotransmitters then to restore homeostasis again, which takes a while in some cases. And because the dopamine levels crash after the cocaine high, cravings increase significantly in an attempt to continue use to try to restore dopamine levels quicker. And of course any dehydration or other problems during the high can contribute to the hangover, just like with alcohol. 
So currently I am experiencing rebound and crash, however it is worsened by my other medical conditions, which were caused by evidently nearly drowning and a concussion. I have yet to steal see my medical file to confirm my deductions. I might feel better than yesterday, however it is far from feeling good.
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hi kade! tell me more about antipsychotics. good luck on your studying <3
Hi North!! I've already studied this one a lot so it might be a little bit shorter, but here is antipsychotics summarized:
While they have several pharmaceutical uses, antipsychotics have largely been developed for the treatment of schizophrenia, so it's important to understand the neurology of schizophrenia.
To keep it really simple, schizophrenia is associated with overactivation of D2 receptors in the mesolimbic pathway and underactivation of D1 receptors in the mesocortical pathway. The overactive of D2 receptors is thought to be behind the "postie" symptoms of schizophrenia (hallucinations, disorganized speech, ect). The underactivation of D1 receptors is associated with the "negative" symptoms of schizophrenia (anhedonia, social withdrawal, ect). Because it's about in imbalance of dopamine, not just low or high levels, simple dopamine increasing drugs like psychostimulants aren't effective in treating the negative or cognitive symptoms.
The first generation of antipsychotics invented in the 50s (Chlorpromazine) just kind of binds to a whole bunch of stuff? But the only important thing it does is bind the to D2 receptors and stop them from firing as much. There are a couple big problems with this. First off, they can only reduce positive symptoms, so the person taking it is left with only the negative symptoms. Basically, feeling really shitty and demotivated and depressed. Secondly, targeting a ton of stuff and blocking the vast majority of D2 activation (up to like 86%!) can cause severe side effects. And that, when combined the increased prevalence of the negative symptoms, can be so unbearable that people will just stop taking their medication.
The second generation of antipsychotics tweaked the chemical structure of the first so that it has a little lower affintiy for D2 receptors. This is good because they have less severe side effects because they bind to D2 receptors less and for a shorter time. But to make up for this, they also are 5-HT2A inhibitors. This is less about direct serotonin effects, rather its downstream dopaminergic effects. The 5-HT2A inhibition helps recover some of that D2 antagonism needed for treatment, but allows D2 receptors to function a bit more normally. They are also a bit better at reducing negative and cognitive symptoms
Still, second generation antipsychotics have lots of side effects and each individual drug is basically the same but tweaked slightly so that they will each have slightly different side effects and the patient can pick a side effect profile that works best for them. <- not a feel good sentence to write. They're hard to study because clinical trials have big drop out rates due to the side effects.
Luckily there's a new theory about schizophrenia! Instead of dopamine being the root cause, some believe that it's actually not enough glutamate. Decreased NMDA signaling reduces mesocortical dopamine activation and enhances mesolimbic dopamine activation. And a new type of drug is currently in clinical trials that enhances NMDA activation, and it is improving Both positive and negative symptoms with less severe side effects! It's in the early stages right now but hopefully we're on the precipice of an antipsychotic revolution and we're about to have wayyy better drugs!!
