r/AskPsychiatry

My daughter completely refuses medication. She is 22 years old and has been diagnosed with a psychotic disorder. Her condition is getting worse and worse and she refuses all medications. What can I do to convince her?

My daughter completely refuses medication. She is 22 years old and has been diagnosed with a psychotic disorder. Her condition is getting worse and worse and she refuses all medications. What can I do to convince her?

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u/Bubbly_Practice5357 — 6 hours ago

I feel like I've fallen through every crack in psychiatry. I don't know what to do anymore.

I'm 27 and honestly don't know where to turn anymore.

I was raised as a Jehovah's Witness and have ADHD, PTSD, OCD, anxiety, depression, and possibly autism.

When I was 21, I was diagnosed with schizophrenia after a traumatic period in my life and was put on clozapine (600 mg) for about four years. Later on, after I became medically very ill and went through a lot of follow-up over time, multiple providers reviewed my history and did not feel a schizophrenia or primary psychotic disorder fit my presentation.

During that same period, I was hospitalized with stage IV colon cancer, sepsis, and a bowel obstruction, and the clozapine had to be stopped abruptly because of the GI blockage. My psychiatrist did not communicate with the hospital or provide taper guidance. Around the same time, I had other serious medical complications, including pulmonary embolisms that were initially missed or attributed to anxiety, which has made it really hard for me to trust the medical system or even my own judgment.

Right now I still live with my parents, have no degree, very little money, and feel completely stuck.

The biggest issue is ADHD. Stimulants tend to spike my PTSD and anxiety significantly. Anxiety meds help somewhat but make me very fatigued and cognitively foggy, which then makes my ADHD worse. It feels like every treatment helps one part of me while making another part worse.

I've been in therapy for over 3 years and I'm trying, but I feel like I'm running out of options and hope. I've also been having suicidal thoughts—not because I want to die, but because I can't see a workable path forward.

Has anyone seen cases like this actually improve? Or does anything stand out in how this might be approached differently?

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▲ 5 r/AskPsychiatry+2 crossposts

Dealing with drug resistant depression and anxiety

Straight to the point, I live in the US. I can’t afford insurance. I don’t know what to do. I have severe anxiety that, at least for me, leads to depression, and I can’t find a doctor or nurse practitioner that I can afford, that will help.

I’ve had insurance in the past, and I’ve mostly worked with a primary care physician. They’ve never truly listened, but I’ve received prescriptions that helped from time to time, but it wasn’t ever effective enough to be a true solution. I also recognize there might not be a solution, but I have to try.

In the meantime, after two decades of SSRIs, NDRIs, off label supplements for those drugs that include antipsychotics, nothing has ever worked long term. And I don’t mean a forever solution, I’d be happy with just a year.

I have hit a wall. I’m having anxiety and panic attacks frequently. I don’t know if there’s a distinction in medical terms, but for me panic attacks are when nothing real is threatening, but I have a flight or fight response. I start to hyperventilate, become hyper vigilant, and can’t stop feeling like something catastrophic is about me to kill me. I’ve had this happen while driving, and I started to lose feeling in my hands, and started getting tunnel vision. I’ve missed work because I had to pull over until it stops. Worse are anxiety attacks, for me that’s when a feeling of dread starts and just builds until I’m crying in a corner and basically living a nightmare until it stops, and then I sob until I get it all out. Last time, I was at the grocery store with my sister, and three minutes in, I told her to give me her keys because I had to hide. I curled up in the back seat of her car and cried until I couldn’t anymore. She’s used to it, so she bought her groceries while texting to ask if we should go home.

All of that to say, the last two doctors that I can’t afford, have denied any kind of anxiety medication. The first told me to start back on Wellbutrin and Seroquel because that’s what the last doctor prescribed. When I protested, and told her it wasn’t working, she said we’d start there, but to call the office immediately if I felt like it wasn’t working, and since I didn’t have insurance, a nurse would let her know and she’d call in a different prescription. I called and was told that she doesn’t take calls like this and she wouldn’t even be told. I threw a fit until they finally made me take an appointment to get me on Buspirone. They stopped giving refills six months later, and I can’t have more refills even though that was the longest I’ve gone without any kind of anxiety crisis.

