ish.fyi ▮

Third Gear

Authors Note: As you read through this essay, you’ll notice my writing style often meanders into tangents (labeled with [T]) and imperfect analogies. I have included numerous links to extra resources, fuel for this writing (aka music) This is a reflection of my personal journey, with all its quirks and imperfections, and I hope you find it relatable and engaging. White people don’t say nigga.

2025 So Far

Since November, I’m been experiencing the tide shift my Bipolar Disorder.  My condition was manageable with my current medications, but it h as deteriorated.  By February, I was tearing at the seams. After a few set backs at work, I decided to it was time to take Medical Leave and received approval for an initial 30 days.

For Depression, they use a rating scale called PHQ-9. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. On February 25th, I had a score of 20. I knew I needed to make changes.

I also use bad analogies and metaphors for how I feel but I’ll try to describe as best as possible how I’ve been feeling since February.

[T] Imagine its a hot summer day. Beads of sweat cross your brow as if you the suns warm radiate throughout your body. You walk inside and grab a cold carbonated beverage (for me, its a Sprite). It’s ice cold and it sends shivers across your skin but its slightly pleasant. You open the beverage and the carbonation dances across your tongue as the cold liquid refreshes and tames the heat.

The physical sensation of carbonation, the pops, crackles, sizzles is what I feel on the exterior. A constant vibration that roams and is constantly moving on the surface. Yet, this feeling isn’t a pleasant one. It oozes into the environment and dances like a shadow cast by a dim candlelight. I see a slight movement and I panic. I hear a sound and I’m distracted. I’m constantly worried about everything. It ranges from whether someone is in my house to past mistakes like forgetting to tip an Uber driver who gave me great falafel in 2019 or missing a commitment to my college girlfriend 15 years ago.  I worry why my body isn’t healing and why I can’t appreciate the good in my life. The driving motor, Anxiety, has an energy source and it is deep well. Each tear that falls from the depression enters into that well where the darkness grows in power.

The darkness is the poisons, peanuty center of a Reese’s.

[T] FUCK REESE’S AND FUCK MR. PLANTER BITCH ASS PEANUT

I’m allergic to Peanuts, its not that serious. No, I don’t carry an epi-pen. I have a spidey-sense for Peanuts. Miles Morales not Tobey Maguire.

[T] People say humans only use 10% of their brains. They fucking lied. We have the capacity for unbound energy within us. My brain just likes to use it for negativity.

Potential Relief?

In April of 2022, I visited the Center for Neromodulation and Stress on the recommendation of my first Therapist, L (I don’t know why I’m not saying her name. I talk about her all the time). She guided me for 5 years and helped define what was happening within me. For that I am forever grateful and in her debt.

The researchers and clinicians there are doing amazing work. I participated in a research study that wanted to test the effectiveness of a brilliant technique called TMS or Transcarnial Magnetic Stimulation.

[T] Developed in 1985! LIke a Virgin, I Feel For You, Out of Touch, Back to the Future, The Breakfast Club, The Color Purple and some fucking powerful magnets. I wasn’t even  swimming yet.

[T] I’ve been a Spotify user since 2011

[T] Spotify is now a hot piece of garbage.

[T] All my homies use Apple Music or Tidal or whatever the fuck else.

A typical (FDA Approved) TMS course happens every weekday over six weeks for a total of 30 treatments. This study would perform 10 sessions per day of imaging-guided active aiTBS (the whole ai revolution thing is hitting everywhere but ai here means Accelerated Intermitent aint no cloud gonna have my brain in it except my own) for 5 days with 1 session per hour at 90% resting motor threshold for 90 000 pulses total.

You might be thinking:

  • YO WTF IS THIS SHOCK THERAPY?
  • HAVE YOU TRIED INSERT PHARMACUETICAL HERE?
  • HAVE YOU TRIED INSERT RANDOM DRUG HERE? (hehe)
  • HAVE YOU TRIED GOING SOBER�?
  • HAVE YOU TRIED MEDITATION?
  • THAT SHIT MUST HURT?
  • WHO THE FUCK APPROVED THIS SHIT?
  • ISNT THAT SCARY?
  • DOESNT THAT SHIT HURT?
  • TOUCH GRASS NIGGA!
  • GET A NEW JOB MY NIGGA!
  • MOVE MY NIGGA!
  • HAVE YOU….

A few things to consider:  (also put this on real quick)

Pros

  • When I’m healthy I AM HIM. Look up himothy in the dictionary, you see [Idris Elba](https://en.wikipedia.org/- wiki/Idris_Elba),  and me

  • I ain’t got no time to wait another 6 weeks to feel if I feel better, one week is nice

  • Non-invasive

  • No Pills

  • Side Effects include:

    • Scalp discomfort and pain
      • Have you ever sat in an african hair salon and got your hair twisted for 5 hours?
      • pshh, i aint worried about that
    • Headache
    • I got a plug for Ibuprohen. Shit is bussin'
    • Tingling, spasms or twitching of facial muscles
    • Im tweakin’ all the time i’ll take it
    • Lightheadedness
      • I got a big ass head that shit ain’t light

Cons

  • I’m being a guinea pig (if you know me, you know I like being a guinea pig so this ain’t a con)
  • 50% I get a sham treatment (ouch!)
  • But really, if its a sham, i can walk into any TMS clinic and get the regular jawn
  • I gotta take a week off work (lol)
  • What if it doesn’t work? What’s next?
  • This is the real scary thing but its not a con its an example of my condition

So I signed up, I spent a week at Penn. I left on the last day feeling brand new. Who is this nigga? Swag is out of control, Mind is at ease, Mind and Body are one. From 2022-2024 the following things happen:

At the end of the research experiment (1-week) my PHQ-9 score was less than 5 [Chart] a 75% Reduction After a Week of Treatment Work starts improving. I’m learning more everyday 0 Professional Courses or Certification in 2021. 8 in Two Years Music Production Improves 10 songs released in a year (I know thats a spotify link they can still eat a dick) I build the confidence in myself that I am worthy of love and fall in love with a beautiful human

I start investing in my health.

