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x-amount-verbs · 2 years
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zaharya · 2 years
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ADHD science ramble – a comment response
So if you know me at all, you know I have ADHD and also a neuroscience degree. Meaning sometimes I ramble a lot about the science behind ADHD and ADHD meds. Generally, people appreciate it at best, or ignore it at worst – but apparently not on reddit! So, I'm coming home – forgive me for straying, Tumblr, please give me back my belief in people's ability to understand nuance.
The comment below was in response to a post asking about ADHD medication, including concerns about stimulants and addiction, and the question of "will I quit these meds or is this a life-long thing". They also mentioned "rejection sensitive dysphoria" (which is not a medical term!) and asked for other people's insights on any of these things. I tried to give that. The original post is now suddenly deleted, and the comment was invisible even before then for whatever reason (I won't speculate whether it was censored by the mods or not, it doesn't matter.)
But since those are all pretty general topics and this was a lot of effort to write, I'm re-posting it here in the hopes someone will benefit from it – it may just read a bit odd at times because it addresses the OP of that post. So if ADHD medication, treatment approaches, stigma, or emotional dysregulation are at all relevant or interesting to you, give it a glance. There's a TL:DR at the bottom as well. If Tumblr could stop bitching at me about the formatting that'd be great. Please ignore potential oddities with the list levels.
COMMENT RESPONSE IN VERBATIM
OKAY SO, buckle in my friend because you have activated my ADHD research deep dive mode. For the record and some context as to where I got all this; I have a BSc in Psychology, and did a research masters in cognitive and clinical neuroscience. Throughout both degree programs, I've written every single paper I could choose the topic for about some aspect of ADHD. (I do not have a license for psychotherapy yet, but I am getting one.) I also just have ADHD myself. What I’m trying to say is: I know way too much about ADHD and now I must tell you about it because what else am I supposed to do with it — ANYWAY … I should probably structure this somehow so it’s less overwhelming. We’ll try this:
Medication
Strattera/Atomoxetine (ATX); how it works, why it may or may not be working for you
Stimulants; how it works, evidence regarding the risk of dependency and abuse, connections to other substance use (since you mentioned nicotine)
Long-term treatment plans; factors to consider / questions for you to evaluate for yourself
RSD — probably a rant, first; why buzzwords are counterproductive even if the experience is 100% valid
Emotional dysregulation; research again, also potentially about meds
rejection sensitivity slkjdsjfs it escalated, help
Community and peer support
Yes? Yes. Feel free to skip any parts that are too sciency, if that doesn’t interest you!
First of all, congratulations on your diagnosis! You’ve already made one of the hardest steps. But let’s get into it, shall we?
ADHD Medication
Non-stimulants / Atomoxetine (ATX)
I must say, I am quite surprised that you were prescribed ATX as your first option, given that stimulants are very firmly established as first-line treatment.
Regardless, a couple of facts about it: ATX is a selective noradrenaline (NA) reuptake inhibitor, which also affects dopamine (DA) levels, specifically in the prefrontal cortex (PFC) because— well because brain chemistry. (I’m trying very hard to keep this simple, can you tell?) Basically, the idea is to regulate DA levels through an indirect mechanism via NA. And that works pretty well, generally. ATX is effective for approximately 50-60% of people, and the effects reach moderate strength.
Now you said that you don’t really notice any effect; that can have several possible reasons:
It just doesn’t work for you; 50-60% of people show a response, sure — but the other 40-50% do not! Unfortunately it is possible that you simply are part of those 40-50% non-responders.
The exact mechanisms of that are still unclear, but there are many factors that might influence someone’s drug response, including individual differences in metabolism, genetic factors etc. --- we’re still researching that
ATX, unlike stimulants, doesn’t necessarily have immediate effects. Full therapeutic effects are generally not evaluated until at least 2-3 weeks after starting it. That also means that the effects can develop slowly, which can make them harder to notice because it’s a somewhat gradual change.