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cruel-angel · 9 months
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you made me feel like it was always my fault. i let go of transgressions you made against me, while you held mine over my head. you made me waste precious time that i'll never get back. and effort. and money. you lied to me constantly- almost any time we would speak. you held me to expectations that were unbecoming of our status as "friends". you never genuinely praised me. you made me feel like i was always doing something wrong. you constantly exhumed the past that should've been left buried. your recollections of those you knew, compared against me. whether friend or foe, they were never my equal. i was always inferior somehow. for being too kind. for being too unkind. you made me feel like i can never win. you made me regret things i don't even remember. you made me like qualities you had just enough to develop some form of attachment. attachment to routine, routine to habit, habit to addiction. you made me withdraw. you never thanked me. you never genuinely thanked me. you made me feel like a stranger. you made me feel like we never knew each other at all. you made me look for you in people and in things you had no business being in. you made me find you in songs and stories. you made me desperate. you made me stressed, depressed, angry, and every emotion except happy. the only positive was the response to stimuli, my synapses firing and releasing dopamine as a reaction to feeding the addiction of contact with you. you made me feel like i didn't know what empathy was. you made me think that everything had been my fault. that everything that had transpired was because of my own accord. you made me believe that i would never meet someone better, or even similar to you. you made me think you were special somehow. you made me uncomfortable. you made me listen to your rediculous rants. you made me listen to you repeat the same words over and over. recalling the same stories ad nauseam. you made me listen to your broken record recountance, preaching how your life was so much worse than others. all the while you surpassed me in everything. you were so superficial. i could see in your eyes that you had seen everything you intended to from just a glance. and then your eyes closed shut forever. yet you kept watching, kept blinking. i know this was a farce, just learned behavior. you saw but didn't look. you heard but you never listened. you were more than just a bad friend. you were a terrible enemy. always too afraid to break your posture. too afraid to care, to give into just an iota of genuine emotion. your tears were probably pure water, devoid of any real substance. just another learned behavior. i don't hate you. or feel sentimental or thankful for the time we had. i am apathetic to you, completely. i would sooner turn my attention to an ant in my path than i would you. i hope that when my life flashes before my eyes, it skips over the completely inconsequential parts that contain you. knowing you brought absolutely no change to my life. as far as my personality, my mannerisms, or my feelings are concerned- it's as if we never knew one another. you never said goodbye. you were always so unkind to me. you'll never see me again. you wouldn't even recognize me anyway. RIP! 🤣
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noortjelanterfanter · 9 months
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I'm going absolutely batshit crazy. The physical withdrawals are not that bad, but mentally it's absolute torture. It would have been bad enough with a semi healthy mind, but I'm depressed out of my skull and I took away my main way to selfsoothe. So now I'm stuck, no dopamine, no motivation, struggling to not order food even though I feel I have no reason at all not to give in, but it's hard. I Just want to feel ok...
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randomappeal · 2 years
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Psychopharmacology Basics
Another day, another class with pharmacology. This is just a little review on drug principles. Most of these notes came from Videbeck's Psychiatric-Mental Health Nursing textbook and the lecture powerpoint deck. Some information is excluded if it was not covered by the professor, so this is not a complete source of information for nursing psychopharmacology.
This section will cover pharmacology basics, treatment principles and neurotransmitters.
Pharmacology Basics
Efficacy: the maximum therapeutic effect that a drug can achieve. Aka, the drug's ability to work within the human body.
Potency: the amount needed to achieve efficacy. Aka, the drug's concentration that allows it to work.
Half-life: the time it takes for a drug to be reduced by half within the body. The shorter the half-life, the more of the drug is required to maintain a therapeutic level within the body. The longer the half-life, the less is required to maintain the same level because it stays in the body longer.
Off-label use: uses for a drug other than what it was approved to treat
Black box warning: if a drug has a life-threatening side effect then there must be a warning in a literal black box on the label so it stands out
Pharmacologic Treatment Principles
Selecting the Drug. The chosen medication is selected based on how well it treats or reduces the patient's symptoms
Starting the Drug. Most psychotropic drugs take several weeks to be effective, so adequate doses must be given over a sufficient amount of time before the effects are realized
Amount of the Drug. The lowest effective dosage is used and titrated up or down as needed
Taking the Drug. The medication regimen should be as simple as possible to promote compliance
Differences for Older Adults. Older adults require lower dosages because it takes longer for their bodies to metabolize drugs
Stopping the Drug. Gradually taper off a drug rather than abruptly stopping it or the patient may suffer from temporary rebound, recurrence or withdrawal effects
Adjusting the Drug. Continuous follow up is necessary to ensure the patient is receiving the adequate dosage required
Neurotransmitters
There are four neurotransmitters that are of particular interest to mental health.
