tl;dr: Did Sunosi make you feel more sleepy? If you stopped taking it for any reason, did you get bad headaches/body aches or any other side effects/symptoms?
I've been taking 70mg of Vyvanse and 20-40mg of Ritalin as needed for about 4-5 years now, and the combo works "okay". It's kind of manageable, but not great. I tried Wakix for two months in 2022 but it made me depressed, and as I have bipolar II with a history of chronic depression that's a no-go, so I stopped. About four months ago I started Sunosi and was up to 150mg - and it felt like it did nothing to help with the sleepiness/exhaustion, and even seemed to make me feel more sleepy? Like with just the Vyvanse/Ritalin combo I still get sleep attacks where I need to lie down, but I can't actually sleep - I have to just relax as if I'm going to nap for at least 30-45 minutes and then I'm (usually) good to go. But with Sunosi in the mix I would actually fall asleep when I napped during the day and I couldn't nap for anything less than 45 minutes, usually more than an hour, which is not dissimilar to how it was before I took any stimulants. I didn't notice any emotional or mental side effects, pretty much just the sleepiness.
I stopped taking the Sunosi about a week ago to see if it was really making a difference, and now I'm definitely having more headaches/migraines than usual (I have chronic migraines as it is), and my regular medication doesn't always make it stop, but I can't be sure if it's from stopping the med or if my migraines are just acting up. I also felt *really* nauseated yesterday morning and actually had to leave work, and my stomach has felt kind of messed up in general. I do feel a bit less sleepy and foggy during the day, but the headaches really suck, and I feel like my pain levels have been worse in general too.
If you've been on Sunosi did you notice any negative effects (other than agitation)? Did you ever feel more sleepy? And if you stopped it, did you have any "withdrawal" symptoms or negative effects? Everything I've seen says that Sunosi doesn't cause withdrawal issues, but I've had some weird side effects with other meds that supposedly weren't common, so I just don't know.
For context: I have narcolepsy w/o cataplexy, bipolar II disorder, ADHD, chronic migraines, and am being evaluated for Ehler's-Danlos Syndrome. I take 70mg Vyvanse, 20-40mg Ritalin, 300mg of Lamictal, 100mg Zoloft, 10mg Abilify, 5mg rizatriptan as needed and just started Emgality injections for migraines

https://ibb.co/JFtHZmH https://ibb.co/K00gtn2
Hi all,
Age is 30F, non smoker, occasional alcohol. Medications are vyvanse 40mg, methotrexate 25mg once weekly, folic acid 5mg once weekly. Starting rituximab infusions in a few days. History of posterior scleritis and optic neuritis.
While getting into bed I noticed this strange mark on my right knee which to me, looks like a bulls eye? My knee is really hurting but I have been struggling with joint pain off and on for about the last year. Both of my knees have been really bothering me today but especially the right one - stiff, hot, etc.
Seeing the bulls eye pattern makes me think of tick bites, though I can't imagine where or how i would have been bitten by a tick. I live in a suburban area in Canada so it's not very warm yet and I haven't been outside much. I did run a few errands today but that's about it.
The mark itself does not hurt or itch and it may be slightly raised but seems mostly flat. It feels hot to the touch but my whole knee is hot, not just in that area.
I am on immunosuppressants (mtx) for inflammatory eye issues mentioned above but have been taking them now for 8 months and I take my weekly dose on Sundays. The mtx is actually not controlling the inflammation in my eyes so I've still had to get steroid injections (triamcinolone) but the last was over 6 weeks ago. This is the reason for the rituximab as well. My rheumatologist has not said whether he thinks my joint pains are related.
In any case, could this reasonably be a tick bite?? And if so what do I do? Sorry if this is a ridiculous question I've just never seen this kind of mark on myself before and am finding it bizarre given that I'm also having increased pain today.
Any help is appreciated, thanks in advance!

Anyone have experience taking zepbound with adderall/vyvanse/concerta? I have not taken the medication yet and I’m very new at this but I am prescribed stimulants too. My Dr didn’t say anything about it but after reading how this medication can increase heart rate, I’m wondering if I should be taking both? Skip on injection day? Discontinue stimulants all together? I’d prefer not to since I do need them, but I also don’t want negative interactions.

So I've been abusing drugs for the past 12 years. It started with heroin and then moved onto fentanyl and dope from the ages of 18 to 30 and now I've recently gotten sober and fully intend on staying sober. Today makes 5 months and some days free from opioids.
​
I am diagnosed ADHD and I am prescribed brand name Vyvanse 60mg for it and it's helped me alot especially I think with maintaining my sobriety because I can do much more than what I was doing before and remain focused on my goals throughout the day.
I am prescribed 45mg Mirtazapine for insomnia, it used to be benzos but now it's just my Remron and while it makes me sluggish in the morning for a while it really does help me get to bed and stay asleep.
I am also prescribed 150mg Pregabalin (Generic Lyrica) 3 times a day. I do not take it 3 times a day though I only take one in the morning and one before bed. My psyche doctor is prescribing it to my for off-label anxiety and it has actually helped alot but the thing is I think I am dependent on it after being on various doses for about 3 years now. Started with just 100mg 3 times a day and then grown to the current dosages.
There have been times I've been able to just stop taking it all together and not experience any withdrawal symptoms but there have also been times where if I stop taking it I go through the most acute and awful anxiety rebounds I've ever had in my life and this is coming from someone who's gone cold turkey off benzos and wanted to die over that feeling alone so many times.
I personally think that my lyrica has destroyed my short and long term memory. I read there are some studies that lyrica fucks up new neurons from being formed in the brain or that there is something it's doing to my brain with glutamate that isn't helping my memory at all.
I'm also on Sublocade which is a 300mg injection once every thirty days that's just long acting suboxone (buprenorphine) and that has been a life saver for me actually because I get that shot and don't have to daily dose my buprenorphine strips how I used to.
I want to get off Lyrica entirely and start weaning myself off it and I was wondering if you guys can possibly recommend something to help me go through that glutamate storm or however it's called and basically recommend me something that's going to help with the WD I'm going to go through and some stuff that can help repair my years of drug abuse and my very poor memory.
I'm excited everyday now and I want to become healthier and get off both the suboxone and lyrica and need help doing that!
Forgot to mention, opioids kill testosterone in the body and I abused from ages 18 to 30 and I got my test levels checked and was at 241 which is super low, also suboxone kills the test as well actively while I am on the shot so I am prescribed now 150mg testosterone cypionate 1x weekly and I'm going on 3 weeks of that and hope it helps as well!

I seem to only be able to find stories of people acting odd after being sedated or just coming out of a sedation.
I (28/M) just had my first experience being given IV sedation. It was to have my lower two wisdom teeth removed.
The staff said I jumped out of my chair onto the ground and tried to fight them all and destroyed their anesthesia equipment and a monitor or something. They said I was actually throwing punches.
This was within moments of getting the drug in my body, and it went on for like 20 mins before they got me in the bed and I was sleeping for another 30 minutes.
I have no memory of it. The only thing I remember is a cold tingling coming over my chest when the drug was injected, the dental surgeon putting a huge block in my mouth, and then closing my eyes. Then I felt a deep sense of dread and panic as I felt like a bunch of people were pushing me down onto a bed while I was suffocating, and seeing technicolor and darkness. It was like I was deeply wrapped in darkness and being buried alive and trying to dig myself out. It was a feeling of having a nightmare, then knowing where I was but still feeling like I was dreaming and I couldn’t see anything. Like a bad high where my body doesn’t want to give up control. I could tell I was in the chair and I could tell people were trying to hold me down but I felt terror and panic.
That sensation was only a few seconds before I woke up with blurred vision and a heavy head being told what transpired for 30 minutes.
They seemed scared and confused about the reaction I had. I followed my instructions to prepare for surgery to a T. I didn’t even have water since midnight. I do not drink or take illegal drugs. I take Zoloft and Vyvanse and I skipped my Vyvanse today to avoid interactions. I am curious how this is possible and what could’ve caused it. Does anyone have any ideas?
For context, the one who administered the drug was the oral surgeon which I thought was odd. It was only him and his dental assistant. They also had to keep clarifying with me that I was actually getting anesthesia.
For context, I have ADHD, OCD and health anxiety (due to negative drug experiences as a teenager). This felt very similar to when I overdosed on cough medicine when I was 15. The only drug I had prior to surgery was nicotine. It’s an electronic cigarette. The doctor said vaping was the only thing he could guess caused my experience, but I have vaped for 10 years. I only use FDA approved e-liquid from a reputable source. I don’t use any CBD/THC or anything like that.
I’m just trying to figure out what went wrong. I’m pretty traumatized from the experience. I still have to get my teeth pulled out but I refuse to be put under ever again.

Hi all,
30F here, nonsmoker, occasional social etoh, no drugs. Medications are 40mg vyvanse daily, 25mg methotrexate once weekly, 5mg folic acid once weekly, 40mg triamclonone injections in my left eye once every 3 months. Starting rituximab infusions in a couple of weeks.
I started having trouble swallowing in about June of 2023. When it first started happening it was more intermittent, and sometimes when I was eating I would begin to swallow but would hesitate as the food reached the "top" of my throat because it felt like the food was going to get stuck if I continued. So I would sort of "cough it up" and then have some water with it and i was okay. I saw an ENT for a salivary gland biopsy in August and he did a quick scope (camera through my nose and down the throat) to make sure there was no obvious mass or blockage. His report said "mild post cricoid edema" but there were otherwise no notable findings.
It has waxed and waned since then , and was better when i was on prednisone (i was pred dependant for 8 months before the mtx) but recently has gotten so much worse and now happens at every meal. I have to take smaller bites and swallow everything with a liquid otherwise i will choke on it. I am not able to eat as much as I typically would because about halfway through my meals my throat becomes so "fatigued" from working so hard to swallow that I lose interest in eating. I don't really have issues with liquids, it is mostly with swallowing solids and pills.
I do have a rheumatologist who I see for an inflammatory eye issue (posterior scleritis). The eye problems started January 2023 and pre date the swallowing issue. There is suspicion of potentially some underlying autoimmune disease causing the scleritis, but nothing has been confirmed to date, so I don't know whether to contact my rheum or my GP about this. I've been kind of ignoring it because the ENT report didn't find anything and I don't want to seem like I'm just complaining about things that turn out to be nothing or normal. For example, I've had a lot of joint pain during this time as well but x rays have all come back normal so I feel like I'm just being overdramatic or like my doctors think I'm a hypochondriac or something.
Anyway lol. I know this isn't normal but I'm also not sure how to ask for help or who to go to, since the ENT already looked at it. Any help or insight would be appreciated! Thanks in advance.

Long story short, I don’t expect anyone to be able to diagnose anything over Reddit. I’m just seeking some guidance as to whether my issues warrant going to the emergency room or something or if it’s all in my head.
I grew up with the mentality that you only go to the doctor when you know something is wrong. That going when it could be nothing is wasting their time and is rude. BTW I know that’s a messed up POV, I’m working through it with my therapist but wanted to explain my hesitation.
Some details about me: - 37M - 6’0” and about 225. Slightly overweight but not obese - I have mental health issues - ADHD, Depression (possibly bipolar 2 - mew doc is unsure of previous diagnosis so trying to reaffirm) - daily i take 70mg Vyvanse (ADHD), 80mg Prozac, 300mg Wellbutrin, 40mg Nexium (GERD), 6.25mg Ambien for insomnia, 2.25 ml of testosterone (weekly injection - since I cannot produce T naturally any longer) and recently like yesterday started taking a vitamin D supplement and Magnesium supplement. My situation predates either of these new adds. - 2 weeks ago a dedicated to get myself back in the gym. I’ve been lifting 3-4x per week for about 30-40 mins each time.
What’s going on? It’s really hard to describe so bear with me.

• it feels like my entire body is swollen and is going to explode. For example, it feels like my brain is too big for my skull or my ear drums are too big for my ear canals.
• This causes some dull aches but no sharp pain. It sort of feels like a headache but also doesn’t. It’s just a dull pressure.
• I’m getting these weird pulsations throughout my body during the day.
• My head and feet can’t be still. Not shaking but like moving around constantly. In circles, back and forth, just fidgety.
• my vision occasionally gets a little blurry and it makes it hard to read. This can last a few seconds to a few minutes
• I get occasional dizzy spells throughout the day. In general I find it hard to do anything other than lay horizontal to keep from passing out
• Recently my mental health has changed drastically. I’ve hit my all time low, had thoughts of unaliving myself (but I’d never actually do it and my wife and doctors are working with me on this), I don’t want to do anything other than lay on the couch or in bed. Because of this I had my worst week at work ever. I was flaky and unreliable all week which I hate because I have always done good work, delivering on time or early, and always been a go to at the office.