So I found another doctor. To three different people in the office, I explained that while depression is an issue, the anxiety is keeping me from work, from family events, from having any semblance of a normal life. I made it very clear that anxiety was why I was there, that Buspirone has been the only successful medication that has helped and if we didn’t do anything else, that’s all I needed. She wanted me to stay on the Wellbutrin and Seroquel for depression, but suggested that we increase the dosage of Buspirone. That sounded great! So I shared that I didn’t really feel like the Wellbutrin or Seroquel were helping, but I understood that a secondary med often helps Wellbutrin work better. I asked if a different supplement could help. She told me I couldn’t afford what she wanted to suggest but fluoxetine might be better than the Seroquel. I was all for it. I left thinking I’d be on a higher dosage of Buspirone, and change the Seroquel to fluoxetine.

That’s not what I was prescribed. And I wasn’t even told before the pharmacy informed me. I got a prescription for fluoxetine at the smallest dosage. No Wellbutrin, no Buspirone, no anything for anxiety. When I called I was again told that communication with the doctor was impossible and the note in my file was that the decision was final and I could come back in four weeks for another appointment I can’t afford.

I’m sorry that was so long, but the details matter to me.

My question is, what on earth do I do for help? Why is Buspirone so difficult to get? It’s not addictive, it’s not Xanax, and from what I understand it’s incredibly therapeutic for many, many people. I’m not drug seeking. Buspirone can’t get me high. It just keeps me from hiding in terror for no reason.

How do I advocate for myself and get the treatment I need?

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u/emerald-rabbit — 1 day ago
▲ 130 r/AskPsychiatry+1 crossposts

My 19-year-old daughter had a severe psychotic episode, was Baker Acted, and the hospital is petitioning for guardianship. I’m devastated and don’t know what to expect.

I’m a mom of a 19-year-old daughter who has struggled with mental health for years (depression, anxiety, self-harm, suicide attempts, prior psychiatric hospitalizations). She has had periodic episodes of paranoia in the last 6+ months, quit college, went no contact with her friends . Went no contact with me for 3 months for unknown reasons (she was still staying at her dorm at this time and lived a mile from her dad and step mom house) and showed up unannounced and was welcomed back.

Then she went No contact with her dad and step mom for the last 2 months with no known reason. Recently had disrupted sleep, decreased hygiene. Agitation I attributed to lack of sleep and being a teen. Last week everything changed.

She developed what appears to be a severe psychotic episode. She became extremely paranoid, believed people were hacking and following her, didn’t seem to recognize family members at times, and came to my house with a loaded revolver. I was able to get the gun away from her and law enforcement Baker Acted her.
After she was hospitalized, we found multiple notes that had been written over months containing graphic plans to kill me, my husband, and her 5-year-old sister. The writings included detailed descriptions of murder and dismemberment. Because of those writings and the gun, I obtained a temporary domestic violence injunction for my family’s safety.

She is currently in an inpatient psychiatric hospital. The doctors have determined she currently lacks capacity to make her own medical decisions, made me her health care proxy, and have now petitioned the court for guardianship because they believe she still needs protection and treatment.
She has started antipsychotic medication. When I was able to speak to her, she sounded confused and disorganized. Later she stopped taking phone calls from me and other family members. My mother told her she had brought a gun to my house, and she said she didn’t remember. My daughter is no longer responding to her name and believes she is someone else. She doesn’t recognize family members. She’s been there 5 days and hardly eaten. She’s withdrawn. She’s laughing by herself.

I feel completely torn. I love my daughter more than anything, but I’m also terrified by what happened. At the same time, I keep replaying her entire childhood wondering if I somehow caused this. I feel guilty, scared, and heartbroken.
If you’ve had an young adult or patient experience psychosis, schizophrenia, bipolar disorder with psychosis, or another serious mental illness:
Did they recover after a first episode?
Did they remember what happened?
Did their relationships heal over time?
Has anyone been through guardianship or an involuntary hospitalization?
What does the future look like?
How did you cope with the guilt and fear?
Provisional diagnosis? I just feel very alone and would appreciate hearing from professionals who’ve treated something similar.

