r/AskPsychiatry

Ever since I was a kid, I’ve dealt with social anxiety. Now that I’m 19, studying cybersecurity, and still living with my parents, I decided to finally take control and see a psychiatrist. It was a massive step for me, especially with the heavy cultural stigma and shame around mental health in my household where people usually assume only "crazy" people need help.

I watched a video of a doctor online who explained that medication should always be a last resort, so I went to see him in person. My mom came with me, but I went into the office alone, which made me extremely nervous.

The session felt rushed and bizarre from the start:

* He barely asked basic questions (just my age and where I study).

* He gave me a high-pressure "test": He asked if I’d go to a restaurant alone, and I said no because of the stress of feeling watched. He then suddenly ordered me to stand up right there and give an impromptu presentation on my major. I was visibly shaken, so he told me to take a deep breath and speak.

* He performed zero physical or blood checks.

* He instantly wrote a prescription for Paroxil (Paroxetine) without explaining the dosage, side effects, or long-term plan, though he mentioned he'd try CBT with me too.

* He gave me an "exposure" task on the way out: He told me to immediately go to a nearby restaurant alone, order food, and eat it.

He asked me to come back next week for a free consultation, but the whole experience felt sketchy and transactional. I don't believe my anxiety is as severe as he made it out to be—I was just over-stressed because it was my first time, I was alone, and he put me on the spot.

I’m now extremely hesitant to take the medication. To test myself, I went to the gym today, forced myself to override my anxiety, greeted 7 strangers, and talked to 2 people. I felt relieved afterward. I genuinely believe I can push through this on my own using my own willpower and exposure, without relying on pills or paying money to a doctor who didn't seem to care.

Sometimes when iam in bed and I close my eyes I see some sort of hallucinations. I need you all to imagine your phone screen as what i see like. Some sort of video? You get the point. I only see four things.

1. A green sauropod with an unaturally long neck

2. A red car (from sideways

3. An oval (this one is very frequent)

4. A grey rat. (Least frequent)

5. Idek how to describe this one it's very new and I will explain in the replies.

I also want to mention that the dinosaur and the car look like they've been drawn my a toddler and the "paper" they're drawn on is cream colored and my eyes also move on their own when they're "zooming in" it's sort of like how a bat's feet work, when they relax their foot it clenches and when they flex it releases. Its sort of automatic they just move when zooming in. I also want to mention that these hallucinations are fairly rare aswell and I get them thrice a month or so?

1. The dinosaur– i need you all to draw a rectangle on a sheet of paper and draw a line connecting the opposite sides like shown and draw that dinosaur. My eyes are zooming in on box 2, where the head is bit at the same time it looks like they're zooming out of the rectangle aswell at the same time like iam looking behind my head without turning my eyes.

2. Red car– this one again, draw a red car inside of the rectangle and my eyes are zooming in on boxes 3 and 4 yet also zooming out just like the dinosaur.

3. The oval– this one is VERY weird. The entire rectangle is black and the oval is nowhere to be found but I can see it by feeling it with my ciliary muscles? Its like my ciliary muscles are wrapped around that oval and I keep zooming in onto boxes 1 and 2 and when i zoom in, i start to feel the oval with the teeth. The more i zoom in the more I "bite into the oval" the feeling is very subtle but there the zooming also slows down the more it zooms in

4. A grey rat– this one looks like a realistic rat but sideways just like the car and it works just like the car the only thing is the surrounding is black like I'm the oval.

5. This one is like iam seeing through the eyes of someone who's falling into a tunnel but the tunnel also changed direction and it has some white square lights

I think it's actually that one phenomenon (i forgot the name) where people start seeing stuff when their eyes are closed and maybe I have this but I get multiple hallucinations at the same time and my brain just said whatever and made me feel them all at once. Idk about me biting into the oval though

I tried to draw what I see and they're in the replies

Is this normal for a 17 year old? Iam also a male. Idk how this info is going to help you identify what iam experiencing but i thought it might be useful

Hello everyone! I have this mutual friend who has been faking her social life for already a year now. She's been using AI to make people believe she's dating this famous volleyball athlete named Moni Nikolov. I am asking for advice on what to do with this matter because it's getting very concerning. Even her family is in on this. So I really need help on what to do with this matter. We are not that close but i also believe that i need to do something about this to stop this from getting worse. Please help