On top of that, if your doctor is even the slightest shred of competent (which I hope), they’ll probably have started at a fairly low dose, meaning that;
you might just not feel it yet, but the effect may still emerge
you might need a higher dose; if that’s the case, this increase is generally done step-wise and quite slowly, to monitor the effects (and side-effects) properly. I suggest asking your doctors about what kind of trajectory they have in mind, so you can decide whether that suits you.
You mentioned mood swings; definitely mention that to your doctor! Psychological side-effects of ATX should be closely monitored
Note that this is especially important if someone has (potentially undiagnosed) comorbid disorders. I don’t know whether that’s the case for you, but better to be aware either way.
All that said, I also take ATX and I must say that on its own its effects are barely noticeable for me. It’s only because I know that my symptoms can be worse that I even consider it effective. I am an unusual case, though, regarding med-response etc. and I take ATX in combination with Elvanse (Lisdexamfetamine; LDX).
Which I guess brings us to stimulants. You say you’re reluctant out of fear to form a dependency, if I understand correctly. Well, the research is quite interesting in that regard — but let’s cover the basics first.
Stimulants
Stimulants, i.e., various types of amphetamines (AMP) and methylphenidates (MPH), are the standard first-line treatment for ADHD. Both AMP- and MPH-class drugs essentially increase the efficiency of the PFC —same as ATX — but where ATX only directly targets NA, AMP and MPH inhibit the reuptake of DA itself as well as NA reuptake. This direct effect on DA levels is basically (very basic; oversimplified even) what makes them stimulants. It is also likely the root for your concerns about dependence risks, because DA is involved in our reward-system in the brain — i.e. the thing that tells you “i want more of this”.
So, yeah, these concerns are not unfounded, HOWEVER
It is important to remember/note that a lot of the public narrative around ADHD and ADHD medication is heavily distorted by stigma. The number of people who worry about stimulants being addictive is leagues away from the actual prevalence of stimulant abuse/dependence.
This also kinda ties into your question about whether you will stop taking meds at some point or not; the idea that treatment must be temporary roots in the stigmatisation of mental health treatment.
I’m not saying that life-long medication treatment is a delight and a joy, but I also don’t think that it is the ultimate evil it’s sometimes made out to be. –– EXAMPLE: Think of a diabetic; they will need insulin for the rest of their life, but in their case nobody would ever suggest that them taking it is somehow a bad thing.
Mental health in general is unfortunately still heavily stigmatised, and that also impacts the narrative around treatment options, including medication. And more often than not, public beliefs about psychiatric conditions are downright and blatantly wrong.
In this particular case, actual research indicates that stimulant treatment actually decreases the risk for substance abuse in ADHDers. (Generally, adequate ADHD treatment reduces risks for all sorts of unpleasant things, like comorbid disorders, social isolation, divorce, accidents — I could go on. Not the point.)
The point is that overall, from a research perspective, the risk of drug dependence due to stimulant medication is quite low. Hell, literally everyone I know who takes ADHD meds will go “shit I forgot my meds” at least every other month or so.
Of course that doesn’t mean that we can all just pop stims however we like without a care in the world. As with any other medication, monitoring effects and side-effects together with a doctor is key.
With all that said, there is good reason why stimulants are first-line treatment for ADHD: 65-80% of people show a treatment response, and for a lot of people who don’t initially experience an effect, switching to another type of stimulant will often do the trick (total response rates of ~90%). Besides the fact that they work for more people, they also generally work better than non-stimulants, meaning that the symptom improvements are stronger for stimulants. Does this mean you should just get over yourself and go for stimulants because they’re clearly superior? Of course not.
Medication response is ultimately a very individual thing; it is basically impossible to know how you’ll react to any given medication before you try it. So in the end, it really comes down to what you want. It’s your decision, based on your priorities and values.
The same goes for your question of “will I take these meds forever” — that’s up to you!
Generally speaking, ADHD doesn’t go away. It is not something you grow out of any more than you can grow a second brain to replace the one you have. And our brains have ADHD. So, symptom-wise, we will always experience ADHD to some degree at least.
