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When Containing Multitudes Feels Overwhelming and Flirting with Some Psychiatric/Neurological/Pharmacological Articles (Tuesday, July 28th, 2020)

As I suggested might benefit my chronic, life-long struggles to commit to a career advancement plan, I’ve been exploring records from various multimedia projects and recordings I’ve undertaken in past years wondering which turns of thought would best indicate the nature of previously broken commitments.

Yesterday I cited, rather abstractly “fear, worry, pessimism, frustration” as fundamental to this personal conflict. Revisiting what I said just over a year ago in what was my last so called “video diary” entry, before changing the label of my multimedia presentations to “vlog” which then turned to “podcast”  —June 14th, 2019—I see I made it quite clear that first of all I was troubled by the variety of my interests—that I essentially, could not integrate them into a poised mental juggle of integrated subjects and thoughts and ideas on those subjects in the context of the unique shape of how my mind synthesized them into an overall integration.   

Speaking about my process of a theoretical conceptualization of the video diary as an artistic medium I said:

“I’m still on a place where I’m thinking about things like how do I sort of want to

structure this?”(16:41-16:45). Indeed—I’m looking at a note in a notebook from Late March 2019 to June 15th, 2019 and I see I wrote in sloppy penmanship: “my mind is in a jumble & I’m trying to organize it.” I was trying to figure out: how would a diarist determine what about her or his day to note versus those parts of the day he or she overlooks?

On approximately June 5th, 2019 I wrote down a possible set of guidelines to follow: What I’ve been up to 1) “professionally” and politically 2) in terms of self improvement.

I also see around this time, according to my notes, not only was my mind bombarded with a plethora of interests but adding to the mix such concerns as the complex and vast dimensions of self-marketing and the background anxiety of feeling at that time rather desperate for some feeling of ability to earn more money than I was now that I had completed my college degree—like, shouldn’t it just have been easier for me to figure out how to “market?”; all I needed to do was just study what was written about it, right?) and that I wasn’t sure if the diary concept ultimately fit better as a vlog or a podcast or both (why I wasn’t into just writing out my thoughts and posting them in a blog like I am now? I don’t know) and then was fretting over which webcams were the best and which podcast mics were the best, which WordPress theme was the best, while trying to keep up with Rachel Maddow like intensity on the political developments—I tried, very obviously, to do too many things too quickly.

Almost Everything is Interesting to Me

Maybe some people just have a knack for assembling their daily routine without anxiety, and process monsoons of information exceptionally fast, and can discuss, with great employment of critical thought, what’s most crucial to them about that information, and on such a wide variety of topics, all the while making their websites and videos and podcasts look and sound so perfecr and crisp or just don’t care—that apathy perhaps even serving as a useful marketing feature?

I don’t have those capacities. I all too often get stuck gazing at possibilities—the beautiful spectrum of options and choices that I never make them. It seems like EVERYTHING IS INTERESTING TO ME. Yes, some things more so than others, but even those things that seem more interesting to me than other things, so many of them can seem so equal in arousing my curiosity—both topics of thought and possible mediums of self expression.

As Montaigne says in his epic essay “On Some Lines of Virgil”: “All topics are equally productive to me. I could write about a fly (God grant that the topic I now have in hand be not chosen at the behest of a will which is as light as a fly’s.) I may begin with any subject I please, since all subjects are linked to each other.” (See page 990 of the M.A. Screech translation of Montaigne’s The Complete Essays published by Penguin Books in 2003. 

(Yes, Montaigne is an absolute hero of mine. The idea I have of what a diary can be could not exist without Montaigne’s commitment to tracking thought so honestly and thoroughly and with as much commitment as he did. Where I find the personal essay and the diary entry 1)of the literary sort to differ is that one strives for as solid an overall thought process on a given topic – like a superb estimation—whereas a diary permits for the mostly or heavily spontaneous flow of thought—mind nearly what it is as it is but trying to essay itself in the very time of its being articulated. It’s a different kind of record keeping essentially. But yes, Montaigne is a hero of mine, just as Anias Nin and Susan Sontag are for their diaries where I find more genre-specific inspiration)

Drugs (Effexor Versus Remeron)

Just spoke with psychiatrist about anxiety, depression, and erectile dysfunction. We are going to try to reduce the Effexor (to wean off) from 150 mgs to 75, and transition to Merpazitine (Remeron is the brand name) at 15 mgs to start. I don’t know anything about Merpazitine.