I’m a middle aged female with BPD who now has a one + year history of self-harm while admitted to hospital and have justifiably spent time in restraints as a result. Yes, it is traumatic and humiliating, and yes, I understand why it was done.
The last time it happened my psychiatrist happened to be close by, likely in the nurses station, and came into my room before they finished placing me in restraints and before I got an injection. He did not appear at all impressed and wanted to know what precipitated my behaviour.
I trust and appreciate my psychiatrist but this time I was extremely embarrassed to see him while I was in this predicament. I wanted to ask if he could come back later but couldn’t bring myself to as I was afraid this was the only time I’d see him that day. He did, in fact, come back later.
How do I/should I communicate to him how I was feeling during that time? It was three weeks ago.
Is this enough information?

He was born in 1930, died in 2007. Married to my mother from 1950 'til his death. School teacher, taught science to middle school kids.

He never grossly mistreated us, fulfilled his fatherly duties, but generally he hated kids. He made breakfast, bought us what we needed, took us on long vacations every summer to every state in the US, was never physically abusive, never called us names, but he would regularly bawl us out, was regularly extremely angry at us over minuscule things.

One of my earliest memories was of having cereal at age 4 or 5, and my spoon would regularly noisily clang on the bowl, and he yelled at me to stop clanging the bowl. And then for weeks he would stare at me eating breakfast and would scream at me if the spoon even touched the bowl.

My mother (1930-2012)would intervene with things like that at some point. She was generally a serious woman and was not very loving either, but she generally did what she was supposed to do, I guess.

He took thousands of pictures on these vacations and would proudly create slide shows for us to watch. We had a room with a wall with shelves holding slide carousels from the vacations. I went through those slides after he died hoping to get some pictures of the family from years gone by. There was not a single picture that contained a human or even a man made object. It was all trees and mountains. I have no pictures of family from my childhood.

One time I was visiting as an adult and there was a time magazine sitting out, and there was a piece of masking tape across the eyes of the child on the cover, because "I can't stand children looking at me".

He burned out and quit teaching about a year before he was supposed to, to get retirement. The district allowed him to drive busses for a year to keep his retirement.

Took fluoxetine for 7 months - 20mg, then 40mg, then back to 20mg. Last dose was late June. Not feeling in perfect shape, but fluoxetine helped with most symptoms of depression, as well as PTSD-related anxiety and OCD-like ritualised behaviour.

Stopped treatment because of high sensitivity to side effects, especially emotional blunting, low energy / motivation, low blood pressure (was borderline fainting a lot). And I had zero to little interest in socialising and decreased interest in things I usually like.

1.5 month after stopping treatment, still no interest in socialising and other things that used to give me pleasure. I understand that alleviating depression and anxiety changes your reward system. But I don’t recognise myself anymore… I feel like fluoxetine has changed my personality, my interests, my curiosity as well my drive.

Can fluoxetine have a long-term impact on such things?

Thanks for taking the time to read :)

Καλησπέρα σας, θέλω να εκφράσω την εμπειρία μου, έχω διαγνωσθεί με Ιδεοψυχαναγκαστικη διαταραχή, επαναλαμβανόμενες ιδέες, ανησυχία, άγχος, υπερβολική αμφιβολία σε πολλά ζητήματα όπως θέμα εργασίας, γάμου, και σε μεγάλο βαθμό έχω ιδέες ότι οι άλλοι προσπαθούν να με χωρίσουν από την γυναίκα μου, ή ότι οι συνεργάτες μου θέλουν να διακόψουν τις συνεργασίες μας ή ότι μου λένε ψέματα. Γενικότερα από την αρχή της διάγνωσης μου, είχα ψευδαισθήσεις, έβλεπα διάφορα πράγματα και άκουγα φωνές, σχετικά με τις οπτικές ψευδαισθήσεις καταλαβαίνω ότι δεν ανταποκρίνονται στην πραγματικότητα ή ακουστικές προφανώς με δυσκόλευαν όταν τις είχα( άκουγα φωνές να με καλούν με το όνομα μου). Οι οπτικές ψευδαισθήσεις συνεχίζονται για πολλά χρόνια αλλά δεν με πειράζουν πλέον τις καταλαβαίνω ότι δεν υπάρχουν στα αλήθεια αλλά οι ακουστικές επανήλθαν πριν από λίγες ημέρες, σε έντονη στιγμή άγχους. Ήθελα απλά να δω εάν υπάρχουν και άλλοι με κοινές δυσκολίες.

