r/AskPsychiatry

Hello everyone. I'm looking for people who have had experiences similar to mine, regarding long-term symptoms after Invega Sustenna; and the Swiss assisted-dying evaluation process.

My last Invega Sustenna injection was on June 6, 2026, and today is October 6, 2026. Since the injections, l've experienced severe fatigue, emotional numbness, cognitive slowing, difficulty concentrating, and a major loss of my previous functioning. I'm very worried that I may not recover.

I also believe I may have been misdiagnosed with psychosis during my hospitalization. The treatment was court-ordered, and I was given the medication despite my disagreement with the diagnosis. I am now trying to understand what medical evaluations and documentation might be necessary to determine what is actually happening to me and what my prognosis is.

Because my quality of life has deteriorated so severely, I have been considering assisted dying and have contacted organizations such as Dignitas, Pegasos, and Athanasios. I understand that approval is not guaranteed and that there are medical and legal requirements.

Has anyone here personally gone through an assisted-dying evaluation in Switzerland, particularly for severe psychiatric or treatment-related problems? If so:

- What was the evaluation process like?
- What kind of psychiatric and medical documentation did they require?
- Did you have to demonstrate that you had tried multiple treatments?
- How did doctors determine whether your condition was treatable or potentially reversible?
- Did anyone have experience with Dignitas, Pegasos, or Athanasios?

I'm interested in hearing from people who are in the process or know someone who has gone through it, rather than speculation. Thank you.

Hi everyone,

Sorry that this is long.

I'm a 30 year old female in Ireland, awaiting a psychiatry appointment at the end of the month with the community adult mental health team. This was following an ED presentation for self harm requiring stitches. I wasn't trying to self harm that badly or kill myself, I didn't really feel anything when it happened but I don't really regret it and I can't say that self harm wouldn't happen again. I was assessed at the ED and the doctor mentioned dysthymia and possible neurodivergence, though I'm not sure if she was using dysthymia as more of a descriptive word. I told her that I had queried autism myself though I'm not sure if it fully fits and if it is the case, it doesn't fully explain my mood. I've been thinking about it more over the last few days and although I have some difficulty socialising and making friends and mask most of the time, I think it's related more to pretending that I'm okay because I don't want to be vulnerable and open up to others, and because I have low self worth and self confidence. I've always been an anxious, shy person and I think maybe feeling depressed meant I didn't develop very good social skills and I have a small support circle. I keep things to myself and I'm never really vulnerable about how I feel. I do have long term friendships, and I think I find socialising difficult mainly because I'm low and exhausted and don't have the energy to pretend I'm not. I also spoke to my mum about it and she said my development was totally normal (I have a brother too) and nothing was ever flagged by schools or healthcare professionals. I've been working alongside senior clinical psychologists and other members of MDTs for years including psychiatry, OT, nursing, SLT etc and no one has ever mentioned autism. I mentioned it once to my supervisor, a senior clinical psychologist, who knew me for three years and she said no straight away. I know that doesn't equal an assessment, but just for context.

I'm a second year trainee clinical psychologist myself and I've been studying and working in psychology roles for the last 11 years so I have some idea of what might be going on for me.

