I've seen various clips/videos of Bryan lately where he's not wearing his Whoop band on either wrist. Now, I suppose he might have switched to a bicep band.
If he doesn't wear a wearable 24/7, I wonder why. He seems to preach about the benefits of tracking your health quite extensively (although I'm sure that he has his routine/protocol so dialed in that he doesn't need to track everything 24/7 anymore).
I’m curious what people here think about TMS and ketamine/Spravato, especially compared with traditional psychiatric medications.
I’m diagnosed with AuDHD, PTSD, OCD, depression, and anxiety, and I’m currently considering TMS and possibly Spravato/ketamine. I know this sub is generally skeptical of mainstream psychiatry and psych meds, which is partly why I want to hear this perspective too.
TMS and ketamine seem a little different from the usual SSRI/antipsychotic route, both in how they work and their side-effect profiles. I’m especially interested in hearing from anyone who has actually tried either one. Did it help, hurt, or leave you with any lasting side effects? Do you view these treatments differently from conventional psych meds, or do you have similar concerns?
Currently prescribed up to 2mg/day of Klonopin for severe panic disorder and sleep doc recently added 600mg Horizant (Gabapentin Enacarbil) to the mix.
While drugs.com says that there's only a moderate interaction between the drugs (and doesn't mention anything about respiratory depression and/or death), several sources online say that the combination can be deadly (even without opioids in the mix).
What is the truth?
28M, looking for direction on the evidence base for cognitive recovery after prolonged critical illness and long-term antipsychotic exposure.
Background, and there's more than this: an episode of sepsis, several months of cumulative hospitalization, multiple major surgeries, cancer treatment, and roughly four years on clozapine for a diagnosis later confirmed to be wrong, ending in an abrupt discontinuation. After that, family independently noticed I seemed cognitively changed, and it matches what I experience. The most noticeable part is that my tolerance for change collapsed, and a disrupted routine derails me in a way it never did before. I also have persistent trouble with concentration and processing. Both have stayed constant regardless of mood and haven't responded to psychiatric treatment.
I'm on clonazepam and prazosin, have a TMS consult scheduled, and have requested a neuropsych eval. I'm not adding anything before those happen since it would confound both. I'm trying to understand what's actually worth pursuing afterward.
What I'm asking is whether there's real literature on cognitive recovery following sepsis or years of antipsychotic exposure, whether the deficits I'm describing tend to be persistent or slowly recover on their own, and what the evidence quality actually looks like for anything commonly recommended here.
More interested in evidence than anecdotes, and I need to know what would interact with a benzodiazepine or affect TMS.
28M, 5'10", non-smoker. Current meds: clonazepam, prazosin.
History, and this is the short version: an episode of sepsis, several months of cumulative hospitalization across multiple admissions, multiple major surgeries, cancer treatment, recurrent C. diff, thyroid issues, and roughly four years on clozapine for a diagnosis that was later confirmed to be wrong, ending in an abrupt inpatient discontinuation. Psychiatric diagnoses include depression, OCD, PTSD, social anxiety and panic disorder.
After all of that, family members independently commented that I seemed cognitively changed. What I notice most is that my tolerance for change collapsed. A disrupted routine or unexpected demand derails me in a way it never did before, and it takes a long time to recover. I also have ongoing trouble with concentration and processing. These have been constant through periods when my mood was better and worse, and haven't shifted with psychiatric treatment.
I know this overlaps with depression, which is why I've asked for objective testing rather than assuming. Is a neuropsych eval a reasonable request given this history, and would testing during an active depressive episode be interpretable, or is it better to wait?
Not looking for medication suggestions.
Posting about my father. Not asking anyone to diagnose him, mainly just want to know if I'm reading this correctly and whether the workup I'm pushing for makes sense.
He's a male in his 60s with lifelong varicose veins and multiple procedures over the years at an outside vein clinic. He also had an appendectomy about 6 months ago after failed antibiotic treatment.
In late August he had another vein procedure. The next day he noticed his right calf was enlarged. A few days later, ultrasound showed a DVT in the right posterior tibial/calf veins plus a superficial calf vein. The common femoral, femoral and popliteal veins were normally compressible. CT angiogram the next day showed segmental/subsegmental PE in the right middle lobe. Troponin was 4 and BNP 44, both normal. He was started on Xarelto.
