so I looked into this because your comment sparked some curiosity and from what I can tell it’s less about the chemical itself and more about how your brain regulates and uses it. There’s also limited evidence as to whether GABA as a dietary supplement is even crossing the blood-brain barrier (where it would cause these effects). The other thing you need to keep in mind with most “natural” supplements is that the FDA regulates them under the F, not the D! Things like melatonin (which I even take personally) are regulated as FOOD, not DRUGS. Drugs have to

• be exactly the chemical they say they are
• in exactly the amounts they say they are per. pill.
• and as over the counter medications have to have approved safe dosages and frequencies on the packaging
• and all pills prescription or not have to have a unique alphanumeric imprint on each pill that can be used to identify it if it is separated from its packaging. Even different doses need unique imprints.

Food needs to:

• mostly probably be the thing it says it is. If it’s a plant it might be a different strain between different manufacturers.
• that plant also might have a variety of other chemical structures in it that aren’t advertised on the bottle.
• say almost whatever the manufacturer slaps on it in terms of dosage or frequency.
• have no imprint whatsoever to identify it if it’s not in the original packaging.

Like I said I use several supplements myself that even have good evidence behind them in terms of safety and efficacy. But you need to be aware of the ways in which they’re regulated differently than drugs and know that you’re gonna have to do a little more research for yourself to really find what’s going to be safe and effective for you. Finding a physician who’s educated in holistic and integrative therapies can be super helpful for something like this.

no good answer due to normal variations in physiology and variations in the specific person’s quality and severity of addiction but in terms of timescale I would say a day-ish? Would be better to ask an ICU RN or MD. At my level and specialty of care (acute psychiatry) and assuming the pt has been screened appropriately by the ED to not already be in high acuity withdrawal (needs medical or ICU) we’re generally not talking minutes to a couple hours but we’re also not talking a week. The scale we use to measure is called the Clinical Institute Withdrawal Assessment.

Depending on the half-life of the medication used for the taper I’m reassessing that score either every 4 hours (ativan) or every 8 (phenobarb). My unit usually does phenobarb because it requires less frequent and precise assessment due to the elongated half-life. And I can always reassess ahead of schedule and give 1 extra dose as a standing PRN order without even needing to call the on-call MD if they’re having breakthrough symptoms.

Also keep in mind that it’s not just mortality we’re worried about. I can’t make withdrawal fun but I definitely don’t want it to suck any more than it has to. There’s also a lot of permanent but nonfatal damage that can happen in the meantime. And it’s actually also an issue of my safety and that of my coworkers. My subspecialty is actually specifically the management of violence and drug withdrawal is an item on MOST violence risk assessment scales. Actually the only one I don’t see it on irrc is the BROSET and that’s just because it’s a rapid 6-12h tool and the CIWA is already addressing that under the agitation and paranoia items at that time interval.

The paranoid delusions and audiovisual AND tactile hallucinations are no joke. One of the COMMON reasons I get called to medical units for backup is CIWA patients because we can’t take them until they’re on the tail end of a high dose taper but the medicine nurses aren’t always equipped to address the psychiatric symptoms and there’s more equipment available to throw / swing at them.

tbh I’m not on the research end I’m on the butt end with the people experiencing it directly (which is where I wanna be the most I wanna do is maybe teach someday) so I have empirical backup but most of my knowledge is experiential. I guess the best way I can describe it is that certain stuff just starts giving you anxiety. Nurse knowledge is like 2-3 years of following strict rules you learned in school then when you hit your stride something crystallizes in your brain and you can just look at certain patients through that lens and your nervous system just says “absofuckinglutely not, no.” So I can’t cite stats I can just tell you where the needle is on how anxious it makes me. Which is it’s own type of knowledge.

it’s wild to me that they’re considered progressive when like. my aunt is literally an old white bitch that romanticizes the kennedys as “american royalty.” Like don’t get me wrong they’re way better but like in the sense that they don’t want to just like. Shoot me. They still want me to know my place as a peasant. They’re not gonna do anything that’s going to risk them actively losing any power in the normal electional way. They’re just crossing their fingers that the other guys won’t just like. Start shooting. We’re reaching the point where it’s the dems that are regressive in that they want everything to stay the same and it’s the alt right that’s pushing for change. It’s terrifying genocidal change but it’s attractive to a certain segment of the population on the sole merit that at least it’s technically change.

fun fact; drugs that act on your GABA nervous system (benzodiazepines such as xanax, also barbiturates and alcohol) are the only drugs that will kill you outright on withdrawal.

