So here’s what I think happened on the biochemical front.
I was born with audhd and a spikey dopamine system with low baseline. This means I am naturally restless and motivated. School cranks this up through random violence, and I crank it up further through moving overseas, building companies, drinking, drugs, athletics, art, the eternal pursuit.
I find a suicide corpse in a local park which sends me into shock, and 6 months later I get hit with PTSD which causes further dysregulation and suicidal images.
An internet doctor sees me and labels me manic, then prescribes valporate, which increases GABA and squashes down the drive to suicide, but also squashes everything else as well. This makes me depressed.
The new doctor adds guanfacine which lowers perceived adrenaline (NE) and provides relief for a while, but the valproate is still dragging me down and I need to use cannabinoids to lift myself up. It’s the booze + weed combo I used to self medicate half my life.
I need to replace the weed because the legal options are no longer weed. I get prescribed aripiprazole. This binds directly to my dopamine receptors putting me at a higher baseline than I’ve ever experienced and getting rid of the jagged nature of my motivation. It is enlightenment in a pill and I am addicted in an instant. I have never known such an abiding sense of wellbeing.
It also causes nighttime hallucinations and crazy writings. I somehow hold it together, despite partial ego dissolution, and I see that the valproate was harming me so reduce it. I feel good.
But then I build a tolerance to aripiprazole and increase the dose. The activation curve for aripiprazole means that the increased dose results in less dopamine; the initial enlightenment-high can never be replicated which is why it’s such a great suicide-inducer. My doctor should have done his research and not titrated it slowly. The higher dose triggers further hallucination and a constant rollercoaster of withdrawal and coming-up.
Reducing the valproate is why I was able to come back to reality at all; if I had still been taking the full dose then the depression would have made suicide preferable. But removing the THC was probably a bad idea and increased the dopaminergic impact of aripiprazole.
Somehow I escape aripiprazole, and guanfacine, but keep a little valproate as a buffer. I need everything tamping down for a while.
Then the new doctor also has no idea about me because I defy all diagnostic boxes, so defaults to ‘mania’ (their catch-all for when they simply don’t know a cause) and increases valproate again. This is their ‘safe option’ for manic people.
4 days later I nearly kill myself, waking up in a totally unprovoked rage after a nap. Valproate is booze without the intoxication but with the suicidality and rage.
So now I’m on half the valproate and have guanfacine reinstated. The new doctor is actually tracking my sleep and talking to my wife and is gradually starting to see that yes - I am sleeping and no - I am not feeling invincible or overly energetic. I speak fast and am intense but I do not fit the ‘definition’ (ha) of mania.
I am following her advice on how to lower it, but this is just perfunctory. It’s so that she will actually listen to me when I say ‘I do not fit in your boxes’. She has given me a referral to a neurologist to look into the likely epilepsy, and I have given her full Japanese chatGPT summaries of my 270,000 word english-language writings.
This word ‘manic’ must kill so many people.
It needs to be abolished.
/jb202508101030