According to a scholarly article from The Primary Care Companion for CNS Disorder published in 2013 and written by Abdulkader Alam, MD,corresponding author Zoya Voronovich, BA, BS, and Joseph A. Carley, MD (“A Review of Therapeutic Uses of Mirtazapine in Psychiatric and Medical Conditions”

[ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907331/ ]

“Mirtazapine is a novel antidepressant originally known as Org 3770. It was first synthesized in The Netherlands in 19871 and introduced in the United States in 1996. Mirtazapine has a unique dual mode of action as a noradrenergic and specific serotonergic antidepressant.2 Mirtazapine shows rapid improvement in the symptoms of depression, with minimal anticholinergic or serotonin-related adverse effects. Comparisons of mirtazapine to the selective serotonin reuptake inhibitors (SSRIs) suggest a faster onset of action.3 Most notably, in a trial designed specifically to test onset of action of mirtazapine versus sertraline, a significant difference in favor of mirtazapine was observed as early as the fourth day of treatment.4 The advantages of quick onset of effects and a favorable safety profile have resulted in frequent use of mirtazapine in psychiatric patients with comorbid medical problems.”

Taking a look at an Iodine.com

[ https://www.iodine.com/compare/effexor-vs-remeron ]

 comparison of the Mirtazapine versus Effexor (which I’ve been taking—Effexor is an SNRI whereas Mirtazapine is a Tetracyclic***) it appears that key differences include:

Effexor tends to cause more side effects

Mirtazapine tends to cause more drowsiness

Effexor is more likely to drain one’s libido and sexual functioning

Effexor may be more likely however to treat panic disorder whereas Mirtazapine is thought to be more so associated with simply treating generalized anxiety. (“Compare Effexor vs. Remeron”)

***what is a Tetracyclic? An article from Drugs in Context  (“Antidepressant efficacy and side-effect burden: a quick guide for clinicians”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630974

by Daniel Santarsieri and Thomas L Schwartz published in 2015) explains:

“TCAs [Tetracyclics], which take their name from the basic three-ring chemical structure common to them, act primarily by elevating serotonin and norepinephrine levels via uptake inhibition (similar to the later developed serotonin norepinephrine reuptake inhibitors [SNRIs] mechanistically). However, as they also antagonize muscarinic acetylcholine receptors, they are prone to anticholinergic side effects (e.g., dry mouth, blurry vision, constipation, urinary retention), which often limit their utility. In addition, TCAs are known to cause prominent weight gain and sedation and can block cardiac sodium channels, which in the case of overdose may lead to sudden cardiac death [19]. In a meta-analytic review of TCA compared with SSRI side effects, Montgomery et al. found that patients on TCAs discontinued treatment 27% of the time compared with 19% for those on SSRIs [20]. In elderly MDD patients, the rates were 33% and 16%, respectively [21].”

So, what’s the deal with these MUSCARINIC ACETYLCHOLINE RECEPTORS? An article (“Targeting Muscarinic Acetylcholine Receptors for the Treatment of Psychiatric and Neurological Disorders

https://www.cell.com/trends/pharmacological-sciences/fulltext/S0165-6147(19)30233-0

 by Sean P. Moran, James Maksymetz andP. Jeffrey Conn) and published by Trends in Pharmacological Sciences on November 8th, 2019 and featured on cell.com says:

“Muscarinic acetylcholine receptors (mAChR) play important roles in regulating complex behaviors such as cognition, movement, and reward, making them ideally situated as potential drug targets for the treatment of several brain disorders. Recent advances in the discovery of subtype-selective allosteric modulators for mAChRs has provided an unprecedented opportunity for highly specific modulation of signaling by individual mAChR subtypes in the brain. Recently, mAChR allosteric modulators have entered clinical development for Alzheimer’s disease (AD) and schizophrenia, and have potential utility for other brain disorders. However, mAChR allosteric modulators can display a diverse array of pharmacological properties, and a more nuanced understanding of the mAChR will be necessary to best translate preclinical findings into successful clinical treatments.”

Hmm…

References   [ + ]

1. of the literary sort to differ

By Sean O'Connor

Hi, I'm Sean O'Connor, a poet and writer pursuing my MFA in Creative and Professional Writing at William Paterson University, where I also work as a learning generalist and where I received my BA in Liberal Studies.

Currently. I also work as a writing tutor at Raritan Valley Community College and Mercer County Community College.

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