Stimulant withdrawal (amphetamines, cocaine, caffeine, nicotine) causes headache, confusion, fatigue, and occasionally suicidal ideation. Opiate withdrawal (oxycodone, heroin, fentanyl), causes anxiety and flu-like symptoms that can be fatal if severe enough (dehydration, GI complications) but, only in the same way that a flu can, and do not kill you outright. (THC / marijuana withdrawal is the chillest, usually only causing mild irritability and appetite loss, which the others do to a much greater extent).

Benzo (and other GABA active withdrawals) causes a rebound of your nervous system’s stress and fight or flight system that cascades from:

1. extreme anxiety and most of the same flu-like symptoms as opiates then into
2. vivid hallucinations (often of being covered in insects including tactile sensation) and paranoid delusions, then finally into
3. back-to-back seizures that eventually result in nervous system failure, hypoxia, and death.

The old-school word for this is “the delirium tremens” or “DTs.”

If you are using these substances at a high enough and especially an unsustainable dose (which can cause respiratory depression / hypoxia and weakness of gait / traumatic head injury, similarly to an opiate overdose) you will need to be withdrawn in a either a specialized rehab with medical capabilities or if the addiction is severe enough a hospital or even specifically an intensive care unit. It’s possible that if you’re a binge drinker (drink large quantities but don’t drink at all some days) you may not need special withdrawal precautions. That said, addicts often minimize the extent of their addiction early in the recovery process so a lot of facilities that are unequipped to manage this type of withdrawal will refuse those patients outright until they’ve been medically evaluated. I’ve actually had a few patients were the ED was like “oh yeah he’s a lil jittery but not actively withdrawing” and a few hours into being on the unit they can barely bring a cup of water to their mouth without spilling it.

Obviously the history of legislative bans on alcohol is a great example of why criminalizing substance use is pretty much always a losing battle but it’s also WILD that alcohol is legal when specifically compared to marijuana being illegal.

This has been a PSA.

One of my points of pride is actually using my teeth. A light scrape or nibble dramatically increases tactile sensitivity and emotional intensity. If you know how to simultaneously integrate the tongue and lips properly you can really leverage that “crazy girl sex” that drives dudes fucking nuts. I may have had years of therapy but there’s a few holdovers just because crazy girls do it better. The other big thing is gregariousness because once you learn to use it with real day-to-day support and respect for people it just magnifies it.

One of my coworkers said she loves working with me because she’s not scared of running into problems because I have the solution to 90% of what she runs into. I was like bitch. what. but then I remembered she doesn’t fight me on having to take charge nurse all the time and like. A few weeks ago she got in trouble for something one of the junior nurses didn’t handle quite right (tbh none of us would though that pt should not have been on our unit) and getting in trouble for shit other people do is exactly why I fight like hell not to be charge nurse ever so like. Just for you. None of you other people. If you’ve ever asked “well why can’t Apy be charge she has the most experience!??!???!” Exactly. Y’all stupid and idw be on the hook for your shit. I’d rather just solve the problem on the sidelines and you can take all the credit for whether it works or not (and like 90% of the time it will so 🫅)

Also if I have to deal with that demented old bint of a house supervisor imma throw hands (although months ago I said to myself that if she writes me up for a third bullshit that’s found completely unsubstantiated I’m filling a complaint of targeted harassment and I think someone actually alerted her to that subtext because I think she got in trouble for the two complaints she wrote about me. One because when they pulled the tapes for me being insubordinate she was standing over me in the nurses station shouting at me for questioning a safety issue and one for snooping in my patients charts trying to find dirt on me). And that second one she came to the unit to try to rub it in my face and I had that charge nurse I mentioned with me and just giggled in her face the whole time and she kept saying “I don’t know what your problem is with me” and I just really wish I could’ve been there when someone pointed out that girl you are the one picking these fights!

If you’re able to access primary care they may be able to bill your insurance for an EKG yearly. Wouldn’t catch everything but might notice if you pick up some a-fib or another lowkey issue that might snowball (although the main issue with afib is usually clots and afib clots usually hit the brain not the heart iirc).

Honestly I’ve spent a good part of my career working with men specifically in acute mental health environments and 90% of the time when a man expresses a lack of sexual attraction I’m relieved. The other 10% is indifference, but the amount of times they yell at me about how ugly I am and I’m like “…good…!?”

Like tbh there’s a not insignificant chance I’m just a gay dude but like. I’m not in a rush to decide. And in the meantime if not looking how they think an AFAB should keeps more men able to interact with me nonsexually that’s basically 100% beneficial. And honestly women aren’t great either (they’re not usually as pushy either but on the rare occasions they are they’re way worse). Tbh that’s probably why I’m a gay dude; bitches (in a romantic context) be crazy I just wanna drink a beer with my male bestie (now 💍) and talk about whether yeast or dogs have been symbiotic with humans longer.