Of course, there are plenty of other treatment approaches such as CBT and literal mountains of helpful strategies to learn about and use. And that’s wonderful! Still, therapy alone is generally considered less effective than meds, but it does help. The best treatment approaches are multimodal, i.e. a combination of pharmacological treatment and behavioural interventions. Aka we take meds and go to therapy. Amazing.
So let’s say you’ve taken meds for a while, you’ve gone to therapy, you’ve learnt all the strategies — you decide to quit the meds. What happens?
Well first of all, nobody can know that beforehand, so keep in mind that these are hypothetical assumptions based on scenarios that research described as likely
Anyway, you quit whatever meds that ended up working for you. Ideally, you do that slowly so you don’t have any withdrawal issues, but eventually you’re off the meds. As a result, your brain isn’t getting that neurotransmitter boost anymore that the meds created (though some research shows that some benefits might persist, yay!), meaning that cognitive impairments are stronger again.
Does this mean all your symptoms come back? Well, yes and no. On a basic brain level, impairments return at least in part, but the strategies you learnt in therapy might still help you cope with those impairments better than you used to before.
So you might be overall more functional, thanks to those strategies, yes.
But strategies will not fix your brain chemistry, and if there’s no dopamine there’s no dopamine, and suddenly you spent all day in bed. Or you’re staring at your work open in front of you feeling like there’s a thick panel of glass between you and your screen/keyboard and you just cannot make yourself type. These things won’t go away, and strategies will not always do the trick
Personally, I dread the idea of living my life entirely off meds. My main hobby is writing, which is nearly impossible without my meds — and even if I had a less challenging hobby; I want to do things in life, not waste my time trying to get myself to brush my teeth. But, again, that is a very personal decision that you ultimately have to make for yourself.
Still, here are a few things to consider that might help you evaluate your options:
Need — what are your primary needs? Which symptoms are impacting you most? (Yes I’m getting to the RSD sfksjhgj)
Want — what are things you want beyond the most important needs? Where do your priorities lie?
Benefit — what benefit are you getting from [medication X]? How much positive effect does it have on your symptoms? On your life as a whole?
Need-benefit — do the benefits fulfil your essential needs? —> if not, that’s probably not the right med for you
Want-benefit — do the benefits fulfil your wants beyond the essentials?
Cost — what costs is [medication X] causing you? Do you have side-effects, if so what are they, how bad, how frequent?
Cost-benefit — do the benefits outweigh the costs, on a somewhat objective level? (effects vs side-effects)
Cost-benefit-want — Are the benefits worth the costs, also taking your individual values, concerns and goals into account?
This last one can get quite complicated, I’ll admit, but in the end I feel like this one is what tips the scale for a lot of people.
You could have the most amazing improvements, if you suffer side effects that keep you from something that is important to you, it’s probably not worth it in the end.
Vice versa, in my case, if it means I can write, I will accept that I’ll feel incredibly nauseated on some days for like 1-3 hours. It all comes down to individual choices in the end.
-deep breath- So, that was a lot, whops. So much, that I should actually go and work, so I’ll try to keep the RSD thing short. Conveniently, the AutoMod already summed up the most important bits:
RSD is not a recognised medical term
Instead of RSD, it is better to use concepts and terminology with solidly established definitions such as emotional dysregulation and rejection sensitivity to talk about the experiences people tend to label RSD
This is particularly important when consulting mental health professionals; well established concepts enable them to assess your symptoms and needs better than vague, ill-defined buzzwords. I have had people tell me they were going to switch to another doctor because theirs wasn’t familiar with RSD --- that is an issue!
Buzzwords like that tend to hinder treatment progress, because they are too vague to be properly informative. Most people have a very specific conceptual definition of RSD --- namely the one that describes their own symptoms best.
That renders it basically useless as a communicative device. Doctors cannot mind-read; you are doing yourself a favour if your communication (including terminology) is as clear as possible.
Obviously nobody expects you to know specialised medical terms --- just try to avoid buzzwords; of any kind! RSD is just a very very popular one and therefore warrants repeated clarification.
