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PaperclipPerfector  1mo ago (text post)   1698 thread views

Wellness Wednesday for February 19, 2025

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

  • Requests for advice and / or encouragement. On basically any topic and for any scale of problem.

  • Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.

  • Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.

  • Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).

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Would SSRIs help in my situation?

I've been struggling in my job for a couple years now and it feels like it's all coming to a head. For a long time I've had a general anxiety and "head-in-the-clouds" syndrome which doesn't allow me to be fully present. I thought that maybe I'm just hopelessly mechanically uninclined. Have any of you experienced great success with meds? I'm put off by the negative experiences people can have on SSRIs. I want to free myself, not lose myself.

I have been on an SSRI for two years to treat my dysthymia, which I’ve had my entire life. It took six months for the SSRIs to fully get into my system at the right dose. They have been incredibly successful for me; they have turned the mountains into hills, and through a combination of medicine and therapy I’m on the road to winding it down this year and getting off of because I’m seeing the results me and my doctor were looking for. I did get fat, but getting fat is worth it lol, plus when I get off of them I’ll go back to normal.

Imo, mental health should be treated the same as physical health. If you had a headache, you could go without painkillers and try to tough it out on your own, but you could also save yourself a lot of time and energy by taking a painkiller in the meantime while you’re trying to sort out the cause of the headache. SSRIs are the same, but I would not start them without clearly defined health goals so you know when to stop them. You are not going to lose yourself in them lol, you have to gradually build it up and will have plenty of time to adjust to any mental changes.

The only drawback for me so far other than getting fat is you can’t miss a dose or your brain will start to glitch out with vertigo and things Will Not Feel Good, but Idk, people with migraines carry around pain meds, the diabetics have insulin, and the sad have their SSRI. At least one of the three is curable.

I'm a thin dude to begin with. Probably could use some extra pounds. But can the fatness be mitigated with exercise?

Oh definitely.

I wouldn't super worry about getting fat if you trend towards thin. I've also been off and on SSRIs for a decade and never had any weight gain.

They're about as effective as placebo, and come with potential suicidality and sexual side effects. Plus, you're entering into an addiction of needing an outside substance to be okay. I'd be careful and try other avenues first.

Everyday I choose not be a resentful person.

My list of contrarian non-emotional twitter anons have scissored. Elon and AGI being the core drivers ofc. Now, they're split between despairing, spewing vitriol or expressing wierdo-optimism towards an AGI world. For the first time since 2016, my social media diet is reinforcing negative emotions rather than becoming a source of information & relaxation. Over Jan & Feb, I've turned resentful, yoyoing between anger and despair.

Thankfully, I have caught myself early. But damn, it takes so much effort to be a positive & well-adjusted individual when your entire echo-chamber is in the midst of mania. I must keep myself off twitter. Hopefully in a year or so, it'll be normal again. Until that point, I must abandon twitter like I abandoned reddit during 2016's Trump hysteria. Thankfully, I have enough going on in life to keep me busy.

This can be a manifesto of sorts. No dead kids or apocalyptic proclamations. Just a promise that, everyday, I'll wake up and choose optimism.

P.S: This is a butterfly effect from tiktok being banned. My instagram reels algorithm was tuned to perfection. Only the funniest low-iq brain-rot. Perfect relaxation. Once a tiktok ban was threatened, reels received all the tiktok kids. Pair that with christmas & mariah carey generally ruining all insta reels, and my reels never recovered. I started using more of Twitter as a result, and it's all south from there.

Twitter turned into giga rage bait recently. Avoid! I say this as someone mildly sympathetic to many current day right wing causes too…

These social media apps need to have user-customizable algorithms. I want to see mostly non-political niche hobby content. Not mass engagement rage slop. I’m sure in the short term this maximizes user-seconds, but at some point people just quit. Does anyone really need to be on twitter?

Be me

Doctor with ADHD

Scrabble tooth and nail to get a refill of my ADHD prescription

Diagnosed and treated abroad, existing script not valid

Local GP takes pity on my bedraggled state and pulls strings so an appointment with a psychiatrist takes 3 months instead of 2 years

Show up to the appointment, after traveling 3 hours

Secure prescription for new drug (dexedrine, based on Scott's stimulant review)

Spend another 3 traveling back

Stop at pharmacy eager to get my meds, having run out of a 3 month supply of Ritalin stretched far too long

Be informed that my shrink has prescribed it as capsules instead of tablets. Said capsules are not a thing in the UK, for some reason.