Additional details: - Monday I went to an urgent care thinking my ear pain was an ear infection. Doctor said I had no signs of any infection and I was probably the constant weather changes we’ve been experiencing - at said appointment my blood pressure was normal and no fever - Since I have been taking my BP at home. Not sure how accurate it is but it says my BP is normal too - Because I’m on supplemental testosterone my hormone levels are checked regularly. So far again, everything comes back normal.
I’m genuinely terrified that it could be some serious like a brain tumor or brain bleed or something. Like I can’t tie any of my mental health issues back to any trigger. It’s just like one day I woke up and was a totally different person.
Over the years my doctor and I have tried several different mental health meds but nothing really works. I see her this week and plan to ask to try a different antidepressant.
Family history (if it matters): - Mom: survived breast cancer and thyroid cancer - Father: passed from COVID. No major medical issues other than hypertension and sarcoidosis - Paternal Grandmother: passed from breast cancer in the 90’s - Maternal Grandfather: passed of liver cancer in early 2000’s
Sorry for all the rambling. I was trying to be a thorough as possible and anticipate any questions up front.
Is this likely just mental health issues causing physical symptoms?
Could it be something worse?
Is it worth going to the ER? This has gotten worse and worse of the last couple of weeks and I don’t know if/when I could even get in to see my GP.

Alright. I’m posting this from a laptop I stole. Probably the only one in this place that can actually access the outside, although I don’t know for certain. Honestly, I don’t know if anybody’s going to see this, but…I have to try. Okay. I don’t have much time. I’m writing this because I want people to know what’s happening to me.
Nothing ever really stays dead down here. That’s the first rule. The most important rule. The rule you really need to remember.
I guess I should start at the beginning–shit, I’m bad at this. I was a college student, before…everything. I mean, before this place. Before the Machine.
But I’m getting ahead of myself. Sorry. Ah, well–here goes.
Not sure how long ago it all started. Maybe two years? One? Three? Time doesn’t really work right here. Anyway—I’ll start at the beginning, like I said. I will try to recall everything as accurately as I can.
I don’t know how I got here. Nobody does. I can’t explain it. I was on a bus to campus, I fell asleep…and then next thing I know I’m waking up in a dark, empty room with steel walls and no furniture.
Initially, I assume I’m still dreaming, which I think is a pretty reasonable initial response. However, I soon feel the tight metal cuffs digging into my wrists and ankles, the icy bite of cold steel pressed against the bare skin of my face and neck—and I realize that this is not, in fact, a dream.
I’m in shock for a bit; I don’t know how long. It could be hours, or it could be minutes. I just kind of stare at the floor and will myself to wake up, even though I know it won’t work.
Once I get past that stage, though, I try to take stock of my surroundings. My backpack is gone. I can’t feel anything in my pockets, either. My clothes are all still there, which is good. I try to stand up a couple times, but with my wrists and ankles cuffed there really isn’t a lot I can do. Eventually, I manage to maneuver myself into something of a sitting position against the wall, and I decide that’s good enough.
I try to push down the panic rising in my chest. Questions like, where am I? How did I get here? Am I going to die? What’s happening to me? can all wait. Right now, I know the only question that really matters is, how am I going to survive?
I just don’t have enough information to formulate an answer. The extent of the information I have can be summed up pretty quickly: Steel room. No visible door. No furniture. Nothing that could be used as a tool. No indication as to my location. No indication as to who brought me here. Dim light, but no visible light source. Basically, I know jack shit. Fear begins to well up in my chest, and I struggle to fight down the panic.
Thankfully, before I can spiral, a door opens. A door! It had meshed so perfectly with the surrounding metal that it looked like a rectangular section of the wall swinging inwards, revealing a dim red glow from whatever lay beyond—silhouetted by two people.
The two people walk in, and the light in the room brightens, though no light source becomes visible.
I don’t bother trying to stand up-–it would just be embarrassing.
The two people, for their part, look quite intimidating. One of them is a pale, well-built bald man with a thick, red mustache. He wears camo pants, a wife beater, and has two wicked-looking knives tucked into his belt.
The other person looks like nobody I’ve ever seen before. The right side of their face is normal—bright green eyes, blonde hair with blue highlights—but the left side is…steel. Literally steel. Think terminator skeleton. Just a grinning, metal skull. There’s no clear seam going down the middle, where flesh and metal fuse. They are seamlessly melded together—honestly, it’s hard to pinpoint exactly where the metal ends and the flesh begins. Then, from the neck down, their flesh looks normal on both sides. They wear a leather jacket, zipped up, and fingerless gloves. The fingers protruding from the right glove are human, but the left looks like bony steel. They wear jeans and combat boots, with two knives tucked into their belt as well.
I catch myself gawking, and quickly turn my gaze back to the bearded man. I’m not sure what I’m supposed to say here. Am I supposed to say anything?
Thankfully, the bearded man speaks before I say anything to embarrass myself. “You got a name?” His voice is deep. Rich, with a subtle southern twang.
“River,” I croak, wincing at the sound of my own voice. It sounds hoarse, as though I haven’t spoken in weeks. It also sounds deep—masculine. I sound like a man, which I hate. Not even an intimidating man—just an awkward, geeky sort of man; the kind of man you’d probably bully the shit out of in highschool. If I hated someone, this is the voice I’d give them. “My friends call me Riv.” I have no idea why I said that.
“We ain’t friends, River,” replies the man coldly. “I’m Chris.”
“Avery,” says the person with the metal face. It is fascinating, how both halves of their mouth move simultaneously as they speak. The human side forms words with its lips, and the steel skeleton side just opens and closes its mouth. The voice sounds pretty normal–it doesn’t sound artificial, like I’d expect. Although I guess to be fair, I have no idea what to expect. “Anyway, with introductions out of the way–-we’re going to ask you some questions. You’re going to answer. Understood?”
Well–Avery certainly doesn’t fuck around. I nod, feeling a twinge of fear on top of the panic that has already made a home in my gut. These people are going to hurt me. This is it. I’m dead.
“You got any useful skills?” asks Chris.
“Uh–I’m good at calculus, and I know how to program,” I reply lamely. I am a math and computer science double major, so that seems like a reasonable claim. Chris’s eyebrows furrow.
“Programming?” Avery asks, raising their eyebrows. Well—eyebrow, I guess. The one on their flesh side. You know what I mean.
“Yeah,” I reply. Is this my chance to not die? I decide to milk it, to make myself seem as competent a programmer as possible. Maybe if these people have a use for me, they won’t kill me. “I know Java, C++, Python, and R.” Avery looks unimpressed, although I guess it’s hard to tell. Chris just looks confused. Hurriedly, I continue: “I can learn any programming language if you give me a little time.”
“Not useful,” Avery deadpans. “You got any practical skills?”
“Like what?”
“Can you fight? Are you strong? Can you build anything? Can you cook?”
“I can fight,” I reply unconvincingly.
Chris looks doubtful, and Avery’s expression remains unreadable. “Look,” Chris begins, “No offense, but—you’re a bit on the skinny side for that, ain’t ya?” I can’t tell if he’s serious or if he just wants to get a rise out of me. Unfortunately—if it’s the latter, it’s working.
Despite everything, I chuckle. “Uncuff me then,” I say with an unreasonable amount of confidence. The truth is, I can fight, sort of—but at the moment my brain is fried with fear, and my whole body is so full of adrenaline that I can barely think. Fuck it, I tell myself. We ball.
Chris laughs. “Alright, alright—calm down, girl. I’ll uncuff you in a second, if you promise not to do anything stupid. I believe you—you got the eyes of a killer.”
I frown, looking away. Suddenly, I don’t feel so confident. Suddenly, I’m overwhelmed with a surge of emotion so powerful that I want to throw up. “You don’t know anything,” I hiss through gritted teeth.
Chris looks confused at my sudden change in demeanor, but he just shrugs it off. Avery cocks their head and just looks at me with that piercing, half-human gaze. They’re looking at me the way I’d look at a bug on my hand, watching it crawl around for a bit before crushing it to death. Those eyes just aren’t right.
“You on any drugs?” Avery asks.
I frown. “What?”
Avery produces a syringe, although I’m not entirely sure from where—and honestly, I think it’s best that I don’t know. Noticing my panicked expression, Avery smiles. I think it’s a smile, anyway. It’s hard to tell with only half a face.
“This isn’t supposed to kill you,” Avery says. “But if you’re on anything, it might. So, I’ll ask you again. Are you on any drugs?”
The syringe needle glints in the light, and I feel my breathing quicken. I cannot have a panic attack right now, I tell myself. Like that’s going to help.
I start talking. Buying time. Maybe somehow, an idea will magically form in my mind that will save me from…whatever the fuck is happening. “Uhh—Zoloft, Vyvanse, Wellbutrin, Estradiol, uh…fuck, I don’t know. Some thyroid medication? Levothyroxine I think? I’m blanking. Don’t inject me with that shit, please. Avery, come on. Hey, come on. Look—”
The human half of Avery’s face curls into a sinister grin, and my protests are cut off as the syringe is slammed into my thigh. I swear I can feel the needle hit the bone. For a second, I don’t feel anything—but then the pain hits, and I scream.
Chris grimaces, closing his eyes—but Avery just laughs.
It’s like a million white-hot needles moving through my body, starting at my thigh and making their way through my entire body. Every piece of my body, every cell is screaming in agony, and I can feel my vision dimming as I start to lose consciousness. I fight to remain conscious—to survive—but I fail miserably. Gripped by terror, I start struggling, convulsing in place…anything to move, to get away—from what, I’m not sure—but just away. I fall flat on my face, since my arms and ankles are still cuffed. I try to maneuver myself into a sitting position, but I feel my whole body shutting down, distancing itself from the pain.
Avery’s laughing face, half human and half grinning metal skull, is the last thing I see before the terrifying darkness takes me.
​
​
I wake up in a bed—and I can almost dismiss Avery and Chris as a fever dream, except that…this isn’t my apartment. This looks like a dorm room, and not one I’ve ever been in. The walls are blackened steel, and the bed frames are made of something I can’t even begin to comprehend. The material is an abomination of steel and dead, well-preserved flesh. The mattress seems normal though, so thank fuck for that.
There’s a window on the other side of the room, and through it I can see…my campus? But—also, not my campus. Look, I’ve been going to UNX (name changed for privacy reasons) for a while now…and I know the layout. What I’m seeing through this window is definitely the layout of a cluster of dorms on the north side of campus, but…it’s all wrong.
The buildings, usually made of red bricks, appear to be made of blackened steel. The walkways between the dorms, which are usually also paved with bricks, are paved with rectangles of the same blackened steel, with some lightly colored ones scattered randomly throughout. It might be a trick of the light, but the lighter bricks look to have an almost…fleshy texture, and I swear I can see them pulsing slightly. A cold shiver runs down my spine, and I screw my eyes shut. Please, let this just be a dream.
“Hey!” says an overly enthusiastic voice from behind me. “You’re awake!”
I spin around, looking at the speaker. A girl, probably around my age. She wears yoga pants and a tank top, like she’s about to head to the gym. Before I can say anything, she continues: “I’m Zoe! It’s great to meet you—River, right?” She smiles.
I scowl at her. “Yeah. Where are we?”
“Ah, yeah—about that.” Zoe gestures at the window behind me. “It’s UNX, but not UNX. I assume you’re a student?”
That is not an answer at all. I continue scowling. “How do you know that?”
Zoe shrugs. “Anyway—yeah, so it’s UNX…but not UNX. Don’t worry, it’ll make sense later.”
I highly doubt that, but I have other concerns to talk about. “How’d I get here?” I ask.
Zoe shrugs again. “Don’t know. Everyone just showed up here, and everyone who’s showed up here so far has been a student.”
“Are you a student?”
Zoe nods. “I am, yeah. I’m an English major, and I like to write.”
That’s crazy, but I didn’t ask, I almost say. But I think better of it. There’s no reason to take out my frustration at the situation on Zoe. After all, it’s not her fault I’m here. Is it?
I look at her more closely. At first glance, she looks…normal. Way more normal than Chris or Avery. If I say the words ‘white sorority girl,’ I guarantee that whatever image you have in your head is probably at least 80% accurate regarding Zoe. She looks like she should be out on the quad, handing out flyers and going “Hey, come check out Kappa Beta Ligma!” or whatever.
White, dirty blonde, very pretty—looks like she should be in line at a Starbucks. But as I look closer, I can see this look in her bright, green eyes (I think they’re green, anyway. I’m colorblind, so it’s mostly guesswork). Something intense that I can’t quite place my finger on. Something slightly unhinged. It scares me a little.
She has a thin frame, but it’s filled out with lean muscle. She looks like an athlete; she looks strong, and carries herself with the sort of confidence I’d expect from a fighter. Briefly, I wonder if she’s actually here to make sure I don’t try to run away. I wonder if she could stop me. Part of me wants to find out, just out of curiosity—but that would be a spectacularly bad idea.
Just then, an ear-splitting screech sounds in the distance. Startled, I turn back to the window—and I swear that just for a second, I can see something on the empty walkway between the dorms. A shadow, vague and indistinct—but somehow I know it’s looking up at us. At me.
Then I blink, and it’s gone. What the hell?
The screech splits the air again, and I cover my ears. It’s not human—of that, I’m certain. But it also sounds like no animal I’ve ever heard. When the screech dies down, I turn to Zoe. “Uh, what—”
“Don’t worry,” she cuts me off. “We’re safe here.”
I am quite worried. “What is that?”
Zoe just shakes her head, her eyes wide. “We’re safe here,” is all she says—but I can hear her voice shaking, and her smile looks plastered on. She’s lying.
I feel tendrils of dread creeping into my brain, and I force the panic down. What the fuck is this place?
“Zoe,” I say, struggling to keep my voice level, “what the fuck is going on?”
She stops smiling, closes her eyes, and takes a deep breath. When she speaks again, her upbeat demeanor is gone, replaced by a very matter-of-fact tone. “The Machine,” she whispers. I frown. “What?”
She shakes her head. “Look, River—there’s a lot you don’t know about this place. I don’t have time to spoon-feed you answers. Just…this dorm complex is safe. If you go past any of the bus stops, you’re dead. Well—not really dead. Nothing ever really stays dead down here. Remember that. Don’t kill anything. It’ll come back, but worse.” She takes a deep breath, and continues quickly before I can ask any questions. “However you came here, that’s how you’re going to stay. Any drugs in your body are going to stay there. You can still eat and drink and starve to death—except you can't permanently like, die here—and you still need to sleep…but whatever was in your system when you got here is staying. Anyway…stay here. Just—go to sleep or something. You’re a liability right now, and one that we can’t afford. I have to go. Bye!”
Before I can say anything, she’s out the door, slamming it shut behind her. I try to follow, but it’s locked. I still have a million questions, and no idea how to process anything Zoe just told me. Nothing really stays dead down here. What does that even mean?
The sound of something slamming into the window behind me snaps me out of my reverie. I turn—and immediately stumble backwards, choking on a scream. My breath comes in ragged gasps, and I find myself hyperventilating. Terror grips my chest, freezing me in place. What the FUCK is that?
Shit, I think I’m out of time. If I get out of this, I’ll try to update. Otherwise…well, it’s been real, y’all.
-Riv