Ευχαριστώ

Can you ask a psychiatrist to let you keep your hyperactivity during adhd treatment?

I'm also autistic and also do not want to lose a SINGLE interest. I want to like gaming until I die. I want to like all the same music. I want to be enthused by how electronics work. I want to go down rabbit holes. I don't mind stimming and find it soothing when I do it or someone else does. I want my full reaction time. I want energy after work.

And I want a world where there's still people who unapologetically stim, violate social rules, and have a lower dose to help them concentrate without having to sit still or make life worse for those who don't.

And I want there to be an audience for fast, chaotic music.

28 yo w/ ADHD-PI, PTSD, OCD, Social Anxiety, Panic Disorder, and MDD.

I've tried many, many medications without much success. SSRI's tend to simply make me feel flat w/o helping anything, while adrenergic compounds like Bupropion, ADHD stimulants, and even SNRI's tend to worsen my panic/somatic symptoms. A2A's somewhat help my anxiety, but worsen my mood/depression.

I'm at a crossroads and don't know what to do. I found an outside provider (out of network) that is open to prescribing an MAOI (Nardil/Parnate), but I also have the option of trying to get TMS/Spravato covered by my insurance (Kaiser).

Obviously, each have their drawback. It may be difficult to get TMS/Spravato covered right away, and MAOI's come with dietary and medication interactions/adjustments.

Thing is, I can't really have two psychiatrists at once (Kaiser vs out-of-network).

Thoughts?

Thank you so much 🙏 🙏

Hi, I was looking to get into psychiatry, Paediatric psychiatry to be exact, for example, diagnoses, etc, is there any books, textbooks that could help me get introduced to the field?(I am not currently studying psychiatry), any recommendations would be much appreciated

Hey guys, I’m about toto start residency in a country where I can apply to multiple specialties at once. Psychiatry is my one and only option. In med school, I didn’t get great exposure to psychiatry but I did spend about a month in psychiatry rotations and have worked across many countries and spoken to a bunch of psychiatrists.

Most of these are not exactly my concerns but everytime I tell someone (especially fellow doctors) they seem to discourage me because of the below mentioned reasons

1. How much of the negativity rubs off on you? Do you have days where you’re very troubled because of a case you saw? Or are you detached? Is it possible to detatch and still be empathetic because people associate detachment with being stone cold

2. Are you a happy well balanced person?
   I’m someone who is very relaxed , calm , balanced. I have a great family and friends and I strive to enjoy live and make the most of it. I’m scared of becoming pessimistic and bitter (again, this isnt my concern but most attending doctors make it seem like you’ll become bitter and sad if you’re a psychiatrist)

3. In med school, I really enjoyed the science of medicine. I loved learning patho physiology and internal medicine. But I’m more interested towards psychiatry (for various reasons) over internal medicine but I do worry that I’ll be missing out on being a general physician. How much of psychiatry is an extension on internal medicine. Is it very heavy on theory or is it logical. This might be a very dense and stupid question but please bear with me.

Primary care interventions aren't helping at all and all secondary care does is reject referal, crisis team won't offer preventive care. All cmht does is schizophrenia and bipolar despite Primary care being ill equiped to handle eupd and cmht being only service that can pay for proper eupd treatment

Hi everyone,
I’m wondering if anyone has experience taking two SSRIs at the same time.
My psychiatrist recently prescribed:
Escitalopram (Lexapro/Exapro) 20 mg once daily
Paroxetine 20 mg/day 10 mg in the morning + 10 mg at night
He specifically told me not to stop the escitalopram and that paroxetine is being added on rather than replacing it. The main reason for adding paroxetine is my premature ejaculation, which hasn’t improved enough on escitalopram.
I know taking two SSRIs together isn’t the usual approach, so I’m curious:
Has anyone here taken escitalopram + paroxetine together?
What doses were you taking?
How long did you stay on both?
Did you notice any benefits or side effects?
Did it help with premature ejaculation?
Did your doctor eventually switch you to one SSRI?
I’m not planning to change my medication based on Reddit I’m just interested in hearing from people who’ve actually experienced this combination.