Dopamine
MOA: Excitatory
Effects: controls complex movements, motivation, cognition and regulates emotional responses
Increases schizophrenia, mania
Decreases Parkinson's Disease
Antipsychotics block dopamine receptors and reduce dopamine activity
Derived from the amino acid tyrosine
Norepinephrine (NE)
MOA: Excitatory
Effects: changes in attention, learning, memory, sleep, wakefulness and mood regulation
Increases mania, anxiety, schizophrenia
Decreases depression
Antidepressants block NE reuptake or inhibit MAO from metabolizing it
Serotonin
MOA: Inhibitory
Effects: controls food intake, sleep, wakefulness, temp regulation, pain control, sexual behavior and emotions regulation
Decreases depression
Antidepressants block serotonin reuptake so there is additional volume available in the synapse
Derived from the amino acid tryptophan
γ-aminobutyric acid (GABA)
MOA: Inhibitory
Effects: moderates the other neurotransmitters through inhibitory action rather than promoting direct stimulation
Increases apathy (lack of anxiety)
Decreases anxiety disorders, schizophrenia, mania
Benzodiazepines increase GABA to help treat anxiety and induce sleep
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APPA!!! *rattles you by your shoulders so hard* You can't post a snippet of such an awesome wip and expect me to be sane!! I'm already in love with what I assume is deity x human sacrifice au and I can't wait to read it! Ahhhh *chomps furiously on plywood* I guess this is one of my fave AUs because I also have like 2 such stories in my head lol
Ahhh sorry for the ramble! Love your writing! I'm sending a big care package of the softest plushies, blankies, sweets and pastries, bathbombs, scented candles and a box of gemstones your way (a huge heart shaped rhodonite included) 💜💜💜💜💜💜💜💜
Wait it was a rhodonite right?
Dear anon, I'm so sorry for saving your lovely ask like a squirrel saves acorns for the winter. I so rarely get asks about my writing anymore (even back when I was somewhat active here) so I felt I needed to wring out every drop of dopamine I could from this one.
Yes, it's a deity x human sacrifice au. We'll see if anything ever becomes of it. I have a bunch written so I might just post that at some point since it seems to interest you. 😊
I'm using this ask to ramble about myself a bit. Writing has been hard lately. I'm still unemployed, but due to everything getting more and more expensive I'm actually actively trying to job hunt now and it's so tough. Rejection after rejection from jobs I don't even want that much (but need since I gotta feed my kid) hasn't been very kind on my mental health. This all coinciding with a noticeable drop in interaction with the stuff I've posted makes the evil trolls in my head rejoice. It's hard not to feel worthless. I'm doing my best to combat the dark feelings. I know where they can lead and I have no desire to fall into that deep depression again.
(To make matters worse, I've been winding down my depression meds for the past 6-ish months and I took my last one about a week ago. I was not prepared for the withdrawal being this hard.)
I want to get back into writing. It makes me happy, and there haven't been that many things making me happy lately. (Except my friends, you know who you are. I love you and you mean more to mean than you can understand. 💜)
P.S. yes, it was a rhodonite ❤️
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Creating a Relapse Prevention Plan For Xanax Addiction
Xanax addiction can be a dangerous and complicated situation to deal with. Many people end up addicted to this drug without realizing the serious side effects. The best way to overcome the condition is to learn about its causes, effects, and how to prevent relapse.
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Physical dependence
Xanax is a prescription drug that is used to treat anxiety and panic disorders. It is similar to other benzodiazepines, such as clonazepam and diazepam. It may also be prescribed to treat depression, premenstrual syndrome, and agoraphobia.
Xanax is a highly addictive drug, and abuse of it is dangerous. It causes a variety of negative effects, including withdrawal symptoms and psychosis. It also slows down the functioning of the spinal cord and brain. It has a short half-life, meaning it will take more of the drug to feel the same effects. It can cause life threatening withdrawal symptoms if abused in large amounts, or if taken with other drugs.
It is common for people who use Xanax to go to a lot of trouble to obtain the drug. They will try to find it in different places, or may crush a legitimate prescription. They may even visit several doctors to obtain more Xanax. They may also be tempted to mix it with alcohol, a polysubstance, which increases the risk of severe withdrawal symptoms and possibly death.