The part I'm actually wondering about is his lymphocytes. His ALC was 5.77 on 8/27 and 5.27 on 8/28. The 8/27 manual differential mentioned moderate smudge cells, a few atypical lymphocytes, a few dacrocytes, and a decreased platelet estimate. Platelets were 112 and then 131. Hemoglobin and MCV were normal.
I went back through his older CBCs and found that the lymphocytosis predates the DVT/PE. ALC was 3.66 in 2021, then 5.94 in February 2026, 5.43 in March, 4.52 and 4.90 on consecutive days in March, 5.17 in April, and now 5.27 in August. So it's been hovering around/above 5 for about 7 months.
Does persistent lymphocytosis like this, especially with smudge cells, warrant peripheral blood flow cytometry? Or is there a good reason this would normally just be watched longer?
Also, is an isolated distal DVT appearing the day after a vein procedure generally considered provoked by the procedure if the proximal veins are clear? The vein clinic says they don't think the procedure caused it, but apparently nobody at his health system has the operative report, so I don't really know what was done.
And finally, if the lymphocytosis did turn out to be a clonal process, would that change how the DVT/PE is classified or affect anticoagulation duration or choice of agent?
I've already messaged his PCP about the lymphocyte history. Just trying to make sure I'm not overreacting or missing something obvious.
Also posted this in r/AskDocs; no replies yet. Posting on behalf of my father, with his knowledge.
Age: 62 Sex: Male Height/weight: 6'2", ~215 lbs Smoking: Never Alcohol: Social Medications: Rivaroxaban 15mg BID (started 8/27, DVT/PE starter pack), finasteride, omeprazole History: Lifelong varicose veins with multiple procedures at an outside vein clinic. Appendectomy ~6 months ago after failed antibiotic management.
In late August, he had a vein procedure on the right leg. The next day his calf was swollen. Ultrasound a few days later showed DVT in the right posterior tibial and calf veins plus a superficial calf vein, with the common femoral, femoral, and popliteal all normally compressible. CT angiogram the next day showed segmental and subsegmental PE to the right middle lobe. Troponin 4, BNP 44, both normal. INR 1.0 before starting Xarelto.
While going through those results, I noticed his lymphocytes were up, then went back down further. Absolute lymphocyte count: 3.66 in 2021, 5.94 in Feb 2026, 5.43 in March, 4.52 and 4.90 on consecutive days in March, 5.17 in April, 5.77 and 5.27 on 8/27 and 8/28. So, above 5 on and off for seven months.
The 8/27 manual differential noted moderate smudge cells, few atypical lymphocytes, few dacrocytes, decreased platelet estimate. Platelets 112, then 131. Rest of the CBC normal. I've since been told smudge cells can be a slide-prep artifact, so I'm not putting much weight on that part.
What I'm asking:
Does a persistently elevated ALC over seven months warrant peripheral blood flow cytometry, or is there a threshold or duration where it's reasonable to keep watching?
The appendectomy might overlap with the February draw. Could that account for the later values too, or does the April count rule out a reactive cause?
Is an isolated distal DVT with clear proximal veins, showing up the day after a vein procedure, usually attributed to the procedure? The clinic says no. His health system doesn't have the operative report.
I've messaged his PCP about the flow cytometry. Mainly want to know whether I'm reading this reasonably or making more of it than it is.
Not diagnosed, and I might be jumping the gun. My dad's 62 and just had a DVT and PE out of nowhere. While going through those labs I noticed his lymphocytes were high, and then found they've been over 5 since February. 5.94 in Feb, 5.43 in March, 5.17 in April, 5.27 last week. The smear last week noted moderate smudge cells and a few atypical lymphocytes.
Nobody's mentioned it to him. I've messaged his PCP asking about flow cytometry.
For those of you who were found incidentally, how long was it sitting in your chart before someone acted on it? Did you have to be the one to push? And is there anything you wish you'd asked at that stage that you didn't think to ask?
Mostly just trying to get a sense of what's normal here and not spiral in the meantime.
28m dx'd with ADHD, OCD, PTSD, Depression, and Anxiety (social & panic disorder). Currently on levothyroxine, rabeprazole, prazosin, Tylenol, and Imodium.
So, I have a history of colon cancer and various GI disorders, and my iron (and ferritin) basically runs chronically low (both in the low 40's). Because I'm technically not anemic (hemoglobin of 13-13.5 is common for me), doctors wouldn't give me IV iron. I'm also on a PPI long term, which I gather doesn't help the absorption side of things.