Including for things like bipolar, psychosis, OCD, adhd, off label autism RRB meds, etc.

Hello! I have panic attacks where I scratch myself or sh in other ways to try and ground myself.

About 4 years ago I saw I psychiatrist for the first time and started on sertraline and klonopin (as needed) because I was very unstable in my crowded college dorm. I think if I were to have been properly warned about ssri discontinuation I would have steered clear. I’m not sure that ssris truly made my anxiety better because I definitely still had panic attacks.

About 2 years ago I wanted off and started tapering (under supervision with NP). I failed miserably as I could not tolerate the brain zaps and new anxiety. My NP then put me on Paxil “because you can be on a lower dosage” which sounds like stupid reasoning because even though it was 12.5mg compared to 150mg of sertraline, it was doing the same thing?

I move again and start a big girl job and decide I really really want to be done and know what to expect. Right? Wrong. I tapered off Paxil with Prozac in the span of about a month.

It’s been about 3 weeks since my last dose and I’m experiencing the brain zaps, dizziness, and nausea like last time. Additionally, and most frustrating, my panic attacks are off the charts. I’m having at least one a day which means my chest, neck, and arms have been littered with scratches and scabs for weeks. Basically any time I experience normal adrenaline (walking quickly, an unexpected surprise, work stress) my body fully overreacts and I panic. I’ve definitely been leaning on the klonopin to get through my work days but I don’t like that. On top of that, I’ve been actually depressed which I don’t think I really was before, I’m having cycles or crying and intense, irrational thoughts (ie. I should just quit my job because I can’t handle basic stress, I’m worthless, etc).

Obviously this is not ideal. I see my psychiatrist tomorrow and I’ve drafted up some plans. I trust him but I also really would like some other professional or patient opinions.

I’ve tried beta blockers and clonidine in the past and I don’t think it helped then but I’m willing to give it a try now.

I’ve also researched the liquid hyperbolic taper where you decrease 10% for months. Has anyone had success with this? I’m scared to start from square one and just take pills all over again, but a plan where I am micro tapering sounds like it might work?

I feel pretty against starting back up at my original dose or trying a different ssri because my symptoms are new, leading me to believe it is withdrawal and not relapse.

Honestly any advice is welcome and I deeply appreciate any comments 🙏

I am a 25F. Sorry this is long, i wanted to get in all the details. I have an older brother (28M) and older sister (26F). We have a pretty bad genetic predisposition to mental illness. My grandma (dad’s mom) is bipolar (she actually took part in a lot of early bipolar drug and treatment testing) and my grandpa (mom’s dad) was likely undiagnosed bipolar. Neither of my parents are bipolar, both are medicated for depression. My mom lived a party girl life when she was younger and tried many drugs. My dad was very buttoned up and has never smoked weed, but drinks a decent amount.

My brother was a pretty normal kid until high school, though he showed signs of an addictive personality from an early age. In high school, he got into drugs (mainly smoking lots of weed, which led him to psychedelics). This led him to multiple psychotic breaks, years of struggles, and an eventual bipolar 1 diagnosis. He was diagnosed around 16/17 years old. We then found out he had a very traumatic event happen to him at a young age, which likely in combination with his drug use made the bipolar really rear its head.

My sister has always struggled with her mental health, with anxiety, depression, and eating disorders. I believe she has undiagnosed autism (I also think my dad has this) and that brought on a lot of struggles. When she turned about 22/23, she was diagnosed with treatment resistant depression. She tried everything, every medication, treatment such as ketamine, and nothing worked. She attempted, but luckily was saved. She then got ECT treatment which saved her life. She drinks and smokes and is LIKELY also bipolar.

Now we come to me. I have lived a fairly mentally stable life, given these circumstances. I was diagnosed with depression, anxiety, and PTSD in college and began taking Zoloft for that. I was pretty parentified as a kid, so I have trauma around that, my siblings disorders, and drugs. A big issue I have is about being in control as I grew up in situations where I felt I had none. I have had a pretty standard mental health journey, though periods of depression occasionally (which were always fixed with Zoloft). I have been in therapy for 2 years. I drink pretty heavily, but less than many of my friends. Definitely could never drink again and be totally content with my life

I have a pretty big aversion to weed, but my partner likes to smoke. It has caused some struggles between us because I have tried to control him with it, which I know isn’t sustainable. I realized that my fear is a lack of understanding. I’ve never been high, so I don’t know what it feels like. I am posting here to see if it is safe for me to try it. I don’t have an addictive personality so I’m not afraid of that, I’m more afraid that the weed could somehow cause a mental break and make me bipolar for the rest of my life. I am curious about it and truly want to try. I don’t want to be scared of it anymore.