  • Weight: 240 lbs –> 220 lbs
  • Blood Pressure: 145/93 -> 133/83
  • Cholesterol
  • HDL 96 -> 77
  • LDL 58 -> 37

What was I doing before the study and after the study and why TMS is the reason for the improvement.

Before TMS:

  • Work Hard/Play Harder (and Faster)

  • You saw some of the health numbers above

  • Medications (For my Clinical and Healthcare Marketing friends Was I taking a drug you market?)

  • Treating the Depression (this keeps me from going to low)\

    • Zoloft  100mg 1x in the evening [Start 2013 | End 2022 | 9 Years Total Medication Time].
    • I always thought that fluffy white cloud was the shit in 2002.
    • I was 12. Little did I know.
    • Side Effects include (aka things I had to counter while on these drugs that were supposed to make me better):
      • Increased sweating
      • Shaking (tremor)
      • Ya’ll def seen this one
      • Agitation
      • Change in sleep habits, including sleepiness or trouble sleeping
      • Sexual Problems (ya’ll dont need to know keep it movin’ pimpin)
      • Tiredness
      • Anxiety

  • Treating Acute Bipolar Mania This keeps me from going to high

    • Depakote ER  250 mg 3x a day  [Start 2018 | End 2022 | 4 Years Total Medication Time]
    • If you knew me from the time period of 2017-2018, I was a lot of fun. Hypomania is why I was so much fun
    • Side Effects include:
      • Hair Loss
      • Shaking (tremor)
      • Unsteadiness
      • Weight Changes

  • Treating my ADHD

    • Vyvanse 70mg 1x in the morning
    • Adderall 15mg As Needed (which is really 1-2x a day, a topic for another discussion)

  • Insomnia

    • Trazodone 100mg 1x at night
    • I wonder why I’m on this? (See First Bullet Point)

After TMS:

  • No More Zoloft!
  • No More Depakote!
  • I need less Trazodone!

Darkest Before Dawn 

2023 wasn’t without my cyclical descent into the abyss. The first real relationship I’ve had in my adult life came to an end. I fell into isolation. There were also pivotal moments in 2023 that energized me and gave me the strength to combat the wave of negativity I often create within my own mind.

People came out of the woodwork, yo.

International adventures minted relationships for life.

A New Years celebration lit a flame in my heart.

There were reasons to persevere.

So I do what I naturally do. I’m an idea guy. I diagnosed with ADHD. What does that mean?

START ALL THE PROJECTS

FINISH NONE OF THE PROJECTS

  • New Music Direction
  • Bro, you should be a 3D Print Master
  • Bro, you need to destroy everyone at Golf
  • Bro, you need to be able to deadlift a Car
  • Bro, you should develop skills and start your own business
  • Bro, you should be ballin’, trips every year, nice whip, dope crib
  • Bro, you’re the shit at work, boss up on these niggas

Through ’the work’—activities like meditation, prayer, cardio, cooking, spa days, or journaling — that help you better understand yourself and how you function that I’ve been diligently performing under the care of my current team. I can see, in hindsight, that I was creating a recipe for disaster.

The energy that now consumes me is one of positivity, motivation and enthusiasm. Anything is possible, all it takes is work. and I can fucking WORK.

But if we look at the things I set out to do, I managed to complete 10% of each item. My brain is racking up the to-do lists, my ADHD is creating more dreams, ambitions, and hopes. I’m working harder. I’m working longer. I’m pouring into my relationships. I’m reaching to pick up fragments of a broken home. I’m using gold to bond broken pottery fragments back together.

But, I find myself empty once again.

Where Do We Go From Here?

I’m empty. I’m exhausted. I’m running. I’m falling. So we are making changes. Yes, this falls into one of my traps (see above) but its the only thing I trust I can do effectively.\

[T] I have many mistakes, impulsive decisions, risky behaviors, and other actions that have led me to this point.

The Plan

  • Mind
    • rTMS
    • at least 36 sessions
    • Ketamine Assisted Therapy
    • at least 8 infusions
    • 3 Guided with a Therapist
    • 5 Post Infusion Guidance Sessions with my Therapist
    • TM Meditation
    • 2x a day everyday for the rest of my life.
  • Body
    • Strength Training
    • 3-5x a week. (Thank you, Sam)
  • Golfing
    • 2-4x a week
  • Weight
    • Get to goal weight
    • BMI SUCKS so I’m thinking like 18% Body Fat?
  • Home
    • Clean up this shit hole
    • Organize it
    • Make it your own
  • Relationships
    • Share as much as I can with the people I love
    • Understand that people worry because they ultimately care
    • (try not to)Do No Harm

It will be a journey. I don’t really think this will ever end. One day at a time.

With you, I’ll be just fine.

With Love,
Ish

March 15, 2025 ∙