Taking Xanax can alter the reward center of your brain, and it can also alter your sleep cycle. The reward center releases dopamine, a neurotransmitter that makes you feel good. It also trains your brain to repeat the behavior that caused the release.
Relapse prevention and management
Xanax addiction is a complicated disease with many factors to consider. However, with a little bit of planning, recovery can be a reality. In this article, we'll talk about how to create a relapse prevention plan to help you stay on track. Whether you have already been struggling with Xanax addiction, or you're just starting down the road to recovery, you'll be surprised at the steps you can take to protect yourself.
In a nutshell, relapse prevention involves taking a look at your life and figuring out what is triggering your use of alcohol or drugs. This may include things like stress, fatigue, or social situations. It's also important to identify your coping skills and learn how to manage them in order to prevent relapse.
One of the most important steps is creating a relapse prevention plan. Using Cognitive Behavioral Therapy, a therapist can help you develop strategies for avoiding relapse. This is a step-by-step process that helps you recognize your triggers and develop a plan to deal with them.
There are several relapse prevention techniques, including mindfulness and meditation. These practices will improve your mental and physical health. They're also a great way to de-stress.
Another relapse prevention strategy is to get involved with a support group. These groups can be an invaluable source of social and educational support, as well as accountability.
Side effects
Xanax is an addictive drug that can cause side effects when used incorrectly. It is a benzodiazepine, which is commonly prescribed for anxiety and seizures. However, it can also be deadly when used in combination with other drugs. It is one of the most addictive drugs in the United States.
Xanax can cause long-term health problems, including memory loss and depression. It may also lead to delirium and psychotic episodes.
Xanax can cause an overdose, which can be fatal. It is also dangerous to mix Xanax with other substances, which can cause negative drug interactions. It is important to seek help if you suspect you have an addiction to Xanax.
Xanax can also cause neonatal abstinence syndrome in babies born to a mother who was addicted to Xanax. This can have long-term health implications for the baby, and can interfere with maternal-child bonding.
Xanax can be physically addictive when used over a long period of time. Xanax causes changes in the reward center of the brain. When this area is altered, people may have positive associations with the drug. These changes can also result in long-term issues with attention.
Xanax can also affect the brain's metabolism, which can lead to sedation. Alcohol can exacerbate these effects. Benzodiazepines have a high rate of abuse.
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revivalhydration0 · 28 days
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How NAD IV Therapy Can Support Addiction Recovery at Revival Hydration
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Addiction is a complex disease that can wreak havoc on a person's life, impacting their physical and mental health, relationships, and overall well-being. Overcoming addiction requires a comprehensive approach that addresses not just the cravings and withdrawal symptoms, but also the underlying physiological and psychological factors that contribute to the addiction. At Revival Hydration, we believe that NAD IV therapy can be a powerful tool to support individuals on their journey to recovery from addiction.
Understanding NAD and its Role in Addiction
NAD, or nicotinamide adenine dinucleotide, is a coenzyme found in all living cells. It plays a critical role in numerous cellular processes, including:
Energy Production: 
NAD acts as a key player in the production of ATP, the primary source of energy for cells.
Cellular Repair: 
NAD is involved in DNA repair mechanisms, which are essential for maintaining healthy cell function.
Neurotransmitter Function: 
NAD contributes to the production and regulation of neurotransmitters, which are chemical messengers in the brain that influence mood, behavior, and cognition.
Research suggests that NAD levels can be depleted in individuals struggling with addiction. This depletion can contribute to various problems, including:
Cellular Dysfunction:
 Reduced energy production and compromised cellular repair mechanisms can lead to impaired organ function and overall health issues.
Neurotransmitter Imbalances: 
Deficiencies in NAD can affect the production and function of neurotransmitters, potentially leading to symptoms like anxiety, depression, and cravings.
Oxidative Stress: 
Reduced NAD levels are associated with increased oxidative stress, which can damage cells and contribute to various health problems.