blog link - https://sapphirestar.substack.com/p/best-in-class-life-improvement
There is an enormous amount of crappy self-help advice. Most supplements do nothing. However, some substances and practices can dramatically improve your life. It's worth being explicit about what those are in my experience.
The American medical system endorses all of these treatments and methods, and you can implement them with a doctor's supervision. The only way I differ from the American medical system is that they operate under a paradigm of treating diseases or perhaps what might be better understood as serious deficiencies. But if a technique is powerful enough to help the ill it is plausible it can also help the well. Make your own choices and set yourself free. Before reading this advice, it is important to note that drug users use a lot of drugs.

In general, recreational drug users take their drugs at doses so much higher than psychiatric patients that they're basically two different chemicals. A lot of our impressions of drugs, what side effects they have, and how dangerous they are get shaped by the recreational users, not the patients. This is sometimes even true for the doctors who are supposed to prescribe to the patients and give them good advice. While studies of recreational user populations can sometimes be helpful in flagging an issue for consideration, we should be judging the clinical risks based on studies of clinical populations.

Ketamine

Ketamine is extremely effective and extremely fast-acting. It often solves depression in a single day. Hence, it should be among the first things you try if you have mood issues.
From Scott's writeup:

The short version: Ketamine is a new and exciting depression treatment, which probably works by activating AMPA receptors and strengthening synaptic connections. It takes effect within hours and works about two or three times as well as traditional antidepressants. Most people get it through heavily regulated and expensive esketamine prescriptions or even more expensive IV ketamine clinics. Still, evidence suggests that getting it prescribed cheaply and conveniently from a compounding pharmacy is equally effective. A single dose of ketamine lasts between a few days and a few weeks, after which some people will find their depression comes back; long-term repeated dosing with ketamine anecdotally seems to work great but hasn’t been formally tested for safety.**6: How effective is ketamine?**Pretty effective.Studies find the effect of ketamine peaks about 24 hours after use. A meta-analysis finds that by that time, around 50% of patients are feeling better (defined as 50% symptom reduction) compared to less than 10% of patients who got a placebo. A more recent Taiwanese study finds roughly similar numbers.Another way to measure effectiveness is through effect size statistics. The effect size of normal antidepressants like SSRIs is around 0.3. The effect size of ketamine is between 0.6 and 1.0, so about two to three times larger.

Ketamine is a psychoactive drug. The state it induces is hard to describe, but it can be psychedelic in its own way. My advice is to take enough ketamine that you are clearly quite high but not so much you are 'out in space.' Ideally, the experience won't be very scary. Ketamine is very short-acting. The peak high should only last about 45 minutes, and the total trip should be under two hours. I recommend either doing a very simple breathing meditation (described in detail later in this document) or enjoying media you find uncomplicatedly pleasant. Watch a nature documentary about trees. Don't watch one about predators. Listen to music that makes you happy.
It's important to get your setting right. Moving around on ketamine makes people nauseous. So, have water and nausea meds (ondansetron or Dramamine) right next to you. In case you need it, I'd also have a puke bucket. Try to stay still and enjoy the happy trip. I strongly recommend dosing alone. Ketamine is safe, and the trip is not long. Whatever happens, you can easily wait it out. You need to be able to focus on yourself. It is highly unpleasant to manage someone else’s emotions while having a difficult experience. This can lead to serious emotional issues. It is also valuable to commit to handling your mind. Unless you accidentally take a very large dose of ketamine, you can handle it.
Scott recommends this person to obtain ketamine legally at a reasonable price of ~$250/month. Many people pay hundreds per session for ketamine clinics, which seems too expensive for most people. I will say the obvious and point out that a dose of 100mg of ketamine costs about $10 in California (100/gram is normal here). Mixing it with distilled water into a nasal spray is not hard since ketamine is water-soluble. I can only speak from personal experience, but I have spoken to multiple local testing services, and all of them report that ketamine is usually pretty pure. It's not a drug with a high risk of dangerous adulterants. Unlike Scott, I recommend dosing only once per week. Ketamine definitely builds tolerance, and you do not want to abuse life-improving medications.

Adderall and other Amphetamines

Amphetamines give you mental and physical energy. They help you focus. Amphetamines consistently take the top spot in surveys of which nootropics and life interventions are the most effective. Many people are obsessed with their intelligence. But having more energy and focus is, for many purposes, similarly effective to being 'smarter.' Returns on effort are exponential, especially over short periods of time. Even if you seek creativity and deep insights, it helps you feel alert. If you genuinely fit the diagnostic criteria for ADHD, you will benefit even further. However, the fraction of people who would benefit from 'more energy and focus on demand' is not small.
If you haven't read it, Scott's write-up on amphetamines is quite thorough. Some amphetamines work better, but are all fairly similar compared to 'not taking them at all.' One non-trivial downside is that amphetamines are not exactly good for your heart. I am not sure why Scott's write-up finds such small adverse cardiovascular effects. Get a heart rate and blood pressure tracker. If needed do some extra cardio to counteract any negative effects.
In Dune, the spice melange has huge mental benefits. The human computers depended on spice. Adderall isn't as good as Spice, and it doesn’t extend your lifespan. But there is an important parallel. You can get high off spice, whereas it’s extremely hard to get high off forms of amphetamines like Vyvanse (it's really an amphetamine prodrug), but you can take others in euphoric doses. It is an incredibly bad idea to EVER use amphetamines recreationally. Do not do this even a single time. Never get high off the spice! I am honestly not the biggest fan of commitments. Arguably, this article aims to set you free from many chains. But this is one time it pays to metaphorically sign the oath in blood and bind yourself to the mast. Never do it. You have been warned.

Exercise Regularly and Safely – You can get huge benefits with little effort or risk

I'm unsure how much I need to sell anyone on 'regular exercise is good.' But it helps with many mental issues. Elizabeth's epistemic spot checks are not easy to pass. But the argument for exercise strongly improving your mental health in Exercise for Mood and Anxiety basically passes. I recommend both the spot check and the book for details. However, many people find it hard to get themselves to actually exercise, and it is VERY easy to cause yourself chronic health issues. Conveniently, the benefits of intense exercise aren't much larger than those of regular but very low-intensity activity. Therefore, I recommend starting with daily walking and basic simple bodyweight exercises (pushups, burpees, leg raises, pull-ups if you can manage them). Listen to a podcast or audiobook. If your cardio is good, you can try adding elevation changes to your walk. Most people aren't that strong. But if you can actually do 10-20+ pull-ups, you might need to add weight lifting. If you go for more intense training, do so because it’s fun or you are willing to take risks.
Romeo has a good write-up that advocates slightly more risk than I personally take (I don't use weights; bodyweight only is safer). This quote captures his conclusions:

The basic idea that lifting twice a week and doing cardio twice a week add up to a calorie expenditure that gets you the vast majority of exercise benefits compared to extreme athletes holds up, especially when you take reverse causality adjustments into effect (survivorship bias on the genetic gifts of the extreme). Nothing I've encountered since has cast much doubt on this main takeaway.What updates have I had, then, both in personal experience and in giving training advice to others, as well as any research that has come out since then?A greater emphasis on injury prevention, as the disutility from injuries vastly outweighs the positive effects of chasing numbers. This one was sadly a foreseeable update with aging, and thus, I lose bayes points for it. I did get an injury deadlifting despite a substantial emphasis on good form and not pushing to the limit as many do.Exercise selection and program optimization likely matter less than I thought, and research that has come out in the meantime has supported this.One and two combined imply that there is no real downside to picking exercises with lower injury potential for the joints and back.

In Scott's post about depression, he is asked which kind of exercise helps, and he answers:

Again, the most important answer is 'whatever kind you will actually do.' Almost all benefits come from exercising at all.

Everyone knows exercise helps a ton. But perhaps they think exercise has to be difficult. Or maybe they subconsciously know that exercising risks chronic injury. So, the important thing to realize is that you can get a huge benefit from exercise with little effort or risk. Hopefully, internalizing this helps you actually do it!

Semaglutide/Ozempic

Semaglutide is the real-deal weight loss drug we have been praying for. It works well for 70%+ of people. Losing and keeping weight off is so difficult that prior to ozempic, it was reasonable advice to preach acceptance or extremely restricted diets. Prior to Semaglutide, I used to assume that most of my friends who wanted to lose weight would fail. Now I assume they will trivially succeed if they get on the drugs. Here is how to get on Semaglutide:

1. I purchased sema, for myself and others, on this site: https://evolutionpeptides.com/products/semaglutide-10mg?variant=42834747326660. It has been a reliable supplier for me. Reliability can always change, but for now, it's where I would go.
2. Start with a dose of 0.25mg. Increase your dose approximately every four weeks. Stay on lower dosages as long as possible. Tolerance can increase rapidly. For example, the official guidelines say to double your dose after each of the first two months of treatment. I would try to increase dosages more slowly.
3. Gray market semaglutide is sold as a powder. You need to mix it into a solution to inject. Search for reconstitution solution.
4. You also need needles. Any insulin needle will work fine but some hurt less than others. Here are the ones I use.
5. To make the solution, I draw 100 units of reconstitution (a 'full' vial) solution into the needle. I then squirt the solution into the sema vial and repeat this process again. This means 5mg of semaglutide per 200 units of solution. So, to do a 0.25 starting dose, I would inject 10 units of mixed sema solution into my deltoid. It doesn't really matter if you inject into fat or muscle.