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u/coconut-cowgirl — 3 days ago

Lamotrigene - is it possible to get it in capsule-form instead of the shield-shaped tablet?

Hello!

Not sure if this is the right place to ask (as opposed to a pharmacy subreddit or something).

TLDR: Is it possible to get Lamotrigene in a capsule form instead of the shield-shaped tablets?

For reference: I take 200mg Lamotrigene (2x 100mg tablets per day). Located in Alberta, Canada.

Unfortunately, I developed a bit of a “pill-phobia” after a suicide attempt via pill overdose many, many years ago, back when I was a pre-teen. It used to be quite bad, where even the thought of taking a pill would inadvertently trigger my gag reflex and make me nauseous. Over the years it’s gotten so much better, it’s relatively mild now. I really don’t struggle at all with taking capsules of any size any more, but unfortunately taking large tablets still makes me queasy/anxious.

Unfortunately, I have to take a lot of daily pills! Although my lamotrigene is only a medium-sized tablet, they are by far the worst ones - it’s a daily struggle. I have to mentally psych myself up to take them every single day, partly because the experience horrific lol. The “shield” shape is dumb, they seem to get stuck in my throat, which makes me nauseous. And they taste absolutely horrendous, like battery acid.

Even though I’ve been on Lamotrigene for 5+ years now and it is arguably the single most important medication I take, some mornings I’m just not up for trying to force them down and I skip my dosage. Which is completely illogical/awful of me, I know. But I don’t struggle at all with taking my daily meds that are in capsule form - they “go down” so much easier, I never skip a dose. So I’m curious if I can address this by just getting my Lamotrigene in capsule form instead!

QUESTIONS:

1. Is it possible to get Lamotrigene in a capsule form instead of the tablets? If not, are tablets available in “pill” shape rather than the “shields”? Or is this drug just simply only manufactured in tablet form and/or as the shields, and that’s the way it is?

2. Is there a difference between how tablets vs capsules are released? Does Lamotrigene have to be in tablet form for some particular reason? Could taking tablets vs capsules change its effectiveness?

If capsules are available/possible:

1. Would my 200mg dosage need to be changed?

2. If the dosage would be the same regardless, is this something I can/would request from my psychiatrist? Can he specify capsules vs tablets on my Lamotrigene prescription? (ie: should I book an appointment with him specifically for this, or is this not even his domain and I should be talking with my pharmacy instead?)

Thank you!

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u/regalshield — 2 days ago

Red flagged from medication

So what happened was I’ve been seen the psych over here in Arizona and for the past four months five months everything was cool with probation. All cause I was taking my psych meds for ADHD which were Vyvanse and Adderall. And then I was having an episode where you know. I told her that I felt like they were coming to get me and I wanted to stay free, and I said I would fight for my freedom at all cost and wouldn’t of happening. Is she ends up red flagging me from getting these meds again and discharging me from her practice. So now even if I go somewhere else I can’t get these meds. No no pharmacy will let me get them. No doctor will prescribe them to me. Does anybody know how long is last or how to take care of this or how to address the situation because it’s getting kinda helpless and I really need these meds. I’ve been taking them since I was a teenager. I have proof of all that. I have a Medical history of it, but it just because my probation had a conversation with my psych did decided to do this on their own like it was kind of crazy like I don’t understand and I’ve been seen other mental health professionals and there’s nothing wrong with me. There’s nothing you know. That’s affect factor too. Me getting these meds, red flag for me. Somebody please help.

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u/oxymoron4you — 2 days ago

Is it okay if I dont want to take a medication due to side effects and want to try a different one?

Been on Effexor for 2 weeks that my psych prescribed. I have been having a horrible time. Increased anxiety, increased depression, feeling out of it, feeling restless, jittery, and more panic attacks.