How NAD IV Therapy Can Support Addiction Recovery
NAD IV therapy involves administering a high dose of NAD directly into the bloodstream through an intravenous (IV) line. This method allows for rapid and efficient delivery of NAD to cells throughout the body. Revival Hydration offers NAD IV therapy as a potential support system for individuals in addiction recovery. Here's how it may contribute to the process:
Reduced Withdrawal Symptoms:
 Studies suggest that NAD IV therapy may help alleviate some of the unpleasant withdrawal symptoms that can occur during detox, such as fatigue, anxiety, and cravings. By supporting cellular energy production and neurotransmitter function, NAD IV therapy can potentially make detox more manageable.
Improved Brain Function: NAD IV therapy has the potential to improve cognitive function and mental clarity. This can be particularly beneficial for individuals in recovery who may experience difficulties with memory, focus, and decision-making.
Enhanced Mood & Well-being:
By supporting the production and regulation of neurotransmitters like dopamine and serotonin, NAD IV therapy may help improve mood, reduce symptoms of depression and anxiety, and promote a sense of well-being, all factors crucial for long-term recovery.
Cellular Repair & Renewal: 
NAD's role in DNA repair and cellular regeneration can potentially help restore cellular health and function that may have been compromised by addiction. This can contribute to a stronger and more resilient body.
Benefits of NAD IV Therapy at Revival Hydration
Revival Hydration provides a safe and comfortable environment for individuals seeking NAD IV therapy as part of their addiction recovery journey. We offer several benefits, including:
Experienced Medical Staff: 
Our team of qualified healthcare professionals understands the needs of individuals recovering from addiction and is dedicated to providing personalized and compassionate care.
Customized Treatment Plans:
 We develop treatment plans tailored to each individual's specific needs and circumstances. Each NAD IV therapy session is carefully monitored to ensure patient safety and optimal results.
Supportive Environment: 
We believe in creating a safe space for individuals to heal and work towards recovery. Our team is dedicated to providing the support and encouragement needed throughout the process.
Holistic Approach: 
NAD IV therapy is offered as a complementary therapy alongside other evidence-based treatment modalities, such as behavioral therapy, support groups, and medication-assisted treatment (MAT).
Is NAD IV Therapy Right for You?
NAD IV therapy is a promising tool for addiction recovery, but it is essential to understand that it is not a standalone treatment. It should be integrated into a comprehensive addiction treatment plan designed by a qualified healthcare professional.
Here are some things to consider if you're interested in NAD IV therapy for addiction recovery:
Severity of Addiction:
 NAD IV therapy may be more beneficial for individuals struggling with moderate to severe forms of addiction.
Underlying Medical Conditions:
 It's crucial to disclose any pre-existing medical conditions to your doctor, as NAD IV therapy may not be suitable for everyone.
Individual Needs and Goals: 
Discuss your specific goals and expectations for recovery with your doctor to determine if NAD IV therapy aligns with your overall treatment plan.
Revival Hydration: Your Partner in Recovery
At Revival Hydration, we are committed to providing innovative and effective solutions to support individuals on their journey to recovery from addiction.
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kernmorrow49 · 4 months
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The Off-prescription Use Of Modafinil: A Web-based Survey Of Perceived Dangers And Advantages - PubMed
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I'm additionally prescribed Adzenys (amphetamine) which is nice for the cognitive and emotional dysregulation points of ADHD, but Modafinil handles other signs: overwhelmed temper that leads to low power, anxiety around process initiation, and naturally extreme daytime sleepiness. It also helps improve my mood. It’s a good medicine for some people, but it surely wasn’t for me. The working system of this treatment is that it raises the substance referred to as dopamine in the cerebrum and stimulates the mind. Sure I take it off label (particularly armodafinil) however it certainly works. These medicines stay up to 12 hours so it is essential to take the medication within the morning hours or 1 hour before you begin your work. Narcolepsy and sleep disorders will be treated by consuming this drug. buy provigil online overnight said cocaine will increase dopamine and now I used to be suffering from not sufficient of it. “I'm a 28 yo male, with former drug addiction (mainly GHB), ADHD and anxiety/depression related symptoms and treated with Zoloft 100 mg., baclofen 70 mg., modafinil four hundred mg.