Semaglutide feels weird in many ways and makes many people nauseous. Fake Dr. Sapphire's medical advice is to use gray market odansetron to manage nausea. But dramamine is OTC in the USA and most other countries and also works well. Don't expect insanely rapid weight loss. It's normal to lose 1-2 pounds a week, which is honestly quite quick!

Testosterone

I try to stick to very compelling arguments. Anyone who has read SSC/astralcodexten should know that interpreting studies and meta-analyses is difficult. High doses of testosterone dramatically boost strength, lean muscle mass, and sports performance. They make it much easier to lose fat while preserving muscle. In combination with other drugs, they make it possible to achieve ludicrous body types. The extreme doses of testosterone taken by bodybuilders are almost certainly highly unsafe. However, lower doses, such as those common in testosterone replacement therapy, also have significant effects. If you want to be stronger, leaner and/or more muscular, you should seriously look into supplementing testosterone.
I am honestly unsure how to accurately model the safety curve for testosterone. Merely having more lean muscle mass is plausibly bad for longevity since it puts more pressure on your metabolic system and causes more accumulated damage. However, there are studies showing the opposite in older people.
TRT doses of 50–200 mg intramuscular weekly injections seem safe enough to me. Injections work better than topical gels in most studies.
It's worth being overt about how testosterone (exogenous or otherwise!) has many potential irreversible side effects. It metabolizes into DHT, which is the main cause of hair loss. DHT blockers to prevent this commonly destroy sexual function in men. Topical DHT blockers applied to the scalp are more promising for most men. Large doses of exogenous testosterone can shut down natural production, and this can persist even after you stop taking testosterone. Increasing your testosterone can also masculinize your appearance in tons of smaller and permanent ways. Testosterone can metabolize into hormones that cause breast growth, and breast growth does not go away on its own. All of these effects are much smaller with the TRT dosages I recommend.

Interlude: Buddhism, Meditation and Psychedelics

You are probably some combination of secular, mentally flexible, open to experience, and attracted to 'dangerous' ideas. Those are often lucrative traits, but they make meditation more dangerous. Let's look at some quotes from Holly Elmore's write-up of the long-lasting harms meditation caused her:

I’m just going to list the harms I am still dealing with today, about four years after ceasing serious meditation and two years after stopping meditating on purpose entirely.Harm: relaxation-induced panicRelaxation-induced panic is a horrible catch-22 wherein relaxing is a cue to panic and become vigilant again. It’s a symptom most often associated with PTSD, and it’s high up on the list of meditation harms tracked by Willoughby Britton.Harm: loss of 3D visionThis is related to the loss of concepts. I can pop in and out of 2D and 3D vision at will, it’s just that 2D is the default, and 3D always feels more real. Whenever I pop into it, I feel suddenly aware that I have a back and that there are sounds behind me as well. I suspect it’s like tapping into the immersive UI model setting of the mind.Harm: exacerbated neurological vision processing issuesMindfulness made my visual snow worse by encouraging me to notice it.Possible harm: difficulty hearing noise or processing speechar exams show that my machinery is good, and it’s so analogous to the visual processing issues caused by mindfulness that I think meditation contributed to it

Obviously Holly’s was an unusually pathological case. But the rationalist/secular-curious-nerd neurotype does genuinely seem at higher risk. Almost everyone, including the medical establishment, highly recommends meditation. Very few people are harmed, and traditional practice considers meditation quite safe and not in need of many warnings. So, it is very interesting to me that the meditation teacher who seems most popular among the rationalist community is Daniel Ingram.
Daniel is famous for popularizing the concept of the ‘Dark Night of the Soul,’ a harrowing and unpleasant stage that can last months or years! I do not wish to make any negative value judgments about the path Daniel and others follow. Different paths, or dharma gates in Buddhist lore, appeal to different people. However, this document aims to teach you consistently effective techniques to improve your health without sending you through dark nights.
Meditation, if done skillfully, is powerful. It has similar effects to psychedelic drugs. Psychedelics and meditation help you relax and see things from a new perspective. This is very useful to heal trauma. It also lets you become a generally happier and more serene person. However, it should be obvious from this framing that relaxing your priors and then making semi-random changes is not obviously beneficial. Many of the harms of meditation and drug use come from using them in an unstructured way. Perception is very strange. We all know about the blindspot, but many optical illusions show us the different ways the mind has to create the coherent reality we experience. Perhaps it is useful for some people to perform this deconstruction. But our goal is to instead cultivate serenity and peace. For this reason, I recommend basic counting breath meditation:

Sit comfortably, with your spine erect, either in a chair or cross-legged on a cushion.Close your eyes, take a few deep breaths, and feel the points of contact between your body and the chair or floor. Notice the sensations associated with sitting—feelings of pressure, warmth, tingling, vibration, etc.Gradually become aware of the breathing process. Pay attention to wherever you feel the breath most clearly—either at the nostrils or in the rising and falling of your abdomen.Allow your attention to rest on the mere sensation of breathing. (There is no need to control your breath. Just let it come and go naturally.)Every time your mind wanders in thought, gently return it to the sensation of breathing.As you focus on the breath, you will notice that other perceptions and sensations continue to appear: sounds, feelings in the body, emotions, etc. Simply notice these phenomena as they emerge in the field of awareness and then return to the sensation of breathing.The moment you observe that you have been lost in thought, notice the present thought itself as an object of consciousness. Then, return your attention to the breath—or to whatever sounds or sensations arise in the next moment.Continue in this way until you can witness all objects of consciousness—sights, sounds, sensations, emotions, and even thoughts—as they arise and pass away.Don’t fall.

Breathing deeply is fundamentally calming; it is the first thing people should try if they are having a panic attack. Focusing on the breath lets your thoughts arise without dwelling on them. If you have troubles, they will come to the surface, but we can very gently process them. This meditation naturally cultivates serenity and simple happiness, which is exactly what we want to cultivate when our priors are relaxed. There is no need to overdo meditation. Fifteen minutes a day, three to seven days a week, with occasional longer sessions, is plenty. If you start meditating substantially more make sure it's actually helping.
This meditation can also be thought of as the strongest defensive magic. Much suffering in life comes from being overwhelmed by unpleasant thoughts or feelings. Practicing focusing on the breath and letting go is extremely helpful in normal life. Meditation can be very psychedelic, but if things become unpleasant, you can simply stop meditating. There is no reliable way to stop a psychedelic experience induced by something like LSD or shrooms. Before you can consider such substances, you need to practice your defenses. Breathe meditation can be fun, but it can also be quite boring. Don’t hurt yourself by holding an unhealthy posture. But you should consider this meditation training and practice; it doesn’t have to be fun to be helpful. However, at worst, the practice should be boring. If you start experiencing seriously negative mental states, stop meditating immediately. Your mind will rapidly return to normal if you stop promptly.
Our meditation goals rely on straightforward mechanisms:
1 - Practice letting go of thoughts and emotions by returning to the breath.
2 - Eventually, be able to let go of unpleasantness, even in difficult situations such as panic attacks or ‘bad trips.’ Knowing we can do this helps us feel safe.
3 - Cultivate serenity and gentle happiness.

• If you become skilled at meditating, you can induce extremely euphoric states. This is helpful in moderation, but being too obsessed with these states is considered unhealthy. If you learn to reach such states, don’t make a big deal about them. They are great for ending panic attacks, but they aren’t our goal.

4 - Create a beneficial ‘relaxed prior’ mental state while being happy and safe.
For the most part, the techniques developed in classical Buddhism are powerful and work for their intended purposes. But it is highly unlikely that you share the goals of the people who developed those techniques. In classical Buddhism, when you become a monk or a serious lay student, you ‘take refuge’ in the Buddha, the community, and its teachings. You are taking refuge from the pain of existence/samsara. The core logic of Buddhism is true. If you undertake a fairly extreme set of behaviors and mental practices, you can be quite happy even in harsh circumstances. Knowing this can inspire peace and courage. If I were faced with very serious adversity, I would take refuge. Even if I was put in solitary confinement, I know that I could be peaceful and happy. People have remained tranquil while setting themselves on fire in protest. The way is tested; if you need refuge, it is always available. But I am currently happily living in Samara. Unless you sincerely intend to escape the pain of Samsara, whatever the sacrifices, you should be extremely cautious about following Buddhist practices unless you understand why they serve your actual goals.
I have tried to give an appropriate warning about the dangers of meditation. But I am not sure it is even possible to convey how powerful classical psychedelics (LSD, Shrooms, 5meo-dmt) can be. Some highlights from a survey of people’s experience:

• Around 4.5% of respondents said the psychedelics caused them to experience psychosis, and another 4.5% said they might have had this effect.
• Specifically, 74% said a psychedelic trip was in the top 20 most enjoyable experiences of their life; 61% said a trip was in the top 20 most meaningful experiences.
• 41% said they had one of their top 20 most frightening experiences on psychedelics, and 32% reported the same thing for mentally painful experiences.
• The majority of respondents say that their psychedelic use caused at least some enduring (>6mo) personality change in them (~32% said “yes, very minor ones,” ~25% said “yes, moderately strong ones,” and ~7% said “yes, very strong ones”). The vast majority said these changes were positive.
• More psychedelic trips are reported to be good than bad (depending on how you count it, there are about fivex-11x as many good as bad trips).

Doing intensive therapy on psychedelics has a long history, and there is a lot of interesting scientific research being done. If you have serious PTSD or other issues, perhaps that is something to look into. For those interested in the theory, I recommend the original work by Stanislav Graf. I have successfully worked as a facilitator before. But I am only willing to work with someone if they are already experienced with psychedelics or they already have done serious preparation. Taking a serious dose of a psychedelic is invoking interstellar overdrive. There is no way to do it reliably and safely, though you can minimize the risks. I recommend safer techniques first. You want to be as mentally strong as possible before you invoke full overdrive. If you go down this route, I strongly recommend using shrooms instead of LSD since shrooms last about half as long. I will discuss MDMA in more detail later, but adding MDMA significantly increases the odds you have a ‘good trip’.
The logic of this article required discussing full psychedelics. I will now move on to discussing the much safer substances I actually recommend.

MDMA

MDMA makes you feel happy and full of love. MDMA lasts about three to six hours with a two to three-hour peak. Drug onset and duration are always highly variable. There is very little risk of a ‘bad trip’ but should you feel strange effects I recommend the usual: focus on the breath and let go. This makes MDMA extremely useful for healing trauma. The FDA has approved MDMA-assisted therapy as a breakthrough treatment for PTSD. There is also significant research showing it is useful for anxiety, depression, and eating disorders. The studies are quite convincing, but I am a man of straightforward arguments, not interpreting studies. A substance that reliably induces happiness and love is obviously useful.
I recommend combining MDMA and meditation. Follow these steps:

• Trip alone and sweetly ask people not to distract you from your goals.
• Create an ideal cozy, pretty setting. Have tasty, nutritious food such as berries nearby.
• Dose MDMA.
• Watch happy media or listen to enjoyable music until you feel the effects hitting strongly.
• Do 45 minutes of breathing meditation. As usual, simply let your thoughts arise and pass away.
• Take a short break.
• Do another 45-minute session.
• Enjoy simple pleasures for the remainder of the trip.
• Make sure you don't have anything to do the next day.