I would rather try something like Zoloft. But im scared my psychiatrist is going to drop me because he thinks im trying to go against him. Im not. I just would rather try something else that doesn't make me feel like absolute hell. I know these side effects are temporary but its been brutal. And hearing about how Effexor is the worst antidepressant to come off of, I'd rather just stop now and try something else.

Ive told him about these side effects and he thinks its just my anxiety and wants to increase my dose of Effexor. But im just not comfortable taking it.

Thoughts?

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u/KurtSullivan — 2 days ago
▲ 5 r/AskPsychiatry+1 crossposts

Is it possible to only have a maniac episode while on antidepressants?

Hello! In desperate need of help, I have a doctors appointment coming but they can’t see me for a couple weeks (doctor on vacation) and I’m worried.

In my early teens I was put on antidepressants and had what was suspected by my old psychiatrist to be a maniac episode. I was not officially diagnosed because I was apparently too young at the time but I was hospitalized. I am now 28 and was re-started on antidepressants via my university health centre by a different psychiatrist and I suspect I am having one again. I sleep for only about an hour a night for over a month and am still very wired and energetic, I am spending like crazy money I don’t have in the thousands which is so unusual for me and am having racing thoughts to the point I cannot comprehend anything I listen to.

Between that first episode in my early teens and now I never had another episode despite smoking cannabis frequently in my late teens (I don’t anymore) and taking prescribed stimulant medication as I am also diagnosed with adhd for years. I’m not taking my adhd medication now and last did about four months ago (before suspected episode started).

Is it possible mania can only be triggered by antidepressants? Or if I had bipolar it would have been triggered before this? Do I have reason to be concerned or is this just anxiety? Thanks for any advice!

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u/evvviiiieeee — 3 days ago

How cooked am i?

So i'm gonna share my experience with weed and a bit of psychosis. I'm posting because i really want to know your guys opinion on how cooked i may or may not be. I'm hoping maybe a psychiatrist or psychologist could chime in and give their opinion (i will schedule an appointment with one but my anxiety would love multiple opinions).

TLDR will be at the bottom

Timeline:
Septemberish 2023 (Age:21) First semester of University after transferring from hometown. Smoked for the 2nd time ever. Was super giggly. Was also paranoid that the dorm security would get us in trouble from smelling weed on us while we checked back in after our "walk". That same night i was still super giggly but id say 30-45 minutes later i started seeing faint geometric shapes overlayed over my vision while also hearing noises. not voices but more like machinery beeps. I was able to maintain insight throughout the entire experience and even recorded myself explaining what it was i was seeing and hearing because i wanted sober me to review and analyze it. even while intoxicated i knew what i was seeing was out of the ordinary. in the video i even say "i know it sounds crazy but this is actually what im seeing/experiencing". All whilst having the high giggles lol.

I should preface that im also extremely sensitive to stimulants. i remember as a teenager having a mild panic attack off of just one of those starbucks glass bottle drinks. preworkout would give me anxiety for years and still does on an empty stomach. shit, even having a can of coke a few hours before bed time always keep me awake for hours.

the rest of the year (2023) my friends and i would get high off edibles periodically (typically the standard 10mg gummies. all bought from dispensaries). i'd get the standard cotton mouth and munchies and overall have a good time.

There was however a time in October of that year when an international student friend gave me his edibles. they were 35mg edibles of what i thought was regular cannabis. i was wrong. my roommates and i split it into 1/4ths and each took one cube. i remember the high taking forever to kick in. but when it did, it slowly got stronger and stronger. after about an hour and a half the high from this edible blew past what i would call 100% of a normal edible high and got me the highest i have ever been to this day. well turns out they were smokeshop TreHouse brand edibles containing (HHC, THC-P, and DELTA-8). That night i got so high i began to text my friend that i was high asf. i was laying in my bed in my room, pitch black apart from the light coming from my phone. as we texted i told him how i felt extremely connected to him and how i believed we were 4th dimensional beings in 3-dimensional bodies. he then told me about his dmt or shroom trip where he encountered an owl and as soon as he mentioned owls i had an insane visual of being at the center of a spherical room made of yellow owls all looking inward at me. that's all i remember from the rest of that night apart from going to bed wanting the high to be over. when i woke up the next day both my roommates and i were still in a weird kind of lingering high though my visuals were gone (they didn't have any visuals but did agree it was the weirdest high they've had) best way i could describe it is a synthetic high hangover. we felt like this the rest of that second day and for me it was into about noon of the day AFTER that. In retrospect it's absolutely stupid of me to ever even want to have any psychoactive substance after that. but as you may have already guessed, i did.