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Thanksgiving, Christmas, New Year's Eve: The Bermuda Triangle for Addicts
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The hardest holiday for a love addict is Valentine’s Day: It’s like New Year’s Eve mashed up with St. Patrick’s Day would be to an alcoholic. But Christmas is pretty tough, too. There are so many expectations around the holidays, so much idealized nostalgesia, so many perfectly lit commercials of perfectly beautiful couples exchanging perfectly chosen gifts in front of perfectly flickering fireplaces. Single people get extra lonely. They pine.
Speaking of pine… fuck fireplaces. I live in LA. It was 75 degrees today, and we don’t need any more carbon particulates in our air.
Back to loneliness. People get extra lonely at this time of year because they have their noses rubbed daily in these fantasy images - images created by a copywriter, staged by a set decorator, and brought to life by a couple of shallow narcissists who spend their days mostly worried that they’ll never work again. (Like I said, I live in LA.) Or, in the case of the image above, by an AI art generator.
We are, as they say in the rooms of recovery, comparing our insides to other people’s outsides. And they’re not even real people. 
I get that it makes the singletons feel left out, though, and sometimes they come to me for relationship advice, because after all, I write about relationships. “They” being mostly women, and mostly women over 40. (Again, I live in LA. Over 40 = invisible.) However I am probably the worst person to come to, because I don’t buy the basic premise that you need to be in a relationship to be happy. That a relationship will somehow fix you. A relationship will not fix you, because you aren’t broken. It’s the premise that’s broken.
Don’t think I’m against love and romance. I love love and romance. Often to excess. But I have no illusions that is it magic elixir, and a lot of greedy people are selling magic elixirs to a lot of lonely people. In my experience, romantic love is closer to elixir of heroin (a popular cough syrup in the 19th Century, by the way): the initial high is great, the withdrawal at the end is bloody awful, and a long stretch in the middle is a maintenance phase that falls somewhere between pleasantly numb and barely tolerable. If your experience has been more positive than that, I salute you. I also think you are the exception and not the rule. You’ve seen the divorce statistics same as I have. All the social science data shows that for everything from blood pressure to depression, marriage is good for men and bad for women. And still women seem to be the ones most hotly pursuing it.
Romance is a multi-billion-dollar industry: $4.95 billion was spent in 2022 on dating apps, plus about another $3 billion in books, seminars, meet-ups, matchmakers, life coaches…. Did you know I could make $5/minute giving advice to the lovelorn online? I’d just as soon be a telephone psychic. Both have about as much validity.
What I can give you is advice on things to do that give you some of the same happy hormones you expect from a relationship. There are plenty of other places to find them, and none has a sign with the words “adult” or “shoppe” out front. 
The addict brain craves dopamine, serotonin and oxytocin. Either we don’t manufacture enough on our own, or we’re just greedy. I pick the former, although I’ve been accused of the latter. “Well, you just want to do everything fun, don’t you?” glowered a Midwestern woman watching me attempt the trapeze at age 52. The answer is yes, yes I do. But fun doesn’t always mean self-destructive… and I barely even injured myself on the trapeze.
You want dopamine? Learn something new. Novelty is a great activator of dopamine. To really bump it up, try something new that is challenging and maybe has a touch of danger attached. Scuba diving saved my ass; you can’t drink, drug, or check your phone while you’re underwater, and it’s beautiful down there. 
Diving also gives me a ton of serotonin, what with the weightlessness and the natural beauty and all. But you could also immerse yourself in an IMAX nature film, or get a massage, or listen to beautiful music. There’s some pretty good chorales showing off at this time of year. Great art, majestic landscapes… anything that produces awe produces serotonin.