No, this has absolutely zero effect on dosage or the dispersibility of the drug

It's a controlled substance, the pharmacist can't do me a solid and just provide the tablets instead

It's an old-fashioned written prescription, can't just ask to change it electronically. I suppress a strong desire to scribble over it to uh, amend the error.

Be fucked

Cherish the irony of possibly getting prescribed drugs by another doctor with ADHD

Ugh. I could really have used my damn meds, I'm resorting to going through my luggage in the hope that there's something leftover. A perk of having ADHD is that something probably is.

My wife tried to continue her mental health treatment in the UK after we relocated from the US and they did not give one shit about the letter she brought from her psychiatrist and they told us it would be a year to see their psychiatrist.

And no we couldn't have a refill for any of the mood meds she was on while she waited. Good luck with the withdrawal, they didn't say.

We ended up finding some private psychiatrist in a fancy neighborhood of London that charged £200 a visit and he wrote her all of the Rxes needed.

We were told by NHS that only NHS could prescribe these meds but the private psychiatrist we found didn't have any issues keeping it up for almost two years.

Fuck. That's not a story that's new to me, speaking generally, but I'm sorry you guys had to go through that. While I don't think it should matter too much where someone got their diagnosis and prescription, this is from the States, and I feel like that deserves additional weight.

I was already exploring private care, and groaning at the prices, honestly 200 pounds is far from how high it could have gone.

You'll often find that the usual contacts, namely secretaries and nurses, and occasionally GPs, can be less than well informed of the finer points of legality and regulation. It seems they were certainly wrong about whether this was a possible, but that did end up working in your favor for once.

I was already exploring private care, and groaning at the prices, honestly 200 pounds is far from how high it could have gone.

It might have been £300/visit actually. I don't quite remember this was ten years ago.

Being an aristocrat's psychiatrist seems like nice work if you can get it.

Given that senior psychiatrists in the business of ADHD prescriptions can charge as high as 800 a go (at the least for the first visit), I don't think you need an aristocrat. Do that long enough and you can probably slip someone money to knight you.

I was looking at 400 for a new assessment to confirm that yes, I have ADHD, that would be done by a psychologist, and about the same for all the rest, including the psych.

£200/300 was the cost of her monthly base touching with the psychiatrist, about 50 minutes a session.

I did get an ADHD diagnosis in the US myself and merely paid $500 for the first workup and $200 per month for that sweet sweet Adderall.

Psychiatry sounds pretty sweet from a money perspective. Though I recall, maybe it was a monologue in The House of God, that it's one of the more boring career paths for an MD.

I feel for you, but it really boggles the mind. Why would he prescribe capsules if they aren't a thing in the UK? How is it even possible for him to do that? Does he make the mistake frequently, I wonder?

I wouldn't be so harsh on him, and I'm actually quite sympathetic. Let the doctor who hasn't made a spelling mistake or mistaken a dose cast the first stone, and I'm not chucking any. Nothing glaring, or lethal, thank god, but all the steps we take to avoid this only seek to minimize the risk, and can't eliminate it.

He didn't get the name or dose of the medication wrong, and usually capsules versus tablets is an irrelevant detail. If he was doing it electronically, it would be constrained by the list of meds recognized in the system. With pen and paper? Much more scope to go wrong.

Dextroamphetamine isn't the first choice for ADHD here, probably somewhere around 2nd or 3rd line. I can understand why he might just look up dose, refer to something that wasn't the BNF, and then put that down.

In fact, when I called back today to get this sorted out, I learned he'd called in sick today, so it's possible that he wasn't feeling so well when I saw him.

Brutal, sorry man. I'd be tempted to use the dark net at that point, or have a friend with good insurance in a country with shorter waits ship it...

Thanks my dude. Luckily I did find a good couple months worth of my previous prescription languishing in a dark corner of my room, so I won't be entirely screwed over if there's a large delay in getting the prescription amended, but it's a pain either way.

I'm too scared to actually try the Dark Web, largely because I have more to lose than the average citizen (I could be deported!). I did once have a friend with an Adderall prescription he didn't use, but he turned out to be an asshole and I wouldn't reach out to him.

My absolute fallback would have been scheduling a flight home and bring as much Ritalin back with me as I could, or just have my family send it over with extended friends and family coming back.