we would proceed to get high off regular edibles the rest of the school year. Until right about May of 2024. up until than when we would get high it would be more of an "event" for us. as in "we're gonna get high this weekend". But that May we found an infinite preroll glitch at our go-to dispensary where you would get a 1gram preroll (9%-11% thc) for every hygiene supply you dropped off for their event. we found a way to average out each preroll to less than a dollar. because of this, we started smoking daily. it became almost a ritual. we'd go to work, come home, and have our end of the day sesh. this went on for 21 months. after the first month or two we graduated to 20-30% thc weed(most days i would average .5g to maybe even over a gram). for the most part it was the standard high i was used to though there were 1 or 2 occasions i would see the geometric shapes again. slowly i could feel myself getting cognitively slower but i also want mention a pornography addiction and depression that predates the weed that was already slowing down my cognition. and what i mean by that is i was not as sharp as i was in high school. i could go deeper if needed but, moving on...

*** READ ME***
If you're scrolling to the TLDR i'd advise you come back and read this part. it is here that I speak of the ideas of reference.

Towards the ending months (let's say 3-6months as i can't pinpoint exactly when it started) i began to develop these ideas of reference. but the important part is that these ideas of reference were not happening strictly during an intoxicated state. they would also happen while sober (but still during the final months of my 21 month stint of daily high thc cannabis use) but anyways for context, i was chronically in my head a majority of the day during this time. ive honestly always been like this but during that period its like my inner voice got a microphone and a party speaker. but back to the ideas of reference, think of it like this... it started by me noticing that quite often, when i would think of something that could be answered with a yes or no, some type of external stimuli would not so coincidentally answer it. for example, i'd think "how bad would it be for my gym gains if i just skipped the gym" and the youtube video i happened to have playing about a stock analysis/prediction happened to say "... would be catastrophic for growth..." right as im thinking that. things like this as well as similar other things would happen often for months before i quit smoking cold turkey. another example is: for months i was debating whether to move back home or stay in the city i was about to graduate Uni from. well one day when i was thinking to myself wondering if the fact that my place of employment closing down was a sign from God to go back home, i saw a hummingbird which i took as Divine. i don't remember where i heard that hummingbirds are kind of spiritual in christianity. but i kind of took that as a very strong possibility that that was a divine response.
one last example, during this time, i developed periodic muscle twitches or spasms that would happen on my legs and arms. i knew it was likely a health problem of some sort but my imagination drew up the very convincing possibility that it could be my guardian angel. Why? Because much like the youtube video or music lyrics or license plate (ex: 7YES982, 8YEE026, 9NOR476) that i would notice right after the thought i was having, the muscular twitches would happen right after those internal thoughts would occur. and slowly those coincidences began feeling less and less like coincidences.

this happened so many times within those months that i started to entertain the idea that it's possible that i was different/unique/chosen and that would explain why i always felt different growing up and why i was significantly more self aware then others.

i do want to point out that though these feelings were veryyy strong, i never lost insight, i was still "tethered" to reality. like i never acted out on any of those ideas of reference. i didn't move back home, i didn't try and preach to people that i was the chosen one, and i still was able to kind of question this. like "all of this feels real or like it could be true but am i really sure this is what's actually happening?". I never broke and had a psychotic episode. was never hospitalized. was never fired or kicked out of school or anything.

I'm now almost 5 months sober and the ideas of reference are practically nonexistent. there are still times where those weird coincidences happen but i don't spend more then a few seconds thinking about it. i'm sort of able to smack myself mentally and say "no. that doesn't mean anything". or for the most part completely ignore it.

