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This is the only thing I'm saving from the other place. If it helps even one person, it's worth it. I posted this back on February 22, 2022, but it's all still true.

Gather around kids! I'd like to talk to you a bit about mental health, and some fun things I've learned recently. I'd first like to thank @rinoliver.bsky.social, @richburroughs.dev, @ashleywillis.bsky.social , and @chloecondon.bsky.social for their help along this journey of mine (1/25) 🧵

First (and thanks to those mentioned) talking about mental health problems is ok. That being said, I've been on anti-depressants for over 30 years. They changed my life. A secondary one (trazodone) allowed me to sleep for the first time in my life. (2/25)

Just because everyone needs a 🎩trick, I was diagnosed with ADD earlier this year. Again, proper meds for that changed my life. So cool, lots of good meds, life is good, etc. But then ... well, y'all know about my year last year. (3/25)

It was, in a word, brutal. And somewhere along the line, shit stopped working. I didn't notice, but apparently others did, but no one said anything to me. so, really important: if you notice a change in your friend, SAY SOMETHING. (4/25)

ASK THEM if they are ok. TELL THEM that you've noticed a change, and that you want to help. Why do I say this? Because as hard as it may be to believe, I didn't even know that I was in such a deep hole. (5/25)

Until a friend finally called me and said "Ok, here's what I've noticed. I don't think you're ok. Let's come up with a plan to help you." It just so happened to coincide with my Insurance Company deciding I couldn't have my ADD meds (6/25)

anymore because they "weren't formulary". Side note: insurance companies getting to over-ride a Dr's Rx should be a criminal offense. So 🖕them. It ALSO happened to coincide with @kiran_oliver's thread about meds. x.com/kiran_oliver... (7/25)

Turns out I was on Vyvanse, and the other 2 meds I was on were listed as "Don't Use" which could also explain part of my tumble back into severe depression. Again, I didn't even notice I had fallen back into the hole. (8/25)

But I had, and ... Me: How did I not notice that I was waking up every day and just wanting to die? Depression: That's how this works. So since I was having to call my doc anyway to get new ADD meds sorted, I brought it up to her. Hoooo boy! (9/25)

Want to get your docs attention? Yeah, that'll do it! But I was already doing a bunch of research on this because HOW COULD THIS HAPPEN TO ME? I'M A SMART PERSON!! Nope. Smart's got nothing to do with it. Seriously. Depression is smarter. Also, I'm not that smart. (10/ 25)

But my friend who finally broke through to me is also on most of the same meds I am, and is a psychologist. And she said "have your doc prescribe Deplin." WTF is Deplin? Well, this is where this thread is about to get interesting, so grab a cold beverage. (11/25)

The most common anti-depressants are what's called SSRIs -- Selective Serotonin Re-uptake Inhibitors. Basically you don't have enough Serotonin, so these drugs prevent your brain from re-absorbing (12/25)

it as well, so that you have more available. For most people, this works well. At one point, doctors noticed that Prozac (and other SSRIs) just sort of stopped working. They called it Prozac Poop-out, and yes, it's a real thing. (13/25)

But it didn't happen to everyone. Just *some* people. Why? Not 100% clear, but, as it turns out you basically cannot manufacture adequate amounts of Serotonin, dopamine, or norepinephrine without a key ingredient: (14/25)

Your nervous system then uses L-Methylfolate to manufacture neurotransmitters like Dopamine, Serotonin, etc. You're starting to see where I'm going with this, aren't you? Right, some people have a genetic mutation (16/25)

called a MTHFR mutation (I'm now calling this the "Motherfucker Mutation") that means either you are incapable, or super bad at, converting folic acid to L-Methylfolate. You're so bad at it, in fact, that you suffer from a (17/25)

deficit of it which in turn makes it very hard to manufacture enough serotonin and dopamine -- that's the good stuff. So an SSRI can help, by letting you use more of what you can make, but it can't help you make more. And you actually need more. (18/ 25)