I think I might have persistent depressive disorder/dysthymia. I have been thinking about this for a few years already. I have experienced low mood/depression symptoms since age 14. I've been self harming since age 14 until now. Mostly I self harm to distract myself or to feel something different, like if I feel nothing or if I feel a difficult emotion I don't want to feel like self hatred, hopelessness or anger towards myself or others. I've had periods of suicidality that I haven't acted on. I think about it a couple of times a day but it's more like passive suicidality/TLNWL. I used to self harm multiple times a day at my worst and nowadays it's more like a couple of times a year. I feel this constant feeling that life is pointless and more difficult for me than it seems like for other people. I don't get reward out of life. I don't see a future for myself. Although there are things I'd like to achieve, like finishing the doctorate, I don't see it happening and I don't have any belief or confidence in myself although objectively, things with work are going well. I don't feel emotions very strongly; I feel quite numb and flat most of the time and I prefer being alone so I can just be low in peace. I do cry sometimes but mainly I feel quite detached. Even during better periods, I'm not happy and I don't feel emotions very strongly, like I don't get excited about things really anymore or enjoy things I thought I would, like concerts or holidays. I don't really do things that I enjoy, I just want to stay in bed all day if I'm not in work. I feel like time gets away from me and I'm wasting my days doing nothing but I don't want to do anything anyway and I can't concentrate. Sometimes in classes, I feel restless and suffocated in the room, and just can't bring myself to care about what's being talked about, or chat with other people or laugh at the lecturers jokes etc. I stopped running and going to the gym, I don't listen when I watch tv and it takes me months to finish a book these days. I find it hard to complete responsibilities like walking the dog and I mostly ask my boyfriend to do it, and I don't clean out my rabbits as often as I should. My self care is terrible and I always put work and assignments first as a distraction but I find it hard to get started. Lately I've found it harder to function, I've been sleeping in late, getting to college late, submitting assignments late which I've never done before. I've been late submitting paperwork like timesheets and performance review forms too but I just don't care. My time management is bad and I'm forgetful. I don't shower or get dressed if I'm not going out and I keep using dry shampoo instead of washing my hair. I haven't worn make up in weeks. I dread socialising and take ages to text people back, and have cancelled on people even though I want my friendships, I don't have the energy for it and I just feel crap. With sleep, my schedule is all over the place and sometimes I stay up late doing nothing and then because I have to get up earlier, I get barely any sleep. Sometimes I find it hard to get to sleep, sometimes I wake up during the night. I've been waking up earlier and not been able to get to sleep again on mornings that I don't have to get up like the weekends but I'll still stay in bed for most of the day. I'm tired all the time. My appetite is hard to describe because I've experienced disordered eating but it's reduced a bit recently and I've lost a small bit of weight.

I feel like I'm always low but I feel worse the last few weeks and I'm wondering if this is a depressive episode on top of PDD/dysthymia but I don't know. Because this has been going on for so long, I feel like this is just who I am now, like this is just my personality, and I find it difficult to remember feeling any other way. But I always compare things to when I was a teenager and it's never been that bad since so I don't know. I've been able to work and study while all of this has been going on but I think that's because I put a lot of pressure on myself and feel like I can't stop. But I have taken the next week as sick leave. I can function most of the time but I don't feel good. There's been a few things going on over the last few years like deaths in the family and leaving my job to start the doctorate, starting and ending placements, struggling with my relationship, but this feeling was present long before that and I would hate that it get dismissed as psychosocial stressors because I generally manage through these things and can still recognise good things that have happened like getting onto the doctorate, passing my driving test and getting my car and making new friends, but I still feel depressed. I do feel like things that are supposed to be really difficult, like losing both of my grandparents, I didn't feel a massive amount about, like I cried but I still went to work/met friends the same day both times etc and wasn't devastated, so I think I'm emotionally blunted.

I got help and attended services between 16-17 and was on 20mg Fluoxetine from 16 to almost 18. I found it extremely difficult to talk and open up and didn't share much but I recently found old letters in which the consultant psychiatrist I saw described a two year history of depression and features of clinical depression. There were things I never told them, like a history of disordered eating. This started at age 15 and included restricting/starving and purging and this went on for many years into my adulthood. I had a lot of food rules and fear foods etc. I'm not engaging in those behaviours anymore but I still do a lot of body checking and weight checking and am very aware of what I eat and am not happy with my weight and body at all and constantly want to try and lose weight, even though I'm objectively a normal weight. Fluoxetine worked for me at first but it started to lose effectiveness after a few months and I was still feeling depressed and self harming. My parents were concerned that seeking help at age 18 would go on my records and would affect college and jobs so I was discharged from services and the meds were discontinued even though I was still struggling a lot, but my parents didn't realise the extent of it.

I struggled a lot getting help again over the years due to a lot of barriers like anxiety, fear, shame and guilt, those old worries that I wouldn't be able to become a psychologist myself if I was struggling (now I know that's not true), and working in mental health services, I knew a lot of the psychiatrists and staff and worked in the main outpatient building in town myself so I felt like accessing help wasn't an option. I also just kept hoping things would get better.