Ultimately the reason i'm posting this is because i want to know if anyone else had a similar experience and fully recovered from it. I also want to know if despite the substantial improvement from those ideas of reference, am i sitting on a ticking time bomb before schizophrenia manifests itself.

TLDR: Smoked (20-30% thc flower) for 21 months straight, had ideas of reference towards the last few months but was still tethered to reality. am now almost 5 months sober, ideas of reference are practically nonexistent now. just want to know if im sitting on a ticking time bomb of schizophrenia despite the drastic improvement of ideas of reference.

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u/Maximum-Bet-2839 — 3 days ago

Should I try a new antipsychotic?

I'm on Zyprexa and Prozac now. I've gained 60lbs from them. The Zyprexa helps me so much. No psychosis anymore.

I want to try cobenfy. Do you think it's worth the risk of becoming sick again?

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u/CourtM092 — 3 days ago
▲ 2 r/AskPsychiatry+1 crossposts

Thoughts on atypical depression and its treatment?

27m dx'd with PTSD, "AuDHD" (yes, I know that's not a medical term), OCD, anxiety (various forms), and depression (w/ atypical features like weight gain, leaden paralysis, mood reactivity, RSD, etc.)

I've tried a slew of meds (SSRI's, SNRI's, beta/alpha blockers, stimulants, gabapentinoids, etc.) without much success. The issue has always been either side effects, or that the med helped in one area but worsened another symptom/condition (ex. stimulants helping ADHD but worsening ptsd/OCD).

At this point, I'm looking into options such as MAOI's or possibly a TCA. I believe that MAOIs have stronger evidence in atypical depression, right?

The two specific meds on my radar are Nardil and Clomipramine.

Do you have any other ideas/suggestions I can bring up with my new psych (who is double board certified unlike the other psych NP's I've met with) in two days?

Thank you 🙏🏻

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u/TranslatorLiving7991 — 4 days ago

Doctor told me today I have mild serotonin syndrome, didn’t suggest reduction of any medication? What? What do I do?

I am on 7.5mg Mirtazapine of a night time and 150mg of venlafaxine in the morning.
At an appointment today the doctor identified high blood pressure and tachycardia. He asked me to hold my hands out and identified tremors and shaking, asked me to lay flat on the bed and checked my reflexes where he says I have hyperreflexia. He looked at my pupils and said they were flicking left and right rapidly. I have felt a bit funny, spaced out but otherwise cognitively well. I wouldn’t have identified these symptoms had he not pointed them out. He had wrote a note for me saying simply “seratonergic syndrome” and suggested I have mild serotonin toxicity.

He didn’t reduce my medication, didn’t tell me to look for anything, just told me to go home and research it.
I feel confused. What does this mean for me?

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u/EnvironmentalLong414 — 4 days ago

What is it ACTUALLY like to be a psychiatrist?

Hi, so I'm debating my future rn. Im currently working on my bachelor's degree. Im considering becoming a psychiatrist, but my only exposure to psychiatry is the show Hannibal, some horror movies, and some youtube videos. I know most of those are probably not the best examples for real life, so what is being a psychiatrist actually like? What is the day to day like? Other than horror movies, I just assumed that the work was the same as being an average therapist, but youre able to prescribe medication to your patients and you can work in a psychiatric hospital if you want. Is it actually like the mental image I have of someone sitting in a chair taking notes on what their patient says, or is it different than that? Does a psychiatrist always have to work in a psychiatric hospital? I literally know nothing beyond basic knowledge. This post is part of my research into this field to see if its what I want to do. Up until a few months ago, before considering this field, I didnt even know that psychiatrist had to go to medical school. I assumed the difference between a psychiatrist and a psychologist/therapist was different licensing and getting a Masters vs PhD. No offense to you guys, I now know different.

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u/Icy-Detective-1 — 4 days ago

Curious about the conduct of my psychiatrist

I am 21 F and not formally diagnosed with any mental illness. I have had long standing anxiety and sought out a psychiatrist to discuss my options for medication.