In this protocol we are taking responsibility for our own mental health. You don’t need other people to help you process. Ultimately, only you can decide how to interpret the events in your own mind. Other people’s reactions are unpredictable, and we want the most reliable protocol possible. MDMA is very safe; you certainly don’t need a tripsitter. However, once you have entered the ‘come down’ phase, bonding with friends and loved ones can be helpful. But beware, anytime you add people to a drug experience, you have increased the variance, so be choosy.
The other protocol I recommend is based on MDMA’s extremely strong ability to facilitate bonding. Choose who you want to bond with wisely. Follow the same steps, except instead of meditating, spend time cuddling or having sex. MDMA is very effective at healing sexual trauma, making people more comfortable with sex acts they have internalized as shameful, or helping partners become more comfortable with each other.
Of course, a small amount of meditation can be useful to set your mind or course correct. If the bonding protocol feels even slightly ‘off,’ safely retreat to the meditation protocol. You never want to force intimacy. The bonding protocol's only real ‘risk’ is that it works extremely well. It's the sort of thing I recommend doing with your spouse or otherwise committed partner. We are trying to make our lives beautiful, not develop unwanted or unrequited feelings. It is worth noting that MDMA causes severe erectile dysfunction in many people. The ED goes away, but if you wish to have penetrative sex on MDMA, you might need Viagra. I would recommend taking the Viagra ahead of time since ED is quite likely during the session.
Some people feel like MDMA ‘overloaded’ their serotonin, and they feel somewhat more down the next few days after a session. This is normal. Of course, a ketamine session the day after MDMA can help. Unfortunately, MDMA interacts badly with SSRIs, and you absolutely should not use MDMA if you are taking one. I don't recommend pausing or skipping antidepressants so that you can take MDMA. That does not strike me as a wise course of action. However, you can consider trying an SNRI instead. Many people respond better to SNRIs instead, and the information value of trying the swap is likely worth it anyway. You also need to skip any stimulants (such as Adderall) on days when you take MDMA.
There is substantial debate about whether MDMA, taken in reasonable doses, is neurotoxic. My personal review is that doing it once every one to three months is safe. MDMA definitely messes with your body's heat regulation, which can harm your brain, so please only take MDMA somewhere cool. You definitely should not mix MDMA with other stimulants such as Adderall since the combination makes the heat/neurotoxic risk much more severe. If you are seriously working on your mental health, I would recommend monthly sessions. Once things are in better shape I would switch to once every three months. I recommend reading these reviews and coming to your own conclusions before dosing.
https://www.thedea.org/mdma-risks-science-and-statistics-technical-faq/mdma-ecstasy-molly-neurotoxicity-brain-damage/
https://dancesafe.org/drug-information/is-mdma-neurotoxic/#2

Appendix

Caveats policy:
There are many caveats I could have added. In general, I chose not to go into an even longer digression on Buddhism and different meditation practices. If AI safety has taught me anything, there is no way to discuss a potential danger without inadvertently pushing many people toward it. I'm aware I probably encouraged people to try psychedelics despite the extreme warnings. But most people have heard of psychedelics anyway, and the EV isn’t so bad. Many Buddhist practices are more obscure and have much worse expected value.

Drug Testing Resources:

https://dancesafe.org/product/ketamine-testing-kit/
https://dancesafe.org/product/mdma-testing-kit/
Neither kit is perfect, but it's better than nothing.
https://www.sfaf.org/services/drug-checking-scope/
Services like the above exist in tons of cities and offer very high quality purity testing.
Drug interaction notes:
https://www.vice.com/en/article/padgjm/everything-you-need-to-know-about-mixing-mdma-and-antidepressants-safe-sesh
https://addictionresource.com/drugs/zoloft/how-long-stays-in-system/

The birds outside my window are mocking me right now, they herald the coming of the dawn and the consequences of my failures to find peace. I'm so bloody sick of this. It's been a long day, I'm exhausted, just the ritual of getting ready for bed feels like this herculean task, so many moving parts, I barely remember to put toothpaste on my toothbrush i'm so worn out. But oh god forbid I find peace in dreams, no, the moment my head hits the pillow it's like someone injected uncut PURE caffine directly into my feet, every thought I'd ever thinked all day is being thunk up in my buzzing noggin, whether I like it or not.
No matter how much I toss, how many turns I take, how many times I reconfuckulate the blankets, hydrate from my drink, pet my dog (He sleeps with me), this machine was built without an off button, and I am boiling in self-hatred because I JUST CAN'T FALL ASLEEP! I know that any amount of bluelight, any screen in my face any checking of the time is just another setback, but damn it all, the anxiety of not knowing how much of my precious rest time has elapsed in vein haunts me. So I cave, I grab my phone off my be- HOW THE FUCK HAS IT BEEN TWO HOURS AAAAAAHH! Every fucking time with this, it's like father time's pulling some elaborate prank, and my ass has been getting punk'd for the better part of this month.
God known what happened to my circadian rhythm, but it's been obliterated harder than Kaiba. Hours pass, I toss, turn, take another of my sedatives in desperation, and then sleep nearly takes me, I can feel my eyes getting heavy. But the universe just won't be having any of that shit, not in it's metaphysical backyard no sir. So a fucking car alarm across the street goes off, and because I'm already in that pseudo-dreaming phase where I can sorta visualize something, but I feel deeply dissociated from it, and I have vague control over it, this shit snaps me awake like I'm slapped in the face. I freak out, and my childhood ptsd from the home security system's wEe-WoO second phase kicks in, so there goes all my progress towards any amount of rest, thanks cosmic overlords!
So here I am, venting into the void because creation itself has conspired to shag me like 1960's carpet flooring, and I have no sort of recourse with which to allot myself some more time for recuperation. Guess I'll die, and I might just take those funny-fucker songbirds down with me!

i got my 10-year tetanus vaccine 2 days ago and didn't think much of it. i have chronic pain so my pain perception is very warped, but i didn't (and still don't) think it hurts all /that/ much. however, i became concerned when i realized my entire deltoid is hard as a rock on the injection side. like it feels like someone just slapped some skin over polished marble or something. i did some googling and couldn't find anything about similar problems (this is wayyy larger than ISNs, it's my entire muscle) and for comparison my deltoid on the other arm is pliable when fully relaxed. in addition, the area is very noticeably larger, hot, and reddened- but i'm aware those are much more normal symptoms. do you guys think this is something i should be worried about and get checked out or am i good to just keep an eye on it and see if it goes away over the next couple of weeks? (plus if i should get it checked out, how urgently are we talking?)
demographics: 21 afab, 5’4, ~190lbs, meds-vyvanse/effexoalbuterol, physical medical issues- asthma/chronic migraines/bertolotti’s syndrome/carpal tunnel, non-smoker

I did my first injection yesterday afternoon. Pretty much immediately noticed a change in my attitude around food. I was watching TV last night after dinner. Usually, if I am still hungry after dinner, I reach for something sweet/unhealthy. Last night, without even thinking much about it, I was like, “hmm, I am physically hungry still. I will eat the leftover veggies I made with dinner.” It wasn’t until after I ate them that I realized how different this was from my normal after dinner snack! It was just easy to make the healthy choice. I didn’t feel like it took any self control or effort to not go for dessert.
As far as side effects, my tummy definitely feels a little bit off. Almost like mild morning sickness. But I am also about to start my period, and I tend to get a little woozy around that time of the month.
The only negative so far has been that I feel like my Vyvanse (ADHD medication) just did not work like normal. I searched within this group (and the Mounjaro group) and read that this is pretty common. I am going to toy with the time I take it and what I eat with it and see if that changes things.
And for stats: Starting weight: 170 + hypertension dx Goal weight: 140 Age: 36
Reading about everyone’s progress and journeys has been so cool. So thank you all for sharing!

30M, injuries, medications, and treatments listed at the bottom. Not diabetic, casual drinker (~3 drinks per week), never a tobacco smoker but an occasional pot smoker (~5x per year), and I semi-frequently take THC edibles at night. I've been suffering from a lot of foot pain and have been told I have tarsal tunnel syndrome and baxter's neuritis. I have had a terrible time trying to get rid of it. My feet (especially my right foot) are constantly tingly all over the bottoms of my feet. My right foot hurts a lot more and feels like it's burning in my baxter's nerve, tarsal tunnel area, and recently in bottom lateral side of my right foot (see "Oct 2023" below). They also feel cold during times of inactivity. I wear orthotics recommended by my podiatrists (see "What makes it feel betteworse").
They all started with ankle sprains which really turned my life upside down (see "Injuries"). It total, I've talked to 4 podiatrists, 3 PTs, a neurologist, an orthopedic surgeon, and 2 PCPs about this. Most are perplexed and have not come across my situation, except for the podiatrists I sought out because of their specializations in nerve pain. My most recent podiatrist thought that maybe my ankle sprains caused tight calves which entrapped those nerves, but frequent massaging and stretching has not seemed to help, and now he's confused too. My calves are pretty flexible now and have been massaged a lot. I also got blood tested for chronic inflammation and it did not indicate any of the markers.
I desperately want to understand where the source of this problem is and how to fix it. I keep thinking there's some sort of entrapment somewhere that needs to be let loose, because I don't know what else could be happening. Sometimes I can even feel very mild nerve tingling on the medial side of my upper thigh (see "What makes it feel worse"). Thanks SO much if you have any new thoughts for me as to what to look into next.
​
What makes it feel better:

• after sleeping, I feel much better in the morning
• wrapping my hands around the areas of pain - the warm of my hands definitely help the pain decrease somehow
  • a couple times my PT has grabbed my foot to stretch my calf and its felt amazing, as if whatever entrapments I have are suddenly let loose. But it's temporary and I haven't been able to replicate this myself very well at home
• walking/exercising - but the podiatrist I told this to assured me that I don't exhibit any signs of a blood circulation problem
• walking in cushy shoes - with/without orthotics doesn't seem to make a difference
• a hot shower or especially a bath
• lidocaine cream helps a little bit

What make it feel worse

• standing on hard surfaces - cushy surfaces are much better. the worst my pain ever felt was when I was walking in my expensive carbon fiber custom orthotics, and it felt better after I switched to cushier orthotics
• Sitting at a desk and in a car driving are uncomfortable for me. weirdly, sitting cross-legged is OK.
• decreasing my gabapentin
• pressing against certain parts of my thigh or calf - it refers extra tingling to my tarsal tunnel and baxter's nerve. makes me think

Injuries

• July 2020 - 1st bad right ankle sprain, no nerve pain afterwards. PT helped
• Mar 2021 - 1st and only bad left ankle sprain, tingliness noticed around ~Nov 2021. PT helped
• Dec 2021 - 2nd bad right ankle sprain, tingliness and burning noticed around 1-2 weeks later. PT did not help and eventually fixed it with surgery in Nov 2022.

Medications

• Gabapentin - 600 mg/day
• Lexapro - 5 mg/day
• Vyvanse - 10 mg/day
• Melatonin - 300 ug/day
• Calcium/Vitamin D supplements

Anesthetic/corticosteroid injections

• Mar 2023 - ~ right shin area, done by a foot nerve pain specialist, felt nothing
• July 2023 - right tibial nerve, prescribed by a UCSF neurologist, performed by a UCSF radiologist, pain came back after initial numbing wore off
• Oct 2023 - right tibial and calcaneal nerves, prescribed by a UCSF neurologist, performed by a UCSF radiologist, and the pain distribution in my distribution seemed to change somehow. If anything, the pain now seems to be more concentrated in the bottom lateral side of my right foot (linked above), but I still feel the pain in my baxter's nerve and tarsal tunnel area.

Other medical history

• Sept 2022 - EMG in my right calf, neurologist said I "couldn't look more normal"
• Nov 2022 - Brostrom ligament repair of my right ankle. after PT my ankle finally felt healthy, but my foot nerve pain remained unchanged.
• Oct - Dec 2023 - PT for increasing flexibility of my calves.

29f 200 lbs 5’4 MMJ user.
Hashimotos ITP
I’m just wondering if any of the medication I’m on could be causing rapid burning? I love being outside in the summer on the lake and if this is any indicator of how it is going to be it isn’t looking good for me. 😭
Daily medication’s:
Wellbutrin 300mg (I have been on this for a long time and this is never happened while I’m on this medicine)
Levothyroxine .25 mcg Pantoprazole 40mg Vyvanse- 60mg
Had a month of Rituxan in October and have the NPlate injections every week for ITP.

How long will it take for me to feel the effects of vyvanse again after I stop taking invega injection. This will be my first month not taking invega injection. I absolutely have zero motivation and other major problems from taking invega. Can someone please let me know how long will it take to completely rid the body and mind off of invega injection?