For now I'm hoping a few phone calls will sort this out, and if not, I'll just suffer a little longer from taking a suboptimal medication that beats nothing.

Wait what’s the problem with capsules?

Absolutely nothing, except that they don't exist in the UK. It's tablets or nothing, as far as the NHS is concerned, and private prescriptions have the same issue AFAIK.

Capsules are not tablets.

He does not have a prescription for tablets, therefore he can not receive tablets. He has a prescription for capsules, and nobody can give him capsules.

Y'all don't have eprescribing in the GB?

Also why no Addy (or better yet - Vyvanse).

We do have e-prescription! It's the default, but while the psychiatrist didn't mention a rationale behind a written one, it was likely because he did it in a hurry, or because he's the old-fashioned type.

https://www.astralcodexten.com/p/know-your-amphetamines

Purely d-amphetamine works better than l-amphetamine or a racemic mixture. And I read elsewhere that dexedrine beats methylphenidate in terms of pure efficacy in adults.

I was the one who suggested it, mainly because I'm sick of the side effect profile of methylphenidate. If I experience anything too unbearable, and I hope some of that is idiosyncratic and dexedrine would be more tolerable. I'll probably ask for an extended release formulation during the next follow-up appointment.

or because he's the old-fashioned type.

Low-key I prefer it most of the time because if the pharmacy is out of whatever the patient can just roll to the next one. Clearly I am positively geriatric.

actual content

Okay soooooo

Puts on attending hat.

This is eventually going to become part of your bread and butter - you should feel very certain that amphetamines of all kinds are better than methylphenidate (or not!) and eventually be familiar with the considerations for use of one or the other (especially since it impacts your own personal life).

You should also stop reading Scott for these things, he writes for lay people and in a very entertaining way, but you have the toolset to actually do a lit review and deal with the less engaging/more scientific writing.

This is going to be important for a few reasons, one is that Scott often elides some of the practical concerns that we need to know about (like actual availability, as you ran into) and he cues into very specific old evidence bases at times which is fine for what/who he writes about but misses new innovation (lets see.....psych example....how about the conversation about Trazodone as a sleep aid?) and importantly isn't necessarily the standard of care - your attendings, billing processes, and potentially malpractice attorneys (yes yes UK) are going to look at you funny if you take him seriously.

He also has a tendency to miss or underemphasize some of the research errors (some spotted in this article! What they are is left to the learner lol).

IIRC Vyvanse is now generic in the U.S. but in short supply (as is basically everything else for ADHD), I don't know what it is like in the UK but for my money it is almost always the better choice if the patient can get it and afford it. Being a prodrug presents a ton of advantages and I'm mildly irked at the way Scott is minimizing it.

Very much my choice for "if my family member asked me what to get for ADHD I'd say try this first..."

Caveat: like all doctors I have my things I am very insistent and convinced about, others may not agree.

It turns out that at least in outpatient settings, the rule is that controlled substances need a hand-written prescription. Which strikes me as odd given that in all my inpatient work, I just had to tick a few boxes and sign a physical copy when it came to those classes of drugs.

This is eventually going to become part of your bread and butter - you should feel very certain that amphetamines of all kinds are better than methylphenidate (or not!) and eventually be familiar with the considerations for use of one or the other (especially since it impacts your own personal life).

Unfortunately, that's going to take a while. My current placement is psychiatry of old age, and the next one ought to be General Adult. It's probably not till I do one for children and adolescents (or learning disabilities) that I would be personally prescribing any. I can only go off my own experience, having exhausted the options back in India, and what I read online for now.

I did do a literature review! (though given that I have ADHD and unmedicated when I did it, it's not going to be published anytime soon haha)

The effect sizes for dexedrine vs methylphenidate were 0.9 vs 0.8 in adults, within spitting distance. My impression is that methylphenidate is better tolerated in some, but it's already been so unpleasant for me that I am eager to try anything else. (Don't even ask what fucking atomoxetine did, it was highly NSFW to say the least).

This is going to be important for a few reasons, one is that Scott often elides some of the practical concerns that we need to know about (like actual availability, as you ran into) and he cues into very specific old evidence bases at times which is fine for what/who he writes about but misses new innovation (lets see.....psych example....how about the conversation about Trazodone as a sleep aid?) and importantly isn't necessarily the standard of care - your attendings, billing processes, and potentially malpractice attorneys (yes yes UK) are going to look at you funny if you take him seriously.