When I first walked in and he asked what was wrong, I started tearing up as it was a while since I had talked about it and I get nervous in clinical spaces. He immediately seemed kind of annoyed, and kept asking me general questions that I would answer to the best of my ability.

At one point while I was crying, he brought his hands to his face and started mocking me. He said “You don’t want your boyfriend to break up with you because you’re crazy, right?” And right after said “How are you going to apply to grad schools like this? Crying all the time?”. He also kept mentioning that nobody but me has come in and immediately started crying, which made me feel honestly crazy when I was simply emotional. He would also say things like “There’s no reason for you to cry, unless I remind you of your dad or some big scary monster.”

He prescribed me Zoloft, Remeron, and Xanax. While he explained Xanax to me, I voiced that I was a little concerned, but he didn’t let me finish and cut me off and said “Don’t do that. I am the doctor. Don’t argue with me. Stop that.” What I have learned from this is that therapy is probably what will help me the most, and I certainly do not plan on going back, but I cannot shake how this conduct made me feel so small and invalidated.

I don’t know if this is the right sub for this story(and per the rules I hope not too soapboxy), but this experience makes me nervous to try finding somebody else and I would like to know if this really is normal conduct. I don’t expect to be coddled and thought this experience must be normal until I told my friends and they were horrified. Or, if I should go about reporting this in some way. Thank you in advance and if there’s a better sub for this I can ask there.

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u/chunkys0ck — 5 days ago

Covering nurse told me to stop looking at screens when I hadn’t slept for 4 days

Hi! My psychiatrist was out last week and I couldn’t sleep- I have bipolar I and was scared I was tipping into a manic episode, as I got 35 minutes of sleep spread out over 4 nights. The CNP that was covering wasn’t concerned and told me that avoiding screens at night and taking Benadryl should help (I have a prescription for hydroxyzine but she said Benadryl was stronger). I ended up going to the ER for emergency sleep meds, which finally knocked me out and let me sleep 8 hours.

I’m stable again, but wondering if that was an appropriate response on the part of the CNP? She knew I have bipolar disorder and specifically told me there was no need to be concerned or go to the ER, but when I contacted urgent care they told me to go, and my therapist said I did the right thing.

Just very torn about it and whether I overreacted or the CNP was wrong. Would love to get some opinions.

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u/ohratsy — 4 days ago

Might be schizophrenic i dont know how to feel

Hi, I 27f have been seeing people out of the corner of my eyes, seeing bugs when they arent there. Sometimes see random objects and then they disappear. Sometimes I hear random voices calling my name. Very few times it has sounded like a call center in my head.

I work in Healthcare and honestly im tired of these daily hallucinations.

I really am trying to live a normal life despite my fucked up childhood.

I have PTSD and Sometimes, work triggers me so I decided to finally take the plunge and seek help.

I went to an NP that specializes in psychiatry. She asked me a series of questions and she wants to put me on anti deprsant (i am depressed and Sometimes I dont sleep well) and eventually a sleep aid and after that anti-psychotic.

Should I seek out a second option? Should i be tested for schizophrenia before being on meds? This was my first visit with her and I feel this is all so sudden.

Im in Oklahoma, USA for reference

I just need insight please.

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u/Parking_Database_390 — 4 days ago

A long time ago, my mental health diagnoses included "borderline traits." Do I need to share that with my new psychiatrist?

When I was young, I was never diagnosed with BPD but was diagnosed with "borderline traits" (so I guess I was close but did not hit all the check boxes). I have grown and healed and developed a lot since then (it's been a decade). I don't suffer from all the "borderline traits" that I used to. Do I have to share that I had "borderline traits" in the past with my new psychiatrist? Or would it be better to "start fresh" and let them make their own evaluation?

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u/shatana — 4 days ago
▲ 3 r/AskPsychiatry+1 crossposts

Why most psychiatrists insist on using Antipsychotics as augmentation for TRD?

This is a very long post but I had to really discuss it because I'm just sick of all the psychiatrists that I've been through throughout my life that gave me antipsychotics next to my antidepressant only to make my situation way worse and completely hopeless.

