u/littlemomentsinlife

My psychiatrist is collaborative, but I feel like I’m directing my own treatment.

I’d really appreciate thoughtful input, especially from psychiatrists, psych NPs, psychologists, or anyone with similar experience.

Lately, I feel like I’m acting as my own psychiatrist. I spend a lot of time reading research papers, treatment guidelines, and forums (including Reddit), then bring ideas to my psychiatrist. He’s very collaborative and is willing to consider medications if there’s a reasonable rationale.

I’m grateful for that, but it also makes me wonder whether I’m missing something obvious because I’m so close to my own situation.

**Current diagnoses / suspected diagnoses**
Bipolar II (most likely)
ADHD
Suspected Autism Level 1

**Biggest issues right now**
Current depressive downswing
Executive dysfunction and decision paralysis
Trouble starting tasks I’ve been avoiding for weeks or months
Constantly losing my train of thought
Difficulty focusing while reading or watching movies

**Current medications**
Zenzedi 10 mg three times daily
Jornay PM 40 mg nightly
Lamotrigine 100 mg daily
Buspirone 10 mg three times daily
Clonidine 0.1 mg twice daily
I also have a prescription for Latuda 20 mg but haven’t started it yet because I’m trying to understand where it fits into the overall picture.

**Things I’ve noticed**
I’ve tried several ADHD medications over time with mixed results. Stimulants help somewhat, but they haven’t fully addressed the executive dysfunction.
One thing that has confused me is that, historically, marijuana and psilocybin seemed to make it easier for me to start tasks, read, stay engaged, and get out of my own head. I’m **not** saying I think those are the right treatment or recommending them—I just mention it because it feels like an important clue about what’s going on, and I’m curious how a psychiatrist would interpret that.

**My question**
If you were evaluating this case from scratch, what diagnoses, treatment approaches, medication classes, or blind spots would you be thinking about?
I’m **not** asking anyone to diagnose me or tell me exactly what medications to take. I’m more interested in hearing how you would think through a case like this and whether there’s something I haven’t considered.

I’m not looking to get high or chase a feeling. I just want to be stable, functional, and mentally healthy so I can be the best husband and father I can be.

Looking for honest input from people with experience.

I’ve been using psilocybin pretty regularly—about 15–20g a month. I’m not recommending it, just being real about what I’m doing. It often makes me feel more present, clear, and engaged.

From the outside, my life looks stable: steady job, no debt, wife, kids, home. I’m doing okay—but I haven’t told my wife about this.

I’m wondering if this is actually sustainable or if I’m missing something.

Questions:

●	Does this seem healthy long-term?

●	Any risks or blind spots I should consider?

●	Anyone else doing something similar?

I’m not chasing a high—I just want to be a better, more present husband and dad.

My psychiatrist is collaborative, but I feel like I’m directing my own treatment.

I’d really appreciate thoughtful input, especially from psychiatrists, psych NPs, psychologists, or anyone with similar experience.

Lately, I feel like I’m acting as my own psychiatrist. I spend a lot of time reading research papers, treatment guidelines, and forums (including Reddit), then bring ideas to my psychiatrist. He’s very collaborative and is willing to consider medications if there’s a reasonable rationale.

I’m grateful for that, but it also makes me wonder whether I’m missing something obvious because I’m so close to my own situation.

Current diagnoses / suspected diagnoses
Bipolar II (most likely)
ADHD
Suspected Autism Level 1

Biggest issues right now
Current depressive downswing
Executive dysfunction and decision paralysis
Trouble starting tasks I’ve been avoiding for weeks or months
Constantly losing my train of thought
Difficulty focusing while reading or watching movies

Current medications
Zenzedi 10 mg three times daily
Jornay PM 40 mg nightly
Lamotrigine 100 mg daily
Buspirone 10 mg three times daily
Clonidine 0.1 mg twice daily
I also have a prescription for Latuda 20 mg but haven’t started it yet because I’m trying to understand where it fits into the overall picture.

Things I’ve noticed
I’ve tried several ADHD medications over time with mixed results. Stimulants help somewhat, but they haven’t fully addressed the executive dysfunction.
One thing that has confused me is that, historically, marijuana and psilocybin seemed to make it easier for me to start tasks, read, stay engaged, and get out of my own head. I’m not saying I think those are the right treatment or recommending them—I just mention it because it feels like an important clue about what’s going on, and I’m curious how a psychiatrist would interpret that.

My question
If you were evaluating this case from scratch, what diagnoses, treatment approaches, medication classes, or blind spots would you be thinking about?
I’m not asking anyone to diagnose me or tell me exactly what medications to take. I’m more interested in hearing how you would think through a case like this and whether there’s something I haven’t considered.

I’m not looking to get high or chase a feeling. I just want to be stable, functional, and mentally healthy so I can be the best husband and father I can be.