He also has a tendency to miss or underemphasize some of the research errors (some spotted in this article! What they are is left to the learner lol).

It's exceptionally cruel for you to burden a neurodivergent trainee with additional research burdens :(

That being said, I do hold Scott in very high esteem. I don't consider him infallible, of course, but I would have the presumption of deferring to him unless I had overwhelming evidence of error. I certainly wouldn't formally cite him in my medical decisions at least at the resident level, but thankfully consultants have significantly more leeway in that regard, and I hope I get to that point eventually.

(I'm aware of trazodone as a sleep aid being an occasional prescription decision, do I take this as you asking me to evaluate whether it's ineffective at that job? I've only heard weak evidence, and mirtazapine would be the first port of call anyway for insomnia)

IIRC Vyvanse is now generic in the U.S. but in short supply (as is basically everything else for ADHD), I don't know what it is like in the UK but for my money it is almost always the better choice if the patient can get it and afford it. Being a prodrug presents a ton of advantages and I'm mildly irked at the way Scott is minimizing it.

The UK is also grappling with a supply shortage. I think dexedrine is comparatively uncommon enough that I have better odds of getting it than the alternatives!

I've previously been on an extended release formulation of methylphenidate, and it did nothing good for due to the increased duration of action. I've never tried an immediate release variant of either, but I'm willing to try the devil I don't know at this point.

It turns out that at least in outpatient settings, the rule is that controlled substances need a hand-written prescription. Which strikes me as odd given that in all my inpatient work, I just had to tick a few boxes and sign a physical copy when it came to those classes of drugs.

Hmm probably helps prevent fraud and such.

meds

....Priapism from the Atomoxetine? Meds you would not expect can cause that.

research

It does sound like you did do some research but you should be looking things up, reading /r/psychiatry and /r/medicine - always be learning! (especially if you feel like you aren't getting enough at work). Be curious! Just the other day I was looking up the pharmacology of a med I use all the time (ODT Zofran) because I realized I had forgotten some details. Chasing stuff like that will make you a better doctor.

Scott

Scott is smart and is a good writer but he has a very idiosyncratic bent to his medical views that often doesn't match other clinicians. Beware. The Last Psychiatrist on the other hand is fucking incredible (and importantly - equally entertaining). I make everyone in every specialty I see who has deep questions about pharmacology of any kind read his receptor article.

Trazodone

In the U.S. Family Medicine, Sleep Medicine, Neurology, and Psychiatry all have different views on Trazodone (and everything else). For a long time lots of these were like "the evidence says it does jack shit" but some recent literature has some weird noodly explanation about why that's all wrong. It's hard to evaluate. Many docs go off anecdotes.

In the U.S. we do use Remeron but are often cautious because we have enough weight to go around... for the right patient it is great though.

Officially the answer is sleep hygiene and other lifestyle mods/therapy (and especially CBT-I first and foremost and all the time before using meds).

Vyvanse

I mean if it works who cares, but if you end up needing something else going forward keep that in mind.

I feel this on a cellular level when my sertraline refill gets screwed up and I start getting spazzy vertigo like a spinning open wire waiting for it. My fist goes to you, hope you find some leftovers.

Tbf you absolutely do not want to go CT on antidepressants, at least stimulant meds don’t really have withdrawals

One time I had to wait two weeks for my refill and by the time I got it I was glitching out of the damn Matrix.

Lo and behold, after your kind blessings, I dug through a pile of belongings in the back of my closet, and found two pristine boxes of Ritalin, just ripe for the taking. I knew there had to be some of the fuckers lying around around haha

I have only mild ADHD but never found Ritalin all that effective. Better than nothing though. Adderal and dex are definitely way better

I'd say my ADHD is quite mild. You wouldn't be able to tell at a glance, and I'm used to working hectic and cognitively taxing jobs without my meds, though they do help.

I'd say Ritalin was 6/10 effective for me, on a platonic ideal where 10/10 would have me locking in and working till I drop. It does help me focus, and I simply can't study without meds. I'd have flunked med school since my old habit of cramming at the last minute no longer cut it as the textbooks approached the dimensions and weight of a healthy newborn, if it hadn't been for Ritalin.

It's mostly the side effects and come downs that put me off it. I get anxious and jittery, and even taken early in the day, it makes me insomniac enough to be debilitating. This is mostly just bad luck and idiosyncratic, it gives my brother, who has ADHD worse than mine, terrible headaches at the lowest dose. He breaks his tablets in half just to try and get by with less.