Age: 25
Sex: M
Height: 5'9
Weight: 93KG
Race: White
Duration of complaint 5 days
Location: Both Hands R+L
Any existing relevant medical issues:
ehler danlos - actual eds I can without letting go of my hands put them up over my head and behind my back.
Current medications: Vyvanse 40mg, Meloxicam 15mg, Sumatripan 25mg, Gabapentin 300mg.
So a bit less then a week ago I went in for carpal tunnel surgery. Should have been fairly simple local anesthetic a few incisions in and out for the most part, well that's not how that went down at all. They prepped the area for injecting the local anesthetic, the second they start the injection I knew something was immediately wrong. It feels instantly like my hand is frost bitten, and it doesn't get better. They told me to rub it in and let it diffuse however at this point I'm in 10/10 pain and it feels like being frost bitten and electrocuted at the same time. I told them several times that I'm in a lot of pain and for whatever reason they didn't seem to take me seriously. Some faffing about later they wheel me into the OR where I told my surgeon there is not anyway in hell I'm letting him touch my hand at this point, asks me why I explain what's going on, does a squeeze test on me I about nearly scream. I had a choice of canceling this and going to the ER or getting general anesthetic I choose being knocked out. (This was an impressively dumb decision however I didn't know when the next time I could get this done would be). Ended up going to an ER after they gave me a boatload of morphine and sent me home.
Now that we are up to speed on what happened, I'm getting nerve pain in both hands not just my right and I haven't a damn clue who to see or what do about this and its been getting progressively worse. I was put on gabapentin after leaving the surgery center and that isn't helping.

Hi all! I’m 36F that’s never been officially diagnosed with AUD (I’m very private about my drinking despite being engaged in mental health treatment). In the last 6 months or so my drinking has really ramped up as I was really unhappy in my marriage and am now separated from my husband. The separation has been harder than I anticipated and I’ve been self medicating hard. I used to drink like 4-6 days a week (usually like 2-4 drinks and more on the weekends), always taking at least one day off a week. I haven’t taken a day off in over a month and I’m really feeling the physical effects and am not doing very well. I’m averaging a bottle of wine daily during the week and probably around 6-9 drinks on the weekends.
I know I need meds in order to stop this time and am considering TSM or potentially semaglutide injections because I’ve also gained a bunch of weight (BMI is 24, still technically within normal range). My official diagnoses include MDD, ADHD, and panic disorder. I’m currently prescribed 25mg of Zoloft, 40mg of Vyvanse, and .25mg of Xanax as a PRN that I probably fill 3x a year. I work in the mental health/SUD field and have worked with insurance companies so I have seen firsthand how the stigma of SUD diagnoses can directly effect medical treatment. As a result of this I’ve made the decision to self pay for the AUD meds/counseling to avoid having the diagnosis in my records. I had a consultation with Ria (telehealth AUD treatment that would likely prescribe Naltrexone) today and I really like their approach and they seemed totally fine with my request for privacy.
I’m just wondering if anyone has any suggestions on direction with meds and/or has experience with doing your AUD tx separately or with a Medspa (which I would probably do if I went the semaglutide route). Thanks in advance!!

I've (F34) just received blood work results that, from my unprofessional interpretation, shows that I am anemic. My ferritin levels are at 7 but CBC, although low, don't seem dangerously low.
My partner bought me some iron supplements (28mg vegetarian capsules, high absorption) meant to prevent iron deficiency.
My doctor will surely phone me this coming week about my results but until then I'd like to get started on some sort of supplementation.
My questions are:

1. Are the aforementioned iron supplements ok to take right away or should I wait until my levels are back to normal and take them for prevention?
   
2. I'm planning on starting multivitamins. Are these okay to go along with the iron supplements?
   
3. After reading comments and posts about how iron can make you feel nauseous, how do I prevent that?
   

Some important information about my current health status:
I suffered a stroke in June 2023 but I'm no longer on my blood thinners other than baby Aspirin. Which I will be taking for the rest if my life. Fun fact: Long time use of low-dose aspirin can cause anemia!
I've recently dealth with a case of menorrhagia that lasted a good 3 months with HEAVY bleeding. Only a few days were blood-free. I'm now on Drospirenone, (progesterone only bc pill), since end of December and it seems to be helping. After getting an ultrasound to see if anything in particular was causing this menorrhagia, an ovarian cyst or follicle was found. Going for a follow up ultrasound in 2 weeks.
I've recently lost 33 lbs (since September).
Here is my list of current medications:
Aspirin 81mg - 1 x daily am Vyvanse 70mg - 1 x daily am Wellbutrin 300mg XL - 1 x daily am Pantoprazole 40mg - 1 x daily am
Slynd-28 (Drospirenone) - 1 x daily pm Sertraline 100mg - 1 x daily pm Naltrexone 25mg - 2 x daily am and pm Ozempic 0.25 mg - 1 x weekly injection on Monday am
I've never felt this weak and out if breath in my life. Even when I weighed close to 300lbs, going up the stairs wasn't this difficult. The dizziness, fatigue, hot flashes, headaches, and most weirdly, the craving for dirt and moss is all getting old. Help!
I've posted my blood work in the comments.

How much did everyone’s Iron/Potassium drop after injections? I’ve been trying to stay in regimen but I’ve been feeling so mentally off and exhausted since injecting B12 EOD 1000mcg!
Dizziness, Confusion, Concentration Issues, Have Been bedridden for the last few weeks with low energy! Shortness of breath, feeling “drunk” and spacey, tired
My hands have been feeling ice cold and yellow so thinking Iron may have dipped down, potassium or both.
Previously I posted about getting weird Depressed/Suicidal thoughts, this was when I was seemingly unaware I was deficient in many vitamins, and was taking Vyvanse, NAC and Lions Mane, as a bandaid fix which I honestly think spiraled me downwards. (Is it true these can increase vitamins excretion?
In the last month or so those have subsided, but now I’m more foggy weak, tired and just unable to think clearly quiet yet, and it’s been a rocky road.
Also taking B Complex, Iron Supplements as of last week (Helping a bit for sure), D/K 5000, Electrolyte mix, Mineral Complex
B12: 260 Ferretin: 38 D : 31
Just scared I’ll be stuck in this state of mental confusion and dizziness forever, it’s getting better very slowly after iron especially but wanted to see if anyone have tips to feel better and back to normal! How long did everyone deal with this until some level of mental clarity? Are these indicative of start up symptoms recovering from deficiencies?
I just feel like my brain is on it’s on mind and acting irrational with weird thoughts that’s severely impacting productivity.
I’m also vegetarian with history of defenciences.

Is there a more controversial topic in this scene than Third Wave Emo? The maligned time period in the genre’s great history was also Emo’s biggest commercial boom, with Emo-Pop and Emo-Adjacent juggernauts becoming household names. The story goes that once bands like Taking Back Sunday and My Chemical Romance burst onto the scene, Emo’s dwindling Second Wave immediately died off and the ethos of the genre perished with it until some brave Revivalists brought it back from the dead in the early 2010s. However, this simplistic view minimizes the hard work that the underground, basement and DIY Emo scenes around the world were putting in during this very same span.
Some bands looked at the 15+ year history of Emo to that point and continued to push those qualities. Others sought to innovate on Emo’s established sound, especially by fusing it with different genres. Others still invoked the relatively unknown Kinsella brothers’ unique approach to Emo and expanded upon it.
With that said, this series will be taking a very deep dive into the world of underground, DIY and otherwise lesser-known Emo during its Third Wave. Many people believe no real Emo music was released during this time and, while the purpose of these articles isn’t to discredit mainstream Emo-Pop or to define what “real Emo” is, I want to dispel that notion completely and recontextualize Emo as a continued underground movement from the Second Wave to the Fourth Wave instead of the disconnected death and revival of a genre.
A few notes before we continue:
-Splitting Emo into different waves isn’t even a universally agreed-upon metric for defining the genre and its characteristics, but I find it to be a fairly useful way to categorize its history. -The general timeline that’s agreed on for the Third Wave is roughly 2002-2008. I used these years as a basis for gathering releases. -There is VERY little information on this topic out there, so I’d like to give a special shout-out to u/4010 and u/intrepid-mall9100 for all of the amazing resources. -I am not a grand Emo historian who’s lived through every Wave and attended millions of shows throughout the world, so if you believe I’ve incorrectly categorized an artist or release, just let me know your opinions in the comments. -I will be putting each section in roughly chronological order. Specific release dates can be hard to find so I’ll do my best to put these out in order. -Please give me suggestions in the comments! I’d love to add to this and make it even more comprehensive.
Now that those disclaimers are out of the way, I present the first part of this series: The Last Vestiges of the Second Wave.
This section will cover Second Wave Emo artists who continued to release music between 2002-2008, especially those who utilized characteristics of that Wave’s sound.

Billy Music - Midwest Index (2002)

With one of the worst band names in existence (and a hair more googlable than their original band name “Billy”), Billy Music released their sole LP Midwest Index in 2002 after a couple of EPs and an appearance on one of the Emo Diaries compilations. At least the album name is appropriate for across 10 tracks is a sort of catalog of Midwest Emo tropes, collected together as sort of a primer for newer fans of the 90s Emo sound. This is a hidden gem.

Kilowatthours - The Bright Side (2002)

Given the band had a lot more Post-Rock influences when they first released music in 1999, they nonetheless released an EP and LP before 2002 with strong Emo influence, so this album deserves to be in this section. Still employing a heaping tablespoon of Post-Rock in their music, this release is more grounded in Midwest Emo than anything they’ve done before. The vocals are soft so as not to disturb the atmosphere of each song.
Check this album out if you are looking for the cozier side of the Second Wave Emo sound and get a minute preview into the future of Emo during the Third Wave…

Benton Falls - Guilt Beats Hate (2002)

Calling this a prototypical Second Wave Emo would do this album a great disservice as it's filled to the brim with passion, feeling and poetry. Benton Falls doesn't quite reach the lofty heights of their debut album, but this release is only a notch below. The Post-Hardcore-tinged Emo that was popularized by bands like Texas is the Reason and Mineral is fully on display here with messy, loud guitars, occasional belted screams and shifting volume dynamics.
This was released in early 2002, making it sort of the swan song to Second Wave Emo. This album is a real tour de force for the genre and is recommended to anyone who misses that 90s sound.

Piebald - We Are the Only Friends We Have (2002)

Piebald was firmly entrenched in Second Wave Emo canon by releasing several EPs and albums in the 90s. These quality Midwest Emo releases would ensure the band had a loyal cult following, but they arguably released their magnum opus in 2002 and changed the trajectory of their legacy forever.
Taking the bones of Midwest Emo and using different time signatures, they unlocked their melodic potential on this album by incorporating elements of the burgeoning Emo-Pop movement. The anthemic hooks only add to the experience, making this arguably their best album. Do not let the Emo-Pop influence deter you - the edginess in the production ensures this is Emo, through and through.

Pop Unknown - The August Division (2002)

Conventional wisdom says this album isn’t as good as Pop Unknown’s previous LP, but I’d like to think The August Division stands on its own next to its progenitor. Taking Midwest Emo, sprinkling in some Post-Punk elements and injecting the whole thing with a ton of infectious melody, Pop Unknown deliver with their swan song. This album immediately grabs your attention and refuses to let go.

Brandtson - Dial In Sounds (2002)

Utilizing classic Midwest Emo as a base and tossing mild Pop-Punk and Post-Hardcore elements is a winning formula with Dial In Sounds. With a career spanning from the late 90s into the mid 00s, Brandtson has released a prolific discography with somewhat mixed results, but this one is a definite notch in the “win” column.

Pedro the Lion - Control (2002)

Put simply, this is a bummer album. The Indie Rock-soaked Emo of Pedro the Lion's previous releases is present with bitter, crunchy guitars and a melancholic storyline that weaves the album together. The slew of mid-tempo tracks with Bazan’s droning voice wear on you emotionally over the course of 10 tracks.
Pedro the Lion is known for consistency, but this is perhaps their most solid and memorable outing as a band.

