“When I’m manic, I feel like I put on Superman’s vest.”
That’s how one patient explained why he didn’t want to stay on lithium.He wasn’t denying the crashes. He just wasn’t ready to give up the highs. Another described it differently: “If you take too much of it you're slightly underwater, but if you take too little you're floating three feet above the water.”
They’ve had terrible luck with sexual side effects. And you’re silently trying to recall which SSRI is "less bad" on GI issues. It’s not that you don’t know the data—it’s that it’s never all in one place.
How many times have you prescribed Abilify for depression and then stumbled over what to call it?
Do you say “antidepressant”? “Mood stabilizer”? Or do you tell the truth—“It’s an antipsychotic”—and watch your patient flinch? We’ve all had this moment. The treatment fits. The label doesn’t.
“I still have to tap 5 times before picking up my wrench—and after putting it down.”
“I think the pipe’s going to burst.” He’s a plumber. And he’s been fighting OCD for years. Multiple SSRIs. High doses. CBT with your most trusted colleague across town.
I told my patient to hold an ice cube until it melted. She looked at me like I'd lost my mind. But it worked better than three different medications.When we—as therapists, clinicians, or just as humans living day to day—have had a little too much of the demands of work, family, bills, we don't talk about distress tolerance skills. We talk about needing to chill out, go for a walk, play a game on our phone.
More teens are saying they can’t sleep because they’re worried about the environment. Today, we’re asking: How do we respond to climate anxiety without pathologizing it?
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