If you read Scott's review of stimulants, the one that's consistently the cause of rave reviews is desoxyn, which is a polite way of saying meth. At actually therapeutic doses, it works wonders, but it's not available legally in the UK, and most psychiatrists are scared to prescribe it even in the States.

That’s what I’m talking about (=´∀｀)人(´∀｀=)

Well, it seems that despite showing up as proper greentext in the comment preview, the local parser doesn't like zero width spaces. Pretend there's a > as appropriate please.

I didn’t expect this on my February bingo card but I had to report a business to the U.S. Department of Labor's Wage and Hour Division for wage theft and illegal termination because like four hours before my first day of training began they sent me my paperwork and there was a gigantic list of straight-up illegal wage deductions including “out of dress code on property” for $100 each “offense” and a line that said they’d terminate for “discussing pay rates with anyone”. I have a bit of a psychological knee-jerk shyness to positions of authority in business so I had to max out all of my bravery points to do it because then the recruiter kept spamming my phone trying to “explain why we had the rules please reconsider” until I busted out the i word, so go me, stickin’ it to the man. (//∇//)\

That was the correct call. It will be disruptive / stressful to have to search for another job so soon before you even started the last, but if you'd submitted to this you would have been preyed upon worse.

Best of luck getting your feet back from under you, and it will be easier in the future to speak for yourself (or others) having done this once already.

My wife works in payroll. It's amazing how many people try stuff like this. I can't wrap my head around "I'm going to break the law in writing in a way that directly motivates people to report me."

I think there are just so many people who want a job and are also desperate/naive and there are so many businesses out there that one business can just keep churning through the fodder for years until someone reports them.

Fair play to you, you made the right call.

I’ve managed 13 pull-ups in a row for two consecutive days. All according to plan. (I am falling behind on the plan.)

What is your pull-up training plan?

Do the same number of pull-ups every day and add 1 pull-up on the first of each month. 13 was hard enough that I think I'm going to keep it constant for another month.

I'm also doing some push-ups and sit-ups, with a similar method: same every day, adding 1 or 2 the first of each month depending on how I feel about the previous month.

I think 13 is a lot, congrats to that.

That's great! My PR is just 9, looks like I need to try harder.

Seconding @FiveHourMarthon, don't worry too much about the original plan, focus on the process. Things go up and down, they don't go the way you want, such is life. Consistency over long, long periods of time will prove itself out with gains.

Great job!

Things go up and down

Ideally more than 13 times.

Thank you. I'm looking forward to the anniversary so I can start measuring the habit in years. I've still only missed the one day mentioned in the link. It's made me aware of how rarely I get sick, in fact. Though maybe if I can do it drunk at 2 am, I can do it with headaches and nausea. I'll go easy.

Don't let falling behind on the plan discourage you! I've literally never perfectly completed a workout plan, I'm always too ambitious, but when I get to the end I'm stronger than I would be if I quit.

thanks. Hope your bjj is going ok.

Appreciate the thoughts and prayers. I'm telling myself this is the worst part, in that I'm no longer totally lost so just surviving isn't doing it for me, but I'm not actually winning much. My hope that a bunch of even newer guys would sign up for new year's resolutions was frustrated, most the classes I show up for I'm just on the bad end of a game of smear the queer when we get to rolling. But every now and then I catch one, so I'm getting better.

The severe, abused-victorian-orphan bruising has mostly stopped, so now my wife is more of a fan of what it's doing to my body，

I'm probably buying a new car this weekend. The 2007 Toyota Corolla has accrued more repairs than it's presently worth. Still drivable, but soon won't be, though it has earned itself 273k miles in its honorable time served.

So, got any car recommendations? Do you buy new, or lightly used? Hybrids worth looking at? If your car right now was summoned to the great car dealership in the sky right now, and you had to buy a new car, what kind of budget is sensible? Are you an old person who makes good car decisions, or a young enlisted man who makes horrible car decisions? I will refuse to listen to you, either way. But I still want to read your replies about car recommendations.

Consider something comma.ai compatible - $1000 for open source self driving. What could possibly go wrong.

Adaptive cruise control is the best. Strongly recommend you get it one way or another if you spend much time on the interstate/etc.

40’s, American. Nissan has motors that last as long as Toyota’s but cabins which feel spacious on even their smallest cars. The Versa is going away soon, but if you can get a late model Versa internal combustion with a manual transmission, you’ll have a dependable, affordable 4-banger equivalent to that Corolla.