The Gloria Record - Start Here (2002)

The successor to Mineral, The Gloria Record was a passionate Midwest Emo band with less Post-Hardcore than their predecessor. The band's sound is often compared to Radiohead, and not just because their songwriting is both excellent and TGR display Indie traits, but because Start Here is this band's OK Computer.
The Emo bones of the band are present here, but the sonic exploration employed by Simpson and the boys is as vast as it is genre-defying. Perhaps calling this a “vestage of the Second Wave” isn’t exactly true as this album could have been revolutionary for the genre had it blown up in popularity. However, as dying branch of the Second Wave, this underrated album deserves its place here for how forward-thinking it is.

Camber - Wake Up and Be Happy (2002)

Bursting onto the scene in 1997, Camber gained some notoriety by being in the first Emo Diaries compilation, along with a very good SDRE-inspired first LP. After a few more releases, they put out their last full-length in 2002 and is considered one of their weaker releases. However, I think there are some pretty decent ideas in here and the songs are pretty neat. Check it out if you’re itching for more authentic 90s Emo.

Kind of Like Spitting - Bridges Worth Burning (2002)

Since the mid 90s, Kind of Like Spitting occupied an unparalleled space during the Second Wave, playing Midwest Emo with heavy dosages of Indie and some Folksy elements for good measure. A prolific discography and a few magna opera later, we’re in 2002 with KoLS’s final Midwest Emo release, Bridges Worth Burning. This LP is arguably on the same level as their previous greatest releases, trending toward being more upbeat.
Beyond anything else, the passion with which this band plays, particularly in the vocals, is undeniable, much like the lyrics. Very few albums sound quite like this, so this is a must-listen. Soon hereafter, KoLS would veer hard into the Indie Folk direction, so this really serves as a denoument to their Emo career.

The Casket Lottery - Survival is for Cowards (2002)

The Casket Lottery is a band with amazing longevity and consistency, having made splits with the likes of Hot Water Music and Touche Amore. After some really good albums and EPs in the late 90s / early 00s, 2002 saw the release of (arguably) their magnum opus, Survival is for Cowards. A potent blend of Post-Hardcore and Midwest Emo, this LP borrows much from the Second Wave but introduces fresh songwriting ideas, making this a sort of breath of fresh air.
Extremely powerful vocals are driven by an exemplary rhythm section that keeps the listener engaged throughout its ~30 minute runtime.

The Jim Yoshii Pile-Up - Homemade Drugs (2002)

Somehow, despite being brighter and overall more hopeful than their debut LP, Homemade Drugs is still a distressing, uhurried album. Tiny elements of Indie and Post-Rock are evident in this album, beginning to turn the Second Wave sound in a new direction.
Homemade Drugs isn’t the most well-known or beloved release in this section, but it is one of the best, especially if you’re looking for Emo music to sit back and dissociate to.

Jets to Brazil - Perfecting Loneliness (2002)

Emo woven with equal parts Indie Rock, this late 90s Emo “supergroup” released their final LP Perfecting Loneliness in 2002. Little debate exists that Jets to Brazil's first album is their all-time musical accomplishment, but their final album is still worthy of praise. Fantastic lyricism and an overall softer tone characterize this album.
Songs regularly exceed 5 minutes of length on this album so if you’re searching for quick bursts of energy as songs, this one isn't for you. However, if you enjoy a mature take on Indie with inextricable Emo roots, this one is worth a listen.

Waxwing - Nobody Can Take What Everyone Owns (2002)

Waxwing produced Punk-leaning Emo goodness with their final LP. Although the album isn’t extraordinary, the songs are quite fun and energetic with pretty good vocals. Notably, one of the band’s guitarists, Cody Votolato, was working with The Blood Brothers at the same time.

Kid Brother Collective - Highway Miles (2002)

Simple, old-school Emo that will make you yearn for simpler days. In the end, that’s all this genre needs. Nothing extraordinary on display, but more fare for those in the Mineral / Penfold camp.

Rainer Maria - Long Knives Drawn (2003)

Although Rainer Maria had changed fairly significantly since the band’s origins in the 90s, namely in the absence of masculine vocals, they had strong Emo ties in this 2003 LP. An Emo / Indie hybrid with the ethos of the Second Wave, what sets this album apart is how poppy Rainer Maria allow themselves to go, giving a memorable quality to the majority of the songs. This is an excellent addition to the band’s consistently good discography.

Cursive - Ugly Organ (2003)

This one is probably one of the most well-known and beloved albums on this list, but I figure it’d be worth including it. Cursive began their career in the thick of the Second Wave, releasing two decent albums in the 90s before unleashing their first masterpiece Domestica in 2000. Following up on this unbelievable LP would be no small feat, but when Cursive released Ugly Organ in 2003, they did just that with an equally (if not more so) compelling album.
About 50/50 Post-Hardcore / Emo, Ugly Organ adds a cellist to the lineup, greatly expanding past the audio barriers of the genre’s typical instruments. Sinister, dissonant and brooding, this one needs to be heard to be believed. One of the best releases during the Third Wave. Fortunately, this band is still kicking and making awesome music.

Elliott - Song in the Air (2003)

The third and final full LP from Elliott, Song in the Air bookends their legendary (if somewhat obscure) discography with another great release, even if it perhaps falls short of the grandiosity of False Cathedrals. Regardless, this record encapsulates the evolution of a band from a more typical Mineral-like vibe to a dreamy, ethereal one. The vocals are smooth and gentle while the atmosphere provided by the instruments is dense and layered.
Elliott typify Second Wave Emo in one respect while pushing the boundaries of the genre at the time. You can really feel that this band could have gotten big under the right circumstances.

Small Brown Bike - Nail Yourself to the Ground (2003)

2003 was Small Brown Bike’s biggest year, having released an LP and EP, both very well received. Utilizing that classic Post-Hardcore / Emo formula with their very own spin, Small Brown Bike sound like no other on this EP. With only five songs (and one being a completely different folksy song with slide guitars), the band gave 2003 a huge opening salvo with this one.

The Appleseed Cast - Two Conversations (2003)

The Appleseed Cast is one of the most prolific acts in all of Emo and, by the Third Wave, had already established themselves as one of Emo’s great innovators. They experimented with Post-Rock on Mare Vitalis and perfected the combination of Post-Rock and Emo with Low Level Owl Vol 1 and 2, all before 2002 even hit!
Two Conversations takes the grandiosity of Low Level Owl and strips it to its barest form, more personal and intimate than anything this band had released previously (and possibly since). A breakup concept album isn’t exactly ingenious, but it’s executed very well across 10 songs; each track is handcrafted to fit the album’s flow perfectly and they add up to be greater than the sum of their parts. This band, and especially this album, would have a huge effect on Third Wave Emo going forward.

Small Brown Bike - The River Bed (2003)

Expanding sonically on what they produced earlier in the year with Nail Yourself to the Ground, Small Brown Bike ended their first run as a band with an immensely influential full-length album. One could argue that the sound palette screams Post-Hardcore and doesn’t have much to do with Emo, but the album owes almost its entire structure to 90s Emo.
The catchiness of the vocals and instruments is juxtaposed perfectly with the rough Post-Hardcore edges of each track, sacrificing none of the heaviness of the band in the process of getting stuck in your head.

Brandtson - Send Us A Signal (2004)

Brandtson dives deeper into the Indie Rock sound but doesn’t lose its core Midwest Emo roots with this full-length. With more Emo-Pop influence than ever, the hooks are as catchy as they’ve ever been for this band. You can hear the evolution of their sound compared even to their previous record, and that’s definitely a good thing.

I Hate Myself - 3 Songs (2005)

With almost no released music in the 2000s, I Hate Myself produced one final outing in 2005 with their 3 Songs EP. Gone are the half-Emo, half-Screamo days of yore and this one is pretty much pure Second Wave Midwest Emo. However, this leaves room for wonderful vocal melodies and driving songs. Definitely worth listening to this band’s final moments together.
This next section covers albums and EPs released in the Third Wave that are heavily indebted to the Second Wave’s signature sound from bands that weren’t really around for that time period. This should go to show that even though Emo was taking on an entirely different meaning in mainstream contexts, there were many acts dedicated to keeping the older traditions alive. This section is called Carrying the Flag of the Second Wave.

.waterpistol. - Between Here and There is Everything (2002)

Debuting with a three-song EP in the year 2000, this relatively obscure band is far enough removed from the Second Wave to appear in this section, at least in my opinion. Fun, active prototypical Midwest Emo is what you’ll find on this album. This definitely sounds like Hardcore kids doing softer Emo music and it shows in the ever-present energy of the instruments and vocals.
Rest of My Life - Rest of My Life (2002) This is the first release from the How is Annie label in Norway, one that is very important to the Nordic Emo scene. Rest of My Life’s self-titled LP is heavily indebted to the sounds of Second Wave Midwest Emo with hints of Post-Rock throughout. This sound palette would be a staple of the How is Annie lineup of bands, some of which you’ll see later in this series.
A strong presence of Post-Hardcore in the occasional screams and heavier moments of this album give the songs a sense of urgency while the Post-Rock influence ensures the serenity of the quieter moments. This small evolution in Emo’s sound helped pave the way for more great releases in the future.

Time Spent Driving - Just Enough Bright (2002)

One of the more popular albums on this list, Time Spent Driving played classic Midwest Emo with Emo-Pop sensibilities on this album, giving the release its own brand of charm. Situated perfectly at the edge where Emo went mainstream and where Emo remained underground.

Rescue - Volume Plus Volume (2002)

With their debut LP, Rescue took the Post-Hardcore / Emo combination that was so popular in the mid-late 90s, added Math Rock elements like changing time signatures and played almost every song with a sense of urgency. Had this released sometime in the late 90s and was picked up by the right people, we might be calling this a minor Emo classic today.
In 2004, the band rereleased this album as Volume Plus Volume Plus, which included a bonus CD featuring their 2002 EP Even People and Not the Odds and other unreleased tracks.

8-Bit Revival - Up & Atom (2002)

Standard 90s-sounding Midwest Emo fare, this debut EP is a great look into an up-and-coming underground Emo band. This group would change their name to Oh Condor but possibly changed it back at some point (not so sure about the name change history), so expect to see more of them in this series.

Time to Fly - Birth.Work.Death (2002)

On their sole release, Time to Fly utilized the blueprints left behind by bands like Penfold and injected it with a high dose of Emo-Pop, a burgeoning influence during this period. Regardless, the LP stands on its own as a Second Wave-inspired Emo.
The vocals are catchy and melodic, juxtaposed by the occasional scream. There are tons of riffs and even some twinkles in there, adding to the diversity of dynamics found throughout the album. This is a true hidden gem.

Rockets and Bluelights - Close At Hand (2002)

Released during an unknown time in 2002, Close At Hand is Rockets and Bluelights’ first demo. Simply put, this thing rocks. Produced with that 90s analog sound, this harrowing mix of Post-Hardcore and Midwest Emo comes at you with great force, but it doesn’t take away from the subtle elements of Post-Rock that somewhat spring this band into the future of the genre. Alas, I’ve decided to place them in this section of the list.

Susquatch - First Demo (2003)

Since the 90s, Japan has had a flourishing Emo scene. Most here are aware of the Japanese Post-Rock / Screamo combination made famous by envy. However, Japan also kept Punky / melodic Emo alive during the 00s, usually with unique influences.
susquatch is a band that gained notoriety in 2009 with their twinkly debut LP right at the beginning of the Revival, but most are not aware of their debut Demo EP. With just the smallest hints that this is Japanese Emo, susquatch actually plays tribute to the greatness of Second Wave Emo quite effectively here. This isn't their only appearance in this series, but with four years to go before releasing their next EP, their sound would undergo massive changes.

Halos for Martyrs - A Rush of Sound and the Silence That Follows (2003)

Make no mistake: this EP is a love letter to Second Wave Emo in both production and style. The ever-present Post-Hardcore accompanies Halos for Martyrs through an Emo musical journey while Math Rock influences seep in through the cracks, particularly in the twinkly riffs scattered about. This release was definitely an overlooked gem in 2003.

A Season Drive - Summer of ‘73 (2003)

On the lighter side of Emo without veering into Emo-Pop territory, A Season Drive delivers a fun Second Wave-esque album in the vein of Sunny Day Real Estate. This album is by no means a classic, but it does keep the old ways alive for just a little bit longer.