For oxytocin I always go to dogs. Love ‘em. You want to put Instagram to good use?Try funny pet videos; it’ll make your day. My sister is all about the children - she’s honorary Bubbie to half the kids in the neighborhood. One of the most reliable ways to produce oxytocin is to be of service to others, and this time of year makes it particularly easy to do that. I don’t know about you, but I always find it easier to be of service when someone just tells what to do. “Here’s a list of Christmas wishes from needy families. Which one do you want to buy?” “We’re serving turkey dinners at the Mission downtown. Meet you at 6:30.” 
I could add that volunteering is a great way to meet new people (like potential romantic partners, hint hint) but like I said, I’m the relationship lady who is not selling the secret to finding a relationship. We both know I would be earning a lot more money if I was.
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In med school and also preparing for my exam. I have to learn a whole course about antidepressants so here it goes I guess !
Hi! I'm sure that the majority of this will be pretty basic review but let's talk about it!
The first generation of antidepressants were monoamine oxidase inhibitors (MAOIs). They were originally invented to treat tuberculosis but in 1953 Iproniazid was developed and patients taking it showed improvements in their depression symptoms. As their name suggests, they function by inhibiting the breakdown of monoamine neurotransmitters (serotonin, dopamine, norepinephrine, ect) by the enzyme monoamine oxidase, and this leaves more neurotransmitters available for synapse. The problem with this method is that there are monoamines in our food. Patients taking MAOIs have to be careful eating foods that contain lots of tyramine because it can't be broken down. High levels of tyramine can cause sudden increases in blood pressure and even cerebral hemorrhage! Understandably, MAOIs aren't prescribed very often anymore.
The next generation of antidepressants, known as tricyclic antidepressants, was developed in the late 50s. These work by inhibiting both serotonin and norepinephrine reuptake. They are also antagonists for postsynaptic adrenergic α1 and α2 receptors, muscarinic receptors, and histamine H1 receptors. Reuptake inhibition is the mechanism found in a lot of our current antidepressants, but they're a little bit more focused.
In the late 80s, Fluoxetine was finally approved by the FDA and SSRIs continue to dominate the antidepressant landscape. SSRI stands for Selective Serotonin Reuptake Inhibitors, and they do what their name suggests, inhibiting the serotonin transporter (SERT) at the presynaptic axon terminal. This leaves more serotonin (5-HT) available for synapse. Additionally, SSRIs target the 5-HT1A autoreceptors. This seems counter productive at first, because the autoreceptor activation slows 5-HT production and release. But over time, this builds autoreceptor tolerance. Generally, autoreceptors can shut off signaling when there's too much and is a main contributor to building drug tolerance. But since the autoreceptor is now being activated, that shut off function loses efficacy and the extra 5-HT in the synapse from SERT inhibition doesn't cause tolerance to be built up (as much). This is why it takes SSRIs weeks to kick in because the two processes do cancel each other out until the autoreceptors have gotten tolerant. There is variety within SSRIs. Fluoxetine (Prozac) has a half life much longer than Sertraline (Zoloft) and takes longer to get peak plasma concentration.
Serotonin-Noradrenaline reuptake inhibitors work very similarly, they just also inhibit norepinephrine reuptake. (Say what you will about anti-depressants, at least they're named straightforwardly lol). Some patients respond better to SSRIs, some respond better to SNRIs. Unfortunately, a lot of patients don't respond well to either and they can come with difficult side effects.
Moving on from depression, let's talk a little about anxiety and anxiolytics. One of the key brain changes in general anxiety is reduced PFC inhibitory control, associated with reduced GABA(A) receptors. This is coupled with amygdala overactivity. Benzodiazepines help regulate anxiety by increasing GABA control. They do so without nearly as many side effects as the previous barbiturates, and took off in the 1960s. But because they act on GABA, mixing benzodiazepines with alchohol (also acts on GABA) creates lots of abuse potential (think of the Valium + martini housewife). The positive side to this is that benzodiazepines can be used to help someone with alcohol withdrawal, which is otherwise very dangerous. Second generation anxiolytics are partial agonists for 5-HT1A receptors. Moving away from GABA reduces the abuse potential, but also makea the drugs less effective. Generally, SSRIs are prescribed for anxiety before other classes of drugs.
Hope that was a good basic review!
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