Now, just cause it’s not A Thing(tm), doesn’t mean it’s not a problem. And yes, the experience of rejection sensitivity in ADHD is valid and should not be dismissed!
Emotional dysregulation is actually one of the most prevalent and most impacting symptoms of ADHD, but because it isn’t part of the diagnostic criteria, a lot of people aren’t even aware of how much ADHD impacts emotions — and how much that impacts life for ADHDers. Emotional dysregulation leads to all sorts of other problems, like social isolation or comborbid mood disorders like depression or bipolar. So, clearly, it’s something should be addressed when it comes to treatment.
And would you look at that, they did! Yay!
Research shows that stimulants are effective for reducing symptoms of emotional dysregulation; as mentioned earlier, ideally you combine that with therapy.
Especially for emotional dysregulation, therapy — not just strategies, therapy — can be very beneficial, because emotions are hard. A lot of ADHDers, especially those that only get their diagnosis in adulthood, develop suboptimal coping mechanisms throughout their life that are very hard to dismantle without help. But resolving those patterns often makes an immense impact on the general quality of life.
Conclusion: Get a good therapist. It’s worth it. (Good = someone you trust and click with, you have to be comfortable.)
Now, one last thing (almost done I promise), because you said you don’t really have anyone to talk to about this:
I strongly encourage you to actively seek out ADHD communities in a format that lends itself to connecting with people on a personal level.
So, quick story time: Back in 2018, I (by complete coincidence) stumbled over a video of a TEDxTalk about ADHD on Patreon – who even browses Patreon?! Anyway, I watched it. Cried. A lot. Backed that Patreon immediately, before even looking at the actual YouTube channel it was for. The Patreon came with Discord rewards — I had never heard of Discord but there’s nothing like ADHD impulsivity, so I made a Discord account and joined that server.
Literally my whole life has changed since then. My perspective on ADHD has changed so so much simply through seeing other people having the same struggles, and yet they were still unique. And it was a wild ride. I look at some of the beliefs I used to have and am baffled at myself. But that’s not the main point, though knowledge always does help. No, the main point isn’t another strategy or lifehack. The main point are friends. True, actual friends who accept you, but also understand you.
When I joined that server, I very quickly met a lot of people. It was wonderful to suddenly be in a space where people related to my experiences that had previously always singled me out as weird or rude or incompetent or whatever. And all those people were lovely, but they’re not the friends I mean; most of them I am not in touch with anymore. I mean the select few. They are what made the biggest difference for me. I met one of my top two best friends like 2 months after joining the server, when we both became moderators. We later did community management together for over a year, until I moved on to other things — they are still Community Manager there! I flew to the other side of the planet for their wedding. We spend hours on video chat sometimes, both just working and hanging out because we like each other’s company (and it helps us focus). I can tell them anything, even if I hate what I did or didn’t do or say or think.
Those friends.
And I don’t know you, obviously, so maybe you already have that friend, in which case I’m very happy for you. But judging by your statement that you have nobody to talk to—
I’m not saying that joining an ADHD community will magically drop a best friend for you out of the sky, but it’s honestly not a bad start. Simply gaining the peer support of people who understand and relate to your experiences is worth it.
Okay, phew. Now I’m done. For your convenience;
TL;DR
non-stimulants might still take effect or you might need a different dose
stimulants are heavily stigmatised and the actual risk for substance dependence is quite low if the treatment is properly monitored by a medical professional
ADHD doesn’t go away; we will always have ADHD brains and there will always be issues that cannot be solved with strategies
It’s up to you to decide whether you want to take medication for it, and whether you want to take them long-term or not. I personally am fairly certain that I will continue to take these meds as long as I can. Even though there are downsides, the benefits are more than worth it for me.
Emotions are hard, everyone should go to therapy.
Make ADHD friends! (I personally really like Discord communities; I can recommend the HowToADHD community — that’s the server I mentioned earlier — but it’s unfortunately behind a (very low) paywall. If you don’t know that YouTube channel, I’d also recommend checking out Jess’s videos.)