Filmmaker - Invitation to an Accident (2003)

Plain and simple, this is Seam-esque Midwest Emo done right, with just the right amount of Indie Rock influence to give the vocalist some fun melodies to play with. This band had one other EP released in 2001, but this would be their final release. Though this album is very short of groundbreaking, it’s a worthy listen for 90s Emo fans.

Settlefish - Dance A While, Upset (2003)

Extremely difficult to find, this album has about half the songs featured on other Deep Elm compilations, so you can still hear the masterful and somewhat bleak Midwest emo songwriting used throughout. Nothing here is exceptional, but this refreshing take on Second Wave Midwest Emo features its share of twinkles and fun, mathy moments.

The Jealous Sound - Kill Them With Kindness (2003)

Quite jealous I am, indeed! To create such pure, unadulterated fun is an underappreciated aspect of Emo but The Jealous Sound does so with very simple song structures. Now yes, let’s clear the elephant in the room: Brian Shehan of Knapsack fame reprises his role as frontman of this band, utilizing a familiar Indie Rock / Emo approach. Knapsack’s unique qualities made them a very influential Emo band from the mid 90s, but few could hope to replicate them. Even The Jealous Sound doesn’t exactly…sound like Knapsack.
Fear not, for while The Jealous Sound is inherently indebted to Brian’s earlier project, they stand on their own two feet. With less overtly-Punk-influenced songs than Knapsack, a healthy use of synths and a few Emo-Pop sensibilities, they definitely are beginning to grow out of the shadow of Second Wave Emo, but perhaps are too intertwined with the time period to be completely removed from it.

The December Drive - Handslikegunsandcrashingsounds (2003)

Releasing in 2003, this album was allegedly in the works for about three years and DAMN does that seem right! At its core, Handslikegunsandcrashingsounds is a Second Wave-inspired Emo / Post-Hardcore tour de force. Small elements of Post-Rock seep into the album, generating a powerful aura around each song. Powerful guitarwork lays the foundation for a truly unforgettable vocal performance.
Although this album takes a lot of direction from the Second Wave classics, The December Drive injects this album with their own flavor, giving this album a slightly forward-thinking edge compared to many of the true 90s Emo bands. This is without a doubt one of the best albums in this entire section.

Dead Letter Auction - Cancer of Time (2003)

Dissonant and noisy, Cancer of Time is Dead Letter Auction’s only full-length and boy, is it a doozy! If you like technical Post-Hardcore with a 90s Emo foundation, you’ve come to the right band. The shouty vocals add to the cacophonous atmosphere as much as the dynamic shifts to quiet.

Outsmarting Simon - Silent Sober and Sound (2003)

Taking as much influence from Mineral and Penfold as they did from early Jimmy Eat World and The Get Up Kids, Outsmarting Simon debuted with this great traditional Emo LP. Silent Sober and Sound showcases the band's propensity for quiet-loud dynamics and dreamy atmospheres. Not the most memorable album, but definitely one with a pulse on the genre.

Rockets and Bluelights - A Smashed City with Flames and Music in the Air (2003)

One of the most criminally underlooked and underrated Midwest Emo releases ever, it’s also ludicrously short with only four songs. The Post-Hardcore guitar tone is punchy and robust, leaning into the Emo clean dynamic seamlessly from the heavy distortion. The rhythm section does wonders in giving the songs style, keeping up with the spastic energy of the highs and the subtly of the lows.
Rudimentary Post-Rock song structures come into play in this EP, giving each track its own identity.

Kid Kilowatt - Guitar Method (2004)

Wow, this stuff is great! It almost sounds like it was ACTUALLY recorded between 1996 and 1999! Oh…well, it looks like it WAS recorded during that time! I’m not sure if this album should count on this list as it’s more of a compilation of the band’s recorded material from that time, released in CD format a half-decade after their breakup, Regardless, Kid Kilowatt featured members of Cave In, Piebald and even Converge. Despite that sort of street cred, they played fairly straightforward Indie-influenced Emo.
This LP can feel a bit disjointed at times, a consequence of releasing all of the band’s material at once in LP format. However, if this album had come out in the late 90s while the band was still around, we might be calling this one of the best undiscovered Emo bands of the 90s (I guess we can technically still call them that).

The 101 - Green Street (2004)

The 101 use analog-sounding production that would be at home with the 90s Emo greats, utilizing some primitive Emo-Pop elements such as great use of melody and the odd synth here or there. The individual songs may not have much to write home about, but the flow of the album is actually quite good, making the sum greater than its parts.
This is especially good if you dig Christie Front Drive.

The Moirai - Bury Yourself (2005)

Brian Carley, vocalist and guitarist of Penfold, refused to let Emo go by the wayside in the 2000s. Somehow, in the year 2005, The Moirai managed to unveil a 90s Emo classic that seemed lost to time and had just been unearthed. Midwest Emo had all but perished from the face of the Earth at this point, especially in the form of 90s Second Wave Emo, but The Moirai’s sole release aimed to inject the dying genre with one last super boost.
Bury Yourself is a true successor to Penfold’s two classic Second Wave albums, featuring almost every member of the aforementioned band in the credits. The complexity of the compositions appears deceptively simple to the untrained ear, but the quiet-loud dynamics that Penfold made a career of are all here in spades. Brian’s vocal performance is as good as it ever has been; legitimately, one of the best vocal performances you’re going to hear in this entire series. The vocal mastery is only matched by the intelligent, passionate lyrics it delivers. Alas, the Second Wave can finally rest easy knowing The Moirai gave it a proper sendoff.

Minor Ache - Black Hours Surround You (2006)

Black Hours Surround You is Minor Ache’s only release, coming in at about 30 minutes. However, despite being released sometime in 2005-2006 (the exact release date appears to be unclear), this has the spirit of a 90s Emo / Indie Rock classic! Light twinkles are strewn together by unpredictable volume and time signature changes. The vocals tend to be a bit droning, but that can be a good thing if you aren’t into the whinier side of the genre.
This gem comes by way of Melbourne, Australia! It seemed as though once the US gave up on Second Wave Midwest Emo completely, the international community stepped up and released a few bangers in the genre’s honor.

Build Nest, Sleep - Build Nest, Sleep (2006)

Another early release from the How Is Annie record label, Build Nest, Sleep produces old school Emo with a Noise Rock twist! The production is relatively lofi and the songs are smartly built around this. It creates a somewhat dense atmosphere, and atmosphere is what Norway’s infamous label does best. Perhaps not the greatest album on this list, but it is certainly quite an interesting one.

Relative - The Progression of Stagnation (2006)

Okay, time to be honest: I couldn’t find much about this band. I mean, can you? Why do half the Emo bands out there have either the longest, easiest-to-identify names in all of music or the least searchable names of all time? As you can see, Relative falls into the latter half; either this band got lumped in with a Hardcore band that released music in the 2010s and they took a vastly different direction with their music after their 2006 debut EP, The Progress of Stagnation or they just released this one EP.
This is arguably more Post-Hardcore at times, but the Second Wave Emo stank seems to have reached this band all the way in the mid-aughts. Look out for lush sections of Emo atmosphere get broken up by chaotic outbursts throughout.

The Brightest Comet - Demo (2007)

Female-fronted, Indie Rock-driven and unabashedly 90s in style, The Brightest Comet is a throwback Emo band in the vein of Rainer Maria or Eldritch Anisette. Their talented vocalist, Andi Camp, also performed vocal and bass duties for a 90s Emo band Ribbon Fix, so definitely check them out if you like this.
By 2007, Revival and Proto-Revival bands were coming together and started making music. The Brightest Comet decided to do it their own way and Second Wave lovers have every reason to be thankful.

Aura… - Enquanto houver sentimentos (2007)

Maybe news didn't travel that fast to Brazil back in the day; Aura… didn't seem to know the Second Wave was long gone and the Fourth Wave was already looming. But damn, did they ever release a 90s-inspired gem with Enquanto Houver Sentimentos.
The analog recording gives this a true DIY feel while the compositions are familiar yet somewhat complex. They sound like they could have opened up for Mineral back in the day.

Everton - Floorsleepers (9/27/2007)

Finally, our journey brings us to Austria with Everton. Floorsleepers features songs of varying lengths, but they always give the compositions time to breathe and create a true individual identity. The clean, chunky guitars provide a nice base for the sound while the rhythm section, particularly the drums, is active and lively, even during quiet moments.
Amazing, the production is also very reminiscent of the period they’re trying to visit. There must be a comparable “Midwest” area of Austria because these talented folks must be from there. The sad vibes are real.
That's it for part one! This one took weeks to compile, so make sure to be on the lookout for part two coming out sometime soon!

Hi! 26F here living in Australia, born in New Zealand.
For the last 14 months or so, I've had severe Chronic Spontaneous Urticaria that came up suddenly after a minor car accident in November 2022. I've struggled with this since, and currently am managing mostly okay with Omalizumab inj 150mg weekly, Famotidine 40mg daily, Montelukast 10mg daily and either 4 x 10mg Cetirizine OR 4 x 180mg Fexofenadine depending on what I have available.
It's been pretty rough, and having hives that cover me 24/7 has been pretty tough on my mental health etc. I take Venlafaxine 75mg as well to help, but recently also started Vyvanse 20mg daily to help with my ADHD.
Recently, I was supposed to have a second ankle repair for my calconeofibular ligament with an internal brace etc, after the initial repair failed after a year of intense recovery and six months off my residential care job, however I have decided to hold off on that procedure as my skin doesn't cope with anything at the minute. I then did a rotator cuff injury at Christmas and have a dropped shoulder due to not using the muscle, but as I can't even tape the shoulder, I don't know how I'm going to recover from it easily.
The physio suggested I look into Hypermobile Ehlers Danlos Syndrome as I have a Beighton score of 9, have had multiple random injuries over the years (hyperextended my right arm when I fell backwards years ago and did a supracondylar fracture, did a cuboidal subluxation just walking down some steps, with my ankle, I did the initial eversion as I was crossing the road), and mentioned that my skin is also a sign of it.
I'm a bit shocked by all this, and I really feel let down by my body at 26, I've been trying to just live my life, and I'm incredibly frustrated.
Happy to attach photos of the urticaria of need be, I see a dermatologist who has told me it's an incredibly resistive type, because even the XolaiOmalizumab injection just stops it being a whole body rash instead of patches. I've had three or four random episodes of angioedema too, and now carry an epipen just in case, but it's usually my eyelid swelling shut, swelling on my lips has only happened once.
I suppose what I'm asking is if there's any known link between CSU and hEDs. I know that some people with hEDs have MCAS, is this a similar type of reaction?
How am I meant to protect my current weak spots (ie. Ankle and shoulder), without being able to use a brace or taping? I work a really physical job that I love, and I don't want to give it up unless I'm out of options.
I'm not sure if I meet the full criteria for hEDs, but it does make a lot of sense if I do, and I'm going to look into diagnosis if that's a possibility.

I'm making this to hopefully SAVE someone from going through what I'm going through right now.
I took 3 Invega Sustenna Injections (biggest mistake of my life, 3 1/2 months in now)
Chest pains (excruciating the first 2 weeks), brain burn, anxiety, drowning sensation, severe anhedonia, sexual dysfunction
The drug has a 49 day half life and stays in your system for average a YEAR. A WHOLE YEAR.
I've been lucky to have some symptoms loosen up like the anhedonia, some days I get to live without as much stress and other days the symptoms crowd around and my day becomes filled with panic and fear. The anxiety stems around how my symptoms get to a breaking point and I pray that they don't cross the breaking point to make my situation unbearable.
I spent 2 months in unlivable circumstances and up to 3 months in barely livable circumstances and right now it is still difficult because of the plethora of symptoms that bother me each day.
The anhedonia is brutal and is like a wall blocking you out from any feeling that revolves around dopamine. You will feel like you are put inside of a hole in the ground buried alive with your idea of reality being to merely exist.
This drug should be banned and there is a bluelight forum of 8 versions of 250 pages that details what individuals are going through being trapped on this horrid drug.
https://bluelight.org/xf/threads/coming-off-invega-xeplion-paliperidone-injections-v-8-0.934528/
It is the only popular forum on bluelight for an antipsychotic and one of the most popular on the website. This is how bad this drug is.
Doctors deny that this drug stays in your system longer than a month which shows how completely clueless they are. This drug has been on the market for 15 years but it is still clear that they didn't do enough research to clear it for safe effective use.