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Seconded. Or piefed needs to add microblogging.

I mean, yeah.

Excellent question. There are some foundational skills the dog needs to be able to participate safely and effectively in the process. This process was also accelerated by the cat being a ho for human attention, making it easier to transfer some of that affection / prosocial behavior.

Cat train the puppy for safety

1. leave cat claws untrimmed for a month before getting the puppy and at least 6 months in
2. Dog was crate trained so unsupervised interaction was a non issue
3. Distract puppy every time her gaze locks onto the cat for more than a few seconds (message: cat = not interesting)
4. When dog learns belly, teach her to do it whenever the cat is <3ft or so away

Habituation

1. Use treats to slowly lure them closer to each other (note: dog must have a solid grasp of “leave it” / be able to understand when a treat is not hers
2. Alternate petting them including alternating which hands are petting them respectively during the same interaction. Specifically try to rub their respective scents on each other near their faces / snouts. The cats scent is best obtained from the cheekbones, while the dog’s scent is usually easy to obtain anywhere on them. I did find the dog liked to lick my hands, so I would rub her saliva on the cats cheeks (it helps to know and leverage exactly what your cat considers a “high value petting.”)
3. Group cuddles: what you see here. Everybody keeps getting treats as long as you’re willing to sit in the cuddle pile. Never ignore or discourage spontaneous attention seeking behavior from either animal in this context.

One of the interesting things I’ve found while reading through is that while there’s a lot of minor sins mentioned once each in the old testament (like mixed fiber clothing) the one commandment that is mentioned more than any other, like almost word for word with every repeat is keeping the Sabbath. And many of those repeat mentions also specify that it applies to your workers / servants as well. Even if they’re not also Jewish, it’s a sin for you as the Jewish person to not give them their rest day. Idk I just found that super interesting especially in this modern context of modern US Christianity flavored capitalism.

Unless it’s a private practice, it’s probably not the psychiatrist that wants to use that tool, it’s probably an initiative on the part of the larger organization. There’s good odds that the practitioner themselves is even against it themselves. That said, this sounds like one of the lower risk use-cases; what you’re describing is more of a souped up dictation software more than it is truly generative AI.

TLDR; don’t let this stress you. Do what feels right for your own care. And, ultimately, keep your own records and notes about your own symptoms day to day vs what treatments you’re trying at any given time. Also do your best to educate yourself on what the meds are supposed to be doing, especially what symptoms (not disorders) they’re supposed to be treating. Taking the initiative to track your own care in detail is what’s really going to get you the best results anyway.

I’ve seen it before. Never seen it work out, but I have seen it.

It’s also almost universally something that the people involved cannot take outside advice on. It seems to be one of those things that must be experienced personally.

Yeah the industry has just kinda accepted that surgeons are just like that lol. A lot of hospitals are settling for just getting them to stop shanking the circulating nurses with spare scalpels. Honestly I used to work with criminally insane men so I could probably grapple a surgeon. My issue with OR was that it’s too cold and I couldn’t scratch my nose when it itches. Also ortho surgeries in particular are a sensory nightmare it was like a soundbyte of a dwarven mine from a fantasy movie on loop for eight hours just –ding ding ding CLANG ding ding ding CLANG ding ding– I could not.

I forgot to buy a tiny dollhouse stool this year anyway (to put in a specimen cup and send down to the lab). No one has time for the old traditions in this economy…

It refers to a preference for “natural” things. The kind of people who make their own peanut butter and grow their own veggies etc.

Like most things it’s a personality trait that’s cute and sweet when they’re putting in the extra effort as a gift to another human–“I recently aged my own cheese and it came out really good; here’s a sample to try!”

vs the nuisance of people those who use it as a measure of puritanical superiority–“you can’t even keep a sourdough starter alive? It’s not even hard! It’s like you don’t even care about the chemicals in store bread!”

Honestly I’m even over “people don’t realize that having the time to keep a sourdough starter is a privilege because–” you don’t even need to think that much about it. Literally anything can be harder or easier or a privilege due to the infinite complexity of the universe. Just stop assigning moral value to random behaviors by default. Eats the soul on both ends when you could be plotting the downfall of wealthy pedophiles.

It’s not uncomfy. I find most pressure on that area is largely interpreted by my senses through a strong contextual filter and I perceive the context as neutral-beneficial so it doesn’t really bother me.