But back to the point: Friends. Whichever platform you are comfortable with – try connecting with people beyond surface level conversations in public comments/threads/channels. Slide into those DMs!
And that’s all. That was way too long and I apologise. I hope any of it was helpful and understandable, I know I can get a bit sciency sometimes. If anything is unclear just ask. Good luck with your journey! It might be hard in the beginning, but it gets easier with time, I promise.
END VERBATIM
I hope anyone finds this useful, if only for validation. Shit's hard, but we'll all be fine, together.
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privateanxieties · 3 months
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Hello! I was just curious, are you continuing to write forget my mercy, take my blame? If not I understand! I came across it recently and was totally hooked but didn’t know if it was on a hiatus or not. You’re a super talented writer and I’ve really enjoyed your work! Hope you are doing well!
Hi! I am actually just getting back to continuing the series. I was sad to abandon it like I did, but come autumn I simply didn't have any more time to write and I haven't really put anything down since late October I think. I'm trying not to force chapters out, so it might take a while for me to get back into the groove of things and remember all that I wanted to do with the story and characters, but as long as my schedule is kind(er) this year, updates should happen soon! I'm glad you've enjoyed the story thus far and hope that will continue being the case as it evolves. Have a happy new year!
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worldtravelerbuff · 3 months
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youtube
So on the 18th of this month, I was just browsing around on my laptop and I got a comment notification on my phone from the Ink Demon Youtooz unboxing that I did, and guess what....Sean Crisden himself the VA of the Ink Demon commented on my video and let's just say that I screamed with joy and also squealed with delight when I saw the comment from a VA from one of the Bendy games I enjoy watching Let's Plays on! So, Sean Crisden…thanks.
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monty-glasses-roxy · 1 year
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Making this a new post so not to flood people’s dashes with one giant AU post!
@jellycreamjammedart​
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Ooooo being away gives him enough time and the space necessary to have the strength to come back at all and Gregory gave him the focus he needed not to get swept away by his own mind... Maybe he stays in touch with Vanessa and they can be talking buddies or he gets an over the phone therapist or something I dunno. Could be fun. Definitely space and time for him to come to appreciate that sometimes arson is the answer to your problems.
Also lmao Roxy yelling at him from across the room to keep his gremlin on a leash. “He don’t bite!” “YES THE FUCK HE DO”
No one tell Gregory the power he has over her now. He will absolutely abuse the fuck out of it.
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jameswoodall · 9 months
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PATREON EXCLUSIVE: Rick and Morty Comment Response Part 2 - The Super Fans.
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those70scomics · 9 months
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Random, but I love your comics! Especially the Laurie and Zenmasters comics!
Thank you! 🥰 I'm happy you enjoy them. 🥳
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dannyemojis · 1 year
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i adore your artstyle!!! could you do some more ram-kin emotes? /nf <3
I’m responding to this just to say that I have seen this! I will gladly make more ram-kin emotes as soon as I get the chance. I’m currently very busy with high school and therapy, so I do apologize for my schedule not being entirely free- but it will be done as soon as possible!
Drink some water and make yourself something nice, you deserve it! Love you :> /p /lh
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djcarnationsblog · 2 years
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Starly, you’ve made a wonderful point-
@starlypenguins I saw your fucking comment and holy shit I didn’t even remember that part XD. Felix is actually a senior, so what he’s doing makes it even MORE pointless because, like you said, he wouldn’t fucking have it for that long. THERE IS LITERALLY NO POINT TO HIS ACTIONS WHATSOEVER??? I mean, at least Edward has a few years to spare as king, if Felix ever became king he’d be the same as that one song artist who made ‘Somebody that I used to know’.
Just one minute in the spotlight and then fucking dip-
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asirensrage · 2 years
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I loved it!! 🖤 thank u for going with the very open pov, it's certainly been a while since I've read anything from that perspective - but it was fun & super neat! any possessive banter is my jam & u write it so well👌
Hahah, I'm so glad you enjoyed it!! Yeah, I usually only write ocs (and sometimes canon characters) but I went with it. You know me, possessive banter is my thing lol. I can't resist.