Just be careful with the temperature dial; if the strings snap, it’ll be $2k to pull the dash and replace the heater core.

I'm not qualified to make car suggestions, since I have come to the Motte for recommendations on a secondhand car before. That being said, I am rather grateful that the market for secondhand cars is much saner in the UK, at least compared to the US. I don't know what on earth covid did to the market, such that prices still haven't returned to baseline 5 years later.

Before the war I was thinking about upgrading to a Mazda CX-5 or CX-30. If something happened to my current car (knocks on wood) I have no idea what I would do, as I have no desire to buy a Chinese car when it costs more than a German car before the war. Probably something used.

as I have no desire to buy a Chinese car when it costs more than a German car before the war.

Is that because of big tariffs on Chinese auto imports?

No, it's because practically all other car makers have left Russia and Chinese ones can charge whatever they want with no competition.

Surely there are enterprising businessmen just driving western and Japanese cars over from Armenia or the Stans?

Yes, but they target the top of the market. I am not paying them $100000 for an E-class Merc.

The 1:1 replacement would be a 2025 Toyota Prius. The new Prius (prime) is a good looking car and will run for ages.

I recommend buying a used EV. The prices are stupid low. I don't know why the market is so negative towards them. But, a used Model 3 is the best deal on the market right now.

Personally, I'm biased towards the Mazda 3 Turbo hatch. Perfect balance of power, handling, premium, longevity and price.

The Gen 2 will forever be my favorite Prius. That car had an unbelievable amount of cargo space. The newer models have much less, unfortunately.

On the other hand, the gen 2 is basically begging to have its catalytic converter stolen. This isn't an issue on the newer models.

Toyota warranties the hybrid battery for 10 years, so you can buy a used one without worrying that it's going to crap out on you soon after.

IMO:

  • You want something about 5 years old, so it's already done most of its depreciation, but is unlikely to have issues for a long time.
  • There are 4 cars worth considering: Tesla model 3/Y, Korean E-GMP (comes in Kia EV6 and Hyundai Ioniq 5/Ioniq 6 flavors), Toyota hybrid (corolla, rav4, camry, prius), Honda hybrid (fit, civic). Everything else is worse or does something you don't want or need. If I had to pick one EV, Ioniq 5. If I had to pick one non-EV, corolla hybrid.
  • If you have somewhere to charge it overnight, get an EV.
  • Look into getting a Comma 3 unit for it. All the cars above should be compatible, but double check (Tesla compatibility coming soon).

I am seriously debating buying a used Tesla, possibly after joining the retards drawing swastikas on them to lower the price.

Anyone have any experience with them? It's not my type of car, I just want something cheap and electric for local use that I can use excess noon solar on.

The Euros keep failing them in large numbers in their road-worthiness inspections at around 4 years. Depending on the exact country, it seems 20%-30% have "substantial deficits" which require major repair work. Worst EV in class, every single time.

The biggest problem is certainly brake rust from under-use (which you can mediate yourself, and Tesla could probably fix that by software update), but the reports I've seen also all mention suspension problems and faults with the headlight systems.

I wanted a used Model 3, but major repairs at 4 years is kinda scary. I've driven my Toyotas all well past 15 years of age, and I'm not confident the early generations of the Model 3 will get anywhere close to that.

I've been looking it up since you wrote this, and the number of common failures is stupid. Faulty charging port motor systems (why the fuck does it have a computer controlled electric motor for the fuel port anyway?!), the front suspension system needing to be cut off by the bolts and replaced, random error messages on the console that not even the Tesla service department can figure out, bricking from updates like a $40,000 Xbox...

Jesus I really want one of these things, but they're doing everything possible to turn me off.

Yeah, I was seriously considering picking one up for cheap in order to benefit from the image damage the brand took from the recent politics... but the cars just seem to suffer from inconsistent quality.

Some drivers really love their Model 3, have zero problems for the first 100k miles and give glowing endorsements to everybody who will listen. Lots of taxis use them, which is usually a good sign. Others are at the dealership all the time, and often for dumb expensive stuff.

Coming from Toyota, I don't like the risk. I expect my used cars to be solved problems.

