One way things often play out is I finish logic processing and know the next step while you're doing emotional processing; I need to offload it so email you but it seems too soon and insensitive. Then later, you need to email me about some practicality, but I'm mid-emotional processing, and the tables are turned.
Hypomania
So unfortunately that pink cloud was hypomania, but it was a little more complex than that so I’ll break it down. A clinician would probably say ‘underlying blah blah’ but it was drugs and a different underlying blah blah.
There’s a reason and I think I’ve got it.
Underlying low dopamine along with dysregulation. And then the drug dose being too low, not too high. Let me explain.
So aripiprazole sits there on dopamine receptors, blocking dopamine from getting in, and activating them about 25% of the level that dopamine would. This means that they are never fully activated or fully deactivated. The occupancy of these receptors is dose-dependent, and the occupied receptors just smoulder away.
I have low dopamine, so aripiprazole raises my dopamine and makes me feel motivated / hyper. It pushes me toward mania, but the thing that tips the scales is a looped thought on the medication. Anyway it’s a combo.
At 1mg it activates about 50-55% of receptors. These were not activated before, so we have that extra boost, plus my normal dopamine spiking around. Higher baseline, better functioning, but also more hyper. I feel enlightened. The med has raised the baseline but it hasn’t shaved the top off enough.
At 2mg it would occupy 60-65% of receptors and it’s a different ball game, because the upper limit placed on dopamine would come more into play. So it would raise the baseline, sure, but it would also lower the ceiling more. I don’t feel enlightened; I feel regulated.
Anyway we are stable at 1mg but after the events of the winter I am very cautious of any kind of motivation. I slipped into depression these last few months and this pill has pulled me out of it. But I don’t want it to tip the scales too much the other direction, and the pharmacology suggests that increasing the dose would make it more of a mood stabiliser, so increasing the dose is probably best.
Essentially it was a titration issue. But reverse-titration issue, I think. My kid, who weighs <30% me, is on the same dose. That doesn’t feel right.
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