Thank you so much!!
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fictionadventurer · 4 months
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Personally, it's always a bit wild to me to see commentators interact with the Hunger Games franchise as if Collins were writing science fiction stories instead of essays with faces. She's just not that interested in fleshing out side characters or digging into the details of the worldbuilding. These characters are concepts and symbols before they're people. There's an almost mathematical precision to who and what she explores and how deeply she does it. This is a step or two away from pure allegory. If she were writing a couple of centuries ago, she'd have named her characters things like Innocence and Anger and Watch-Carefully-Your-Soul-Lest-Ye-Be-Damned, but since she's writing for modern audiences, she has to settle for puns and allusions. If she has another essay to write, she'll assign some faces to it; she's not going to look into backstories or other eras just for the sake of storytelling, and it's not a failing as a writer that she doesn't.
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x-amount-verbs · 2 years
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Stupid sexy silco
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lgbterrorist · 5 months
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privateanxieties · 1 year
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So, let’s clear something up, @eevylynn​
First of all, I don’t think that’s dramatic at all. It’s a tumblr blog. Blocking isn’t that serious. I block people without ages in their bio. I block empty blogs. And yes, I block people who serially like without ever reblogging or commenting. Why? A couple of reasons.
Likes do nothing. At most, they are a way of keeping stuff to yourself but off your blog. This isn’t instagram or youtube. Likes do literally nothing for helping anyone’s work (be it writing or drawing or anything at all creative) be spread around.
The other reason is that I find it personally kind of insulting. Someone tearing through my masterlist one by one while binge reading and leaving likes just tells me they like my fics a lot - enough to spend hours on them, but never three seconds to reblog or half a minute to comment. It means something to them but not enough to give it the time of day, or consider that others might want to read the fics they find so very enjoyable, and the only way they can do that is if someone reblogs them.
Second of all, this blog is mine to do with as I please. These fics are mine to do with as I please. I share them because I want to, but the simple act of them being shared does not make people entitled to them. I can restrict access for anyone, for any reason. I find that the reasons I have given are more than fair. No age? Blocked. I don’t want minors reading my fics now that I’m writing more mature content. No content on a blog? Blocked.
Constant disappointment caused by those who consume everything but never share it? Never have even one word to say in return for the thousands they’ve read? Blocked.
It takes me hours and hours to write these stories. I have a job. A personal life. Responsibilities. This is a hobby - an uncompensated one, the only reward for which exists in people’s responses to it.
Serial likes are the following response: I like your stuff so much. I’ve read almost all of it. But no one else should find it. And I won’t bother saying anything to you. Just keep creating stuff for me to consume, please. Faster if possible.
Does anyone wonder why creators everywhere, for any type of content, burn out and leave platforms? Why they just don’t participate as much as they used to? Well, this is the answer. No engagement. None of the things that we actually create for are received. We want to love and engage in fandom like the rest of you. We want a sense of community. That’s why we share our works.
I don’t want the constant disappointment of a million likes in my notes. Go find another writer here who won’t tell you the same. I’d rather have a tight-knit group of people who actually care enough to interact with my stories. Even just the once! I don’t think that’s demanding or, as you put it, dramatic.
If my personal decision is off-putting to you, you are welcome to not engage with my fics, or my blog. That’s what adults on the internet do. We curate the space we want to inhabit.
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emily-e-draws · 3 months
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something something jumping on that twitter trend
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morganski-19 · 2 months
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Steve seeing something on tiktok and trying it on Eddie
Steve: You know what I kinda really want right now, an orange
Eddie: Do we even have the oranges?
Steve: I’m not sure
Eddie: *getting up* Let me check. Nope, be back in ten
Steve: *to the camera* I was not expecting him to go that far
Ten minutes later
Eddie: *comes back to the apartment with a bag of oranges* Do you want peeled or sliced
Steve: Peeled
Eddie: Ok
Steve: *looking at the camera* I think he passed
Eddie: *handing Steve a bowl of peeled orange slices* Passed what?
Steve: Nothing
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