I finally recently convinced a sleep doctor (out of all docs, haha. I have a hematologist/oncologist, a gastro, and a PCP who all wouldn't order it) to order me 1000mg iron dextran. A few weeks out, I'm already experiencing a reduction in anxiety (especially somatic symptoms like air hunger and adrenaline surges) and a reduction in OCD type thinking and compulsions.
This has got me wondering: have all of my previous med trials been tainted by the fact that my iron and ferritin have run chronically low? My new psych is/was about to try an MAOI with me, but I'm now wondering if I can even call myself treatment-resistant (perhaps one of the previous meds would've helped if my iron was normal when I tried them). And if that's a real possibility, is it worth waiting to see where my levels land before starting something new?
Any input would be immensely appreciated. Thank you!
28M. Diagnosed GAD, health anxiety, ADHD-PI. Post-oncology, in remission, complicated treatment course. Four years of antipsychotic exposure in my early twenties from a diagnosis that was later reversed. Ongoing issues are recurring iron deficiency and anemia, an incisional hernia, and some enlarged lymph nodes.
Target symptom is sympathetic overdrive. Elevated resting arousal, exaggerated startle, constant muscle guarding, poor sleep onset, interoceptive hypersensitivity. Mood is secondary and not what I'm trying to fix.
I've been through most of the standard first-line psychiatric options without meaningful response, plus the usual over-the-counter anxiolytics. Assume the obvious ones have been tried. Currently working with a prescriber on stellate ganglion block, TMS, esketamine, and possibly phenelzine.
What I want from this sub is the adjunct layer. Specifically, anything with evidence for parasympathetic tone or HRV rather than general anxiolysis, and anything worth knowing about interactions if I end up on an MAOI, since that rules out a large share of what usually gets recommended here. Also interested in whether anyone has found anything that helps with interoceptive hypersensitivity in particular.
Please skip anything that raises blood pressure or affects clotting.
28, in remission from stage 4 colon cancer. Treatment at 25 went badly. I was septic more than once, threw clots, had several surgeries, and kept getting C. diff. I was told I might not make it on at least two occasions. Medically I'm mostly fine now. Neurologically I never came out of it. My nervous system still behaves like the threat is live, all day, most days.
Formal diagnoses are GAD, health anxiety, and ADHD-PI, with a PTSD history predating the cancer. Most first-line medications have been tried without much benefit.
Spravato is one of the options on the table. What I'd like to hear is whether it did anything for arousal and startle specifically, or whether the benefit was mostly mood, since nearly everything written about it is framed around treatment-resistant depression.
I'd also like to know how people carrying a lot of medical trauma handled the treatment setting itself. A clinical room with monitoring equipment and a two hour observation period is uncomfortably close to the thing my body is still reacting to, and I'd rather know in advance if that's a problem people have run into.
Practical answers are welcome too. What insurance approval actually required in your case, and how many sessions in you knew whether it was doing anything.
One detail I'm unsure matters. I was on antipsychotics for four years in my early twenties for a diagnosis that turned out to be wrong. If anyone has been told that prior antipsychotic exposure affects esketamine eligibility or response, I'd like to hear it.
I'm 28, diagnosed with GAD, health anxiety, and ADHD-PI. I have traits consistent with several other things but I'm not here to self-diagnose.
Relevant history. PTSD following a traumatic event at 18. Misdiagnosed with schizophrenia at 21 and treated with antipsychotics for roughly four years before that diagnosis was reversed. Treated for stage 3 colon cancer at 25, later restaged to 4, with a course complicated by septic episodes, thromboembolism, multiple abdominal surgeries, and recurrent C. difficile. Currently in remission. Ongoing findings are some enlarged lymph nodes, recurring iron deficiency and anemia, and an incisional hernia.
The presenting problem is that baseline arousal never normalized. Resting state feels like continuous threat monitoring. Exaggerated startle, persistent muscle guarding, difficulty with sleep onset, and trouble distinguishing benign somatic sensation from warning signs. This dominates the picture more than low mood does.
Most first-line options have been trialed without meaningful response. The interventions I'm reading about now are stellate ganglion block, TMS, esketamine, and MAOIs such as phenelzine.
I'm not asking anyone to treat me. What I'd like to understand is how these four are weighed when the target is autonomic hyperarousal rather than depression, whether trauma that is primarily medical and somatic responds differently than interpersonal trauma, whether there's a conventional sequence they get tried in, and whether prolonged unnecessary antipsychotic exposure bears on any of these decisions. I'd also like to know what commonly gets considered at this stage that isn't on my list.