Oh cool! So I started a tricyclic antidepressant for Pain And GI Stuff and it’s supposed to be sedating but now I am in a brainstate that resembles Mild Hypomania. Also speculating about my brain’s weird responses to medications. I... am self-diagnosing with acetylcholine fuckery. Would be cautious about this self-diagnosis if I planned to make any med or other changes based on it; as is, I’ll just get excited about it for a week and then get used to the tricyclic and lose interest. Fuck yeah brains.
Under cut, hypomania-adjacent-state disclaimer and acetylcholine fuckery.
(Epistemic status: I’m hypomania-adjacent and ridiculously overconfident and just. Don’t update on this. I am not updating on this.)
Disclaimer: I am sleeping okay so, you know, if I stop sleeping I’ll worry. The impairing examples of this category (which isn’t dxed as bipolar and I don’t think that’d be a valid dx, the last psych I saw diagnosed me with “yeah you should watch out for more bipolar symptoms” and I think that’s accurate) have been like -- sleeping zero hours every other night and sleeping six hours the others and feeling fine, speech so pressured it’s not interpretable.
This isn’t happening. Slightly increased insomnia, slightly increased irritability, my baseline impulsivity is variable but high so I’m not sure how to evaluate that. I feel substantially more creative and able to think about things.
(”Actually tell your GI doctor you are having Side Effects” endpoints: significant reductions in sleep, impulsivity affects functioning in a way that’s different from typical impulsivity, irritability has interpersonal consequences, I eat less.)
Also I suspect there’s something going on with how my body [handles? receives? metabolizes?] acetylcholine. Cluster of impulsivity/inattention/memory deficits, family hx of weird dementias, dysregulation of broad range of autonomic functions that are all theoretically related to acetylcholine.
(I mean. Impulsivity/inattention/memory deficits is kind of a standard ADHD thing. But also acetylcholine fuckery is plausibly a standard ADHD thing.)
Most damning: always had really really bad cognitive reactions to specific medications. Said reactions included sudden confusion, disorientation, sedation, lethargy, paranoia, psychosis, absence of consistent sleep-wake cycle. The response was not at all in proportion to the med given, other people don’t generally get strong effects on those doses. These meds range from amitriptyline to olanzapine to fucking Benadryl. I didn’t think there was any common thread! These all are, however, medications that have anticholinergic effects. (And... it does seem to be a medication-specific thing. I recall being fine with haloperidol, which is AFAIK regarded as strongly sedating? But olanzapine, also a neuroleptic, renders me nonfunctional. Even just within the second-gen antipsychotics, the same thing: risperidone fine, olanzapine Not Fine.)
TBH the effects resemble the delirium geriatric inpatients get when you put them on, you know. Anticholinergics. (That’s an oversimplification. Delirium is only sometimes preceded by anticholinergic administration. It is, however, very plausibly related to central cholinergic deficiency.)
People use Benadryl as a sleep aid! I take one pill and am agitated and irritable and disoriented and paranoid and dull for like six hours! I take several Benadryl and I can’t function!
Hypomania-adjacent brainstate wants me to acquire an anticholinergic and test it out, do some diphenhydramine megadosing. I’m not doing that. Might look into, I don’t know, atomoxetine or something, I need ADHD treatment options anyway and if I suspect there’s an acetylcholine problem it isn’t obviously worse than stimulants. (And doesn’t have the downside of “you need good executive functioning to get the executive functioning meds” -- though of course working fifty-plus hours a week in a hospital with a pharmacy makes filling prescriptions a bit easier...)
Ooh, or donepezil!
Anyway I should get my genome sequenced and look for polymorphisms in related genes. Acetylcholine receptors, cholinesterases, whatever cytochromes metabolize those anticholinergics. This would not give me any actionable information but would be cool.
(Obviously “oh I should do my own genetic analysis” is the right conclusion. I’ve done some bacterial genomics, humans can’t be that different, right?)
Also I should probably be supplementing with choline whether or not I’ve got acetylcholine fuckery since I’m not eating much that has choline in it. Just soybeans and peanut butter.
Yay. Yay poorly-informed speculation. I promise not to do anything that becomes a bad idea if I am wrong about everything.
So -- generally I am proud of my independent living skills, I am progressing very well in a lot of life contexts, but
(cw: local absolute doofus induces mild allergic reaction and mild medication reaction)
tonight I was deciding what to make for dinner and went okay, you know what, I’m allergic to tomato but I have one can of tomato in the cupboard, I have onion and tofu and black salt and spices and also polenta, I really shouldn’t be eating things I’m allergic to but I can do it this one last time, not throwing this perfectly good can of tomato away, I can still have shakshuka if I take antihistamines, I’m not like anaphylaxis allergic
and so I made shakshuka and took diphenhydramine and had a wonderful dinner and now the world is vaguely blurry and I can feel my pulse in my abdomen and my mouth is itching horribly
The blame-the-racists (the fools, the yokels…) narrative generates a clear demarcation between good (us) and evil (them), but it does violence to the truth. It also obscures an important root of racism – anger displaced away from an oppressive system and its elites and onto other victims of that system. Finally, it employs the same dehumanization of the other that is the essence of racism and the precondition for war. Such is the cost of preserving a dying story. That is one reason why paroxysms of violence so often accompany a culture-defining story’s demise.
Charles Eisenstein. The Election: Of Hate, Grief, and a New Story