I'm glad you said something! I was just looking at a used Tesla since these posts made me aware of how cheap you could get them on the used market. I wonder if this could be mitigated by buying a used 5 year old one from Tesla which comes with a 1 year/10k mi warranty? These appear to be typically "repaired," so they likely ran into the 4-5 year issues you mentioned.

At around $15,000 for a 5+ year old 50k-75k mi model 3, I'm struggling to not go for it and find out. It won't be my only car so worst case scenario I'll just return to my land cruiser.

They're awesome. But I now can't stand driving ICE vehicles after owning an EV.

Could you explain why? I'm driving an ancient car into the ground, but I'm going to need a new car (or two, depending where my oldest goes to college) in the next couple years, and I'm still struggling with both "new vs used" (one of our current cars was new, one was used, and the tradeoffs seem to change with warranty policies and market fluctuations) and with "EV vs ICE".

We're in the exact same situation. My '92 Ford really wants to die, but I haven't given it permission yet

The acceleration and handling feels much more responsive in an EV. I never realized how jerky ICE cars are until I had an EV to compare them to.

Much less maintenance involved since the cars are so much simpler. I've had one for 3 years and don't miss oil changes or other annual service bullshit. Your actual brakes last longer as well because of regenerative braking.

Regenerative braking is nice because it enables "one pedal driving" most of the time: if you're not pressing pressing the accelerator the car slows down -- nice in stop and go traffic.

A lot of people will say they hate this, especially if they're too cool, but I find the app integration really convenient. EVs don't need the motor running to have power, so it's actually a computer that's always available to take commands over their cell data connection, like warm the car up, or tell me your location, close the trunk now that I'm inside the house with all of the groceries, etc

As a software engineer I find all of the software in cars borderline retarded. In Teslas it's actually relatively good (though still sometimes retarded).

In the summer time you can tell the car to never let it get above 100 degrees while parked, so you don't have to burn your balls off when you get in. Uses power but not that much. And power is cheap.

Never have to visit a gas station again. Ended up buying a portable tire inflator that connects to the cigarette lighter port since I'm not going to gas stations anymore but still need to inflate tires once in awhile.

Thanks!

How long have you had yours? I do like to drive cars into the ground, and I worry that everything but the Model S still has less than a decade of track record. On the other hand, my current 20yo car is a Hyundai, and IIRC when I bought it their track record was so bad that they had started offering extra-long warranties to try to prove to customers that their latest models weren't more of the same, and I didn't regret it.

The best option is to order a plain jane version of the model you want through a dealership. It will be significantly cheaper than the fancier ones the dealer has in stock. Your second best option is to do significant research on finding a used car deal and purchase it. Get preapproved through a bank at the lowest rate possible so you have a backup option to whatever financing the dealership offers.

Hybrids are definitely worth looking at because the cost difference keeps shrinking.

Are pluggable hybrids still a reasonable thing, or did they get squeezed out of the market by full EVs?

I used to think they'd be the best of both worlds, with electricity for the bulk of our driving on short commutes/errands but with gas range/refueling-speed for road trips.

I tend to buy used, though I would like to have a new car at some point. I was pretty impressed with the 2022 Mazda CX-30 my wife had. It seemed to me like Mazda has the right idea in that it was just... a well made car. Nothing fancy really, but I want a car that gets the basics right and doesn't try to be high tech. I will definitely consider a Mazda for whenever my Mustang bites the dust.

Yeah I can second this -- we drove quite a lot of cars in the 'lightly used' and 'new on the lot' categories a couple of years ago, and ended up with a nice Mazda. In some ways nicer that the 'budget' euro models, and something like 20-30k less money. No problems a year in, decent fuel economy, and I kind of like driving it.

I have driven a mid-2010s Buick sedan for four years. It's been the best car I've owned in terms of reliability and cost of ownership. And I appreciate that it's more plushy than the most basic transportation appliances. I was a Volvo enthusiast for many years, but I no longer have the spare time or patience to do the maintenance that went into that.

I admit that I find Hondas and Toyotas too common/boring to be worth their sterling reliability rating; most modern cars are so much more reliable than what we used to have that it's not nearly as big a deal as it used to be. (I drove a Honda Accord for many years, and got my fill.) I also have potentially irrational biases against Nissans, Jeeps, and most German makes. I like the looks and features of Stellantis products, but I just can't bring myself to trust them.

