Quick question regarding Acute Melancholia:
Could you use Patron of the Arts to drive insane a character you've committed to a story (say Starving Artist) to then play Acute Melancholia on another character? The difference is between "drive insane" and "made insane" but I think it works. This opens up all kinds of fun possibilities with bonus card draw and The Greatest Fear.
I was thinking you could combine it with targeted insanity once a character is committed to a story, so I think that strategy is sound.
I was thinking of Hastur with ST - Josef Meiger gets you Drawing the Sign, Magical Theorist can accelerate tokens being placed, and The King in Yellow Folio means you have pure terror struggles as well as a tome for the Theorist.