(TLDR: I want to smoke weed because I am curious and think it could help me understand my partner better; but I am scared to based on my genetics)

I am a 29 y/o female who has been getting mental health treatment for 8 years. During this time I have tried ~26 medications, CBT, DBT, IFS, EMDR, partial hospitalization, and more. I have had 2 neuropsych evaluations 4 years apart where the results looked very similar. I am self aware in a sense where I can say "xyz happened, it made me feel abc that could be due to (past trauma.)" I am not self aware in a sense where I can know who I actually am and how I actually feel. I think I come across as a very stable and rational person, but I do not think I am stable or rational.

My newest provider who I only saw for a few months recently quit and I was passed off to another provider. I've met with her two times. The first time, I tried explaining that I was not stable. I expressed concerns in work, relationships, self image, emotional dysregulation, concentration. I expressed feeling like my med regimen was not working. She did not change anything and instead asked me to take a GeneSight test. I understand many psychiatrists don't believe it holds any clinical value, I feel the same way. I got nothing out of this testing except a huge bill when I was promised that they wouldnt submit it for testing unless it was covered.

My second time seeing her, I expressed these same concerns and told her I was feeling like I am at my lowest. She went over the GeneSight results and basically said this was most likely due to the MTHFR gene and not tolerating medications. She suggested a bunch of vitamins and supplements. Prenatal (not pregnant,) Vit D, Vit B12, Folic Acid. I told her that my previous provider was getting ready to get me started on Spravato. She ignored this statement and she offered Buspar due to me not being able to sleep. I said I was hesitant to again start adding new medications. She asked the normal SI questions and when I said no, I feel like I got ignored even more. I want to try Spravato and have been told by 3 providers that it may actually help me. And if it doesn't, thats fine too. She said we would start the buspar then never even sent it to the pharmacy.

I see her again in 2 days. How do I accurately express to her that I believe her holistic method will not work for me? I do believe in some holistic practice but not now when I am not stable and cant even handle activities of daily living. I have an extensive trauma history and have been given 11 diagnoses over the past 8 years, some of these issues being know as hard to treat. I am suffering and I need something to change. I don't even feel like an actual human anymore. I am not suicidal with an active plan but I know I cannot keep going like this. I have made a new appointment with a psychiatrist at the end of the month but feel like I am deteriorating more each day. I would like something to change even sooner.

I’ve been on 15mg mirtazipine for the past 3 months suffering from severe anxiety and insomnia.

My new psych wants me to switch to trazedone and stop the mirtazepine cold turkey. He says there is no need to taper the mirtazipine as the trazedone is replacing it. Is this a common approach?

He has also prescribed clonozapam, which I guess might take the edge off any withdrawals. But I’m still nervous…

Context: Two fifteen year olds, one male and one female, share a foster home. They attend weekly therapy for certain reasons. The female character is high strung, overbearing, bossy, and thinks she's smarter than everyone around her and she approaches each counseling session as a battle between her and and the therapist. Without going into the details of her actual motivations and beliefs, she's relentlessly domineering with her foster brother which is one of the things being explored in their sessions.

The therapist, who by this point knows the girl fairly well, has begun to grow a bit frustrated with her because she's got an excuse for everything and a reasonable explanation for why she does anything she does. He one day finally loses her cool with her briefly in reference to her foster brother. He says something to the effect of "Good lord, just ease up on the boy, will you?"

He immediately recognizes the unprofessional lapse, and in her eyes the girl has just won a great victory in their battle. However, the girl now feels like she's in the dominant position between the two, and this feeling of superiority makes her more willing to open up and be more honest.

Would the therapist exploit this, using the benefit that came from his lapse in judgement to advance their session now that she's going to be less difficult? Would he have some kind of professional obligation to remove himself from her case, or to take a step back? Something else?