The wife and I are actually looking at getting her some kind of crossover in the next few months. Budget is 20k, seeking something certified pre-owned of about 3 to 5 years old. Most common brands are on the table. Something cheap and cheerful like a Mitsubishi would be fine with us, or indeed another Buick like an Encore. If we wanted to spend more money on it, we'd probably go for a Mazda. There's also nothing wrong with Ford Escapes and Edges etc.; but I've driven those and just wasn't very impressed by them. (I also drove a jellybean-type Ford Taurus for some years, and honestly I liked it a lot. I have the opinion that Ford has lost its way.)

I am not closed off to hybrids, but I have a local mechanic who I really like and trust, and he only knows ICE technology. I don't drive long enough distances that the gas mileage benefit of the hybrid is meaningful to me.

Actually, now that you mention it, I was thinking of getting a Honda because it might be cheaper than a Toyota, but I always hear that their transmissions are worse and are usually the first thing to go bad. Is that true? Also is it worth learning to drive stick shift? I am thinking it is not, since you lose out on cruise control.

There are many implications to each of these questions.

1.) Honestly, "the transmission is the weak point" is something I've heard about nearly every make of vehicle. They just seem to break more than other components of the drivetrain. Ironically, the only transmission I have direct personal knowledge of failure in was that of my mom's Toyota Camry back in the 2000s. Anyway, the only vehicles I'd specifically avoid for that reason are Nissans. Bear in mind though, this is just my anecdata. You could find hard facts about failure rates if you went looking. My impression was always that Honda made some of the best automatic transmissions around.

I have always gone out of my way to proactively drain + fill automatic transmissions with fresh fluid every 50k miles or so, and have never had a transmission-related problem. On my old Volvos, it was almost exactly the same procedure as replacing the oil, so not a big deal.

2.) I think knowing how to drive stick is a skill worth having. It doesn't take that long to pick that skill up - maybe just one day if you have someone to show you and plenty of time to practice. Additionally - manual transmissions are much more repairable and durable than auto-transmissions, and some people get them just for that reason. You'll be able to drive any vehicle you encounter, and honestly, it's just kind of badass.

I don't like them that much for city driving, though. It's kind of a pain in stop and go traffic.

Manual transmissions are a complete pain for city driving with regular changes in speed and lots of stopping and starting. It doesn't just become a background process in your mind. I say that as someone who drove manuals for years.

They are, however, significantly cheaper on the used market.

Whenever I look for manuals in the cars I'm interested in, they're going for a premium over the automatics. Maybe that's untrue for used corollas or cars like that.

the only vehicles I'd specifically avoid for that reason are Nissans

It's their CVTs that are the problem. Toyota gets around that problem in their CVT models mostly by having a gear for "first".

My impression was always that Honda made some of the best automatic transmissions around.

Honda makes the best transmissions more or less period.

manual transmissions are much more repairable and durable than auto-transmissions

You also get to the point where shifting a manual is automatic- a background process that lives in your head and hand motions that you don't consciously think about. It helps if the transmission isn't terrible; if you have to fight it into gear you're not going to like that very much, but otherwise it's... well, automatic.

I don't like them that much for city driving, though. It's kind of a pain in stop and go traffic.

Technically, the best answer to this is to buy a car whose engine has enough torque to pull it forward simply by letting the clutch out. 300 ft-lbs is enough to do this to a car that weighs 3500 lbs (250 is only enough on level ground).

It's their CVTs that are the problem. Toyota gets around that problem in their CVT models mostly by having a gear for "first".

According to /o/: The problem with Nissan's CVTs is that they are too small for the engines to which they are connected. Mitsubishi uses the same CVTs, but matches them better with engines, so Mitsubishi cars don't have the same transmission problems. For example, according to Wikipedia, the Jatco JF015E is used both in the Mitsubishi Mirage (76 horsepower) and in the Nissan Juke (122 horsepower).

Seems common with Mitsubishi products. Everyone says their mini splits are better because of the fancy tech, but most of it is that their heat exchangers are massively over-spec for their rating. Just vastly more copper than a Midea unit. (They can only do that because their compressors have such good turndown ratios, admittedly)

Coming up on middle age, I don't care about cars as much as I used to, so I'm still driving a Scion that I leased a decade ago and then decided to purchase when the lease was up. Were I buying now, I would probably buy a Subaru, likely either a Crosstrek or an Impreza. I like hatchbacks for their practicality, the AWD is excellent in the winter, I think they look nice enough, and I'm not super price sensitive.

The main reason I'd consider spending more would be to get something with solid self-driving capabilities.

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