In 2021, I tried to reach out to the GP for help but I was so anxious to call that I messaged them on Facebook and they didn't see it. It took me until 2023 to try again. I saw a GP who really didn't understand and said things like I was a beautiful girl and shouldn't feel this way and that I didn't have a sense of self. It really upset me and made me feel so misunderstood and invalidated. She prescribed Sertraline 50mg and I took it for six months but it didn't help at all and I stopped taking it. I went to six sessions of counselling over the summer as part of my doctorate and the clinical psychologist said I was very detached and trying to protect myself. I didn't feel safe with her and although I explained what happened when I was a teenager, she didn't ask if things were still bad and I didn't feel able to tell her or talk about it further, which is a shame because I really hoped I'd get something out of it, but I don't think it was a good fit. We have to get personal therapy each year so I'll try again this year and hopefully click with this person.

That brings us to now. I'd been considering going back to the GP and asking for a referral to adult mental health services before I ended up in the ED. Ideally, I'd like a proper assessment and to actually know what's going on and medication that I can take long term, because that's what I think I need because of how long this has been going on. I really don't want to be discharged back to the GP because this has been going on for so so long. I'm wondering if this sounds like PDD/dysthymia to you or something else, if medication sounds reasonable, and if so, what ones you might consider.

Thank you.

TLDR: I think I have PDD/dysthymia, and I'm wondering if that sounds right and what medication might a psychiatrist suggest if any.

Hello, Im wondering what the norm is for psychiatrists consulting with other psychiatrists that may have more experience in certain area?

Are md to md consults exist in psychiatry?

Edit Additional context: my physician realized he may have missed a diagnosis for several years, he explained that it is not the focus area of his practice and that may have contributed to the mistake, I asked if he could now do a peer consult with another physician who focuses more on that area of practice and he told me 'that's not a thing' and that he couldn't cold call other doctors. It was my understanding that md to md consults especially if it's a complex case is not uncommon and reasonable. I am confused why he is insisting it is not.

Would appreciate any insight. Thanks​ so much​

I was unofficially dropped by my psychiatrist/therapist in a subtle way, im in the USA and this wasn't a private practice. I know there are probably horror stories of dealing with unhinged mentally ill patients. This was nothing like that I was always calm and polite during each appointment.

They did not officially refuse me as a patient, but I went in to see the therapist one day around the 4th appointment and she would continually ask me "what can we do?" "how can we help you?" without making eye contact she was looking at her computer and be typing something during the appointment showing no interest in me as the patient, then told me that the psychiatrist thought I had no mental health issues and instead had neurological problems and needed a brain scan and gave me a word salad medical terminology answer that did not seem accurate. Then they recommended me to a telehealth therapy service since the psychiatrist said I don't have any actual psychiatric problems apparently, something my current primary care doctor disagreed with, as well as my previous primary care doctors. It made me feel like I was being thrown away and that I can't be helped. This particular psychiatrist was in residency as well, and never really looked over my case.

I got the sense they did not want me there any longer. My primary care doctor was enraged and started dropping the f-bomb when I told him what happened, I have never seen a doctor act that way in a clinical setting. This incident occurred after I showed my private journal to the therapist. I feel that there was something in there I wrote they did not like or misinterpreted. Is this normal for therapists/psychiatrists to drop a patient if they see something they disagree with or do not like or maybe are just uncomfortable discussing? I told my doctor I did not want anyone to get in trouble, they just seemed to not know what to do with me or perhaps were overwhelmed with to many other patients and were having a bad day, im not sure.

I just wanted to ask if this is normal or common? how often do psychiatrists/therapists drop patients in an "unofficial" way, by just ignoring you until you leave? I remember towards the end of my last appointment I said that maybe I should find a different care team, and then her face lit up and said yes of course sometimes its just not the right fit, that was kinda how I knew that they didnt want me there. I feel a bit humiliated, I opened up and shared with them trauma I had written in my journal and never told anyone about then was discarded as a patient basically. My best guess is that since im a younger male, was a witness to a murder-suicide of a close family member, and suffered abuse as a kid from older women in my family that maybe they took it the wrong way thinking I might be a misogynist or hate women or something, in reality I absolutely do not, but my entire care team at the time were younger women and I think they took some things I said the wrong way. It may also be that they are simply used to patients coming in with more "normal" mental health problems where they know how to give common sense advice to them, and perhaps felt intimidated to deal with a patient where actual