I found medications ineffective, but my last therapist helped me tremendously. If your therapist isn't helping, find a new one. There's no shame in switching.

The most important thing in therapy is relational depth. Doesn't really matter what the method is.

"There is research to support common factors theory. One common factor is the client–therapist interaction, also known as the therapeutic alliance. A 1992 paper by Lambert showed that nearly 40 percent of the improvement in psychotherapy is from these client–therapist variables."

Quote from https://en.m.wikipedia.org/wiki/Dodo_bird_verdict

I am on my second therapist. The first was was a remote therapy based out of Israel. He was great and convinced me to quit my terrible job at the time and reorient my life. His therapy worked to an extent but I never could relay my deep insecurities to him. When I tried to explain deeper concepts to him it nver really registered. I just found myself wasting 120$ per session with no real payback. I continued with him on and off for 5 years before just giving up this year after my father passed away and I gained no comfort from talking to him about it.

A second remote but local(because of covid) therapist was assigned to me as part of this Wellbutrin trial. A total of 10 sessions are to be done with this trial. So far she has only told me what I already know: that I should keep trying little steps every day like increasing my exercise. She gives me little goals but I don't like the fact that since these sessions are 45 mins with no way to extend, there always seems to be a time crunch.

There are tons of therapists in my area with no way to evaluate the differences. This is an expensive proposition as it stands and so I don't know how I will find the perfect one without evaluating each and every different therapist in my area. :/

> If your therapist isn't helping, find a new one.

This has been my experience as well, both personally and through friends.

An important point is that a therapist which works for someone might not work for you, it's rather personal.

Buproprion is quite good at removing false reward loops. Made me really tone down video games. It's used also for smoking cessation. It's quite subtle. The other SSRI/SNRI meds have strong side-effects.

I will say that the effect is permanent. It's rewiring your brain when you use it.

If it's helping you to spend some time on harder but more important self-improvement, then great.

If not, you should consider switching drugs.

I currently take ADHD medicine, which is helping in many ways, but a mixed bag in others.

All the drugs are going to grease the wheels in some way, but you'll have to experiment to find the one for you.

>Buproprion is quite good at removing false reward loops. Made me really tone down video games. It's used also for smoking cessation. It's quite subtle. The other SSRI/SNRI meds have strong side-effects.

That would be a miracle if it did that. My doctor put me on this precisely because it is less strong than other drugs like Adderal. He does not want me going down an addicting road unless necessary. (my summary of what he told me)

So far I have been taking it for about a month although I have missed days here and there and while I try to take it at the same time, sometimes the window varies by +/- 1-3 hrs. I am on the 150mg XR version. What is typical time frame we are talking about before we notice changes? 1 month? 6 months? How long did it take you?

The fact that I am on HN/Reddit/youtube for a couple hrs each day instead of exercising/coding/tidying up/working on my life seem to indicate that no reward loops have been broken thus far. In fact I am slowly sinking in the other direction(but i'm not sure if buproprion is causing it). I have broken another all time record for weight gain despite increasing my exercise regime somewhat.

Was considering stopping treatment after a month if no changes are noticed and wait some time to clear it out of my system before trying something like ayahuasca or psilocybin.

I took Wellbutrin for several months. As mentioned, the effects were subtle for me. The pill isn't going to do the work for you, just grease the wheels a bit. You should probably give it 3 months before quitting.

I'm currently on Adderall. If you have ADHD, it has more benefits than drawbacks in my opinion, and the effects are not as subtle. It does give you focus for tedious tasks, though it's up to you to assure that those tedious tasks are actually important and not a rabbit hole.

Neither drug is going to make you stop browsing Reddit or HN. If you want to reduce browsing Reddit, turn off all the default subs and then subscribe to specialized subs catered to real, specific interests of yours. You will not miss the default subs. HN is only good for about 1 page usually, then it's scraping the bottom of the barrel.

If you want to do more exercise/coding/tidying up/etc. set a 5 minute timer, do at least that much work on that, then reward yourself with some HN. You'll find that starting the activity is the hardest part.

Re: weight loss, you can't outrun your own fork. All the fad diets have a kernel of truth to them, a lesson to apply or discard in your own life. Intermittent fasting is quite effective IME. Besides calorie reduction, it also resets your hunger signals. For me, it got me over this irrational fear of being hungry that I had, and also revealed just how much I was eating out of boredom rather than hunger. Also, you have to pick a problem and focus on it. Mitigate the weight situation, but don't force yourself to fight a 2 or 3 front war.

If you have ADHD, you should be on an ADHD med, unless you literally can't trust yourself to take only one pill a day.

If you have treatment-resistant depression, you can also look into ketamine, either intravenous or now intra-nasal. Pay the price to have it administered professionally, as it's not a good idea to develop a black-market hookup for something so addictive.

which ADHD medicine is good these days? do they raise blood pressure or act as a stimulant? (I guess I'm asking if there's anything better than adderall and ritalin these days)

Yes, there are much better options like Vyvanse or extended release Adderall or Concerta.

Note that these are still stimulants tho. Vyvanse is unique in that its a slightly modified dextroamphetamine (adderall) molecule that gradually gets metabolized by the liver into dextroamphetamine, sort of a "natural" extended release and has a much smoother (side) effect curve. Concerts and XR are just cleverly designed pills that release two doses of plain methylphenidate/amphetamine spaced out, so there's two distinct peaks with a small lull between.

Yes, that's correct. The slow release makes a big difference for a lot of people compared to traditional Adderall/Ritalin

Escitalopram is what I found worked for me. None of the SNRIs did (Effexor and so on), and bupropion isn’t even prescribed where I am for depression for what it’s worth, but I’ve heard some people have decent luck with it, typically as an adjunct with an actual SSRI though.

It took me months to find the right one for me though. Worth talking to your doctor about it if it’s not helping much!

I tried Lexapro 6 years ago when I first attempted to work on this issue. I was prescribed some minimum dosage(I forget what). I will never forget the first day. I didn't feel happy or sad or even anxious. It was as if every emotion was stripped out of my head and instead it was replaced with perfect neutrality. Nothing mattered int he world anymore. I had no thoughts or opinions, just complete neutrality of thoughts and emotions. This also became my most productive week in years. The thought process was literally "Ok I have this task to do, let me do this task, I am done with this task, ok lets do the next task. Repeat until there are no more tasks." No breaks, no distractions were noticed while the task is being performed.

Unfortunately, the side effects were so bad I gave up after a week. Horrible nausea all the time. Such extreme fatigue that i'd sleep 16 hours and still feel exhausted. Not to mention other side effects that are not appropriate to discuss here.

I am considering trying this nightmare of a drug again because I still remember that productivity but man that first experience literally felt like poison was seeping into all areas of my body.

Yeah that absolutely apathy is what kept me alive when I was so close to the edge.

But the side effects (and primary effects!) are also why I only ever stay on it for 3 to 4 months. The sexual side effects alone are enough to impede my recovery, let alone some of the other ones.

So I use it like a bandage to get through the worst parts, rather than a “take every day for years” drug. The “take every day” bit for me is CBT exercises to rewrite my mind, and it’s worked :)

The physical sides for Lexapro at least for me disappeared. I also got the nausea initially. It’s rough, I know.

There are other more modern SSRIs that might be worth trying too, but if escitalopram seemed to work then it might be worth trying to stick it out to see if the sides get better. They usually do

Can you expand on what these CBT exercises are?

I gave up after the Lexapro until this year where I am trying to tackle this issue again with the Welbutrin. I keep reading that maybe ayahuasca or psilocybin might be the miracle key that solves the underlying issues.