Apparently it's a very common practice to use an Atypical antipsychotic as an augmentation to antidepressants even if the patient already experiences Anhedonia and Apathy that was either there before he started the antidepressant or got worse after the addition of it (as is the case with alot of the SSRIs).

Now even though they argue that certain atypical antipsychotics such as Aripiprazole are not only Partial D2/D3 agonists with low intrinsic activity which therefore significantly reduce dopamine which would therefore worsen Anhedonia and Apathy (therefore becoming counterproductive) but they also argue that this usually comes with strong 5HT2A antagonism that supposedly helps reduce the side effects perceived from this significant dopaminergic reduction such as Akathisia. In reality that's not the case.

Cariprazine, Aripiprazole and Brexapiprazole are atypical antipsychotics that share the same function as D2/D3 partial agonists but with different intrinsic activities that are in the end very low compared to that of a full agonist and therefore act much more as stepped down antagonists rather than full and down to the throttle antagonists. This apparently reduces dopamine where dopamine is usually high such as in the Striatum and Nucleus Accumbens while the 5HT2A antagonism increases dopamine where dopamine is generally low such as in the Prefrontal Cortex.

Now this would be very beneficial in certain disorders where this is actually the case and that dopamine is very high or supersensitive in the Nucleus Accumbens and Striatum and is very low in the PFC such as in Schizophrenia therefore their use in conditions like these makes sense. Now why in hell would they be used in conditions that actually have low dopamine everywhere including the Striatum, Nucleus Accumbens and PFC and not just the latter? Most of those who're depressed are people who have low dopamine in those 3 areas hence why they already suffer from Anhedonia and Apathy. Why would I give them such drugs in the very first place?

To make matters worse they're rarely used alone and are mostly used as augmentations to antidepressants which ends up making the symptoms way worse because guess what? The most widely used antidepressants are SSRIs/SNRIs all of which at least inhibit 80% of the SERT and therefore end up overactivating the 5HT2A/C receptors which end up reducing dopamine and norepinephrine even further.

Now even if the strong 5HT2A antagonism from those Atypical Antipsychotics gets to reverse some of the SSRI/SNRI induced reduction in dopamine and norepinephrine in the PFC they mostly lack any strong 5HT2C antagonism/inverse agonism and therefore end up lowering dopamine even more in the Striatum and Nucleus Accumbens therefore not only causing Akathisia (very common when an Antipsychotic is added to an SSRI/SNRI) but also significantly worsen the Anhedonia and Apathy along with causing patients to significantly gain weight that can be very hard to lose afterwards if they ever decide to stop.

Finally multiple Meta Analysis studies confirm that Atypical Antipsychotics when used as augmentations in depression are generally not only less efficacious than placebo but also have very poor tolerability due to the many unwanted side effects that come with them. I'll leave the links down below for everyone to see and I really hope someone can prove me wrong or explain any misconceptions for me.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4756722/

https://pmc.ncbi.nlm.nih.gov/articles/PMC7968624/

https://pmc.ncbi.nlm.nih.gov/articles/PMC4537657/

https://www.madinamerica.com/2017/12/scientists-clarify-risks-augmenting-antipsychotic-medications-depression/

u/Curious_Mind-98 — 6 days ago

Why is everyone online saying they have "AuADHD" ?

Genuinely dont want to be rude, but I see so many women online saying they are autistic now. I look at there profiles they have a husband, kids, and can hold down a job, as well as an active social life.

As someone with an actual mental health disability it is kind of frustrating that it feels like people are "identifying as neurodivergent" and claiming to be disabled in order to avoid the fact that they actually are just normal people with the same problems everyone else has?

I dont want to be rude/mean here. Is this actually a real thing? I could be wrong, its just highly suspicious to me, how can someone have a mental disability if they had no trouble finding a successful relationship, raising kids, bought a home, have a job, regularly go out with friends, etc.

Has there been an increase in the number of people coming into psychiatry offices claiming they have a condition that you immediately know they don't have?

reddit.com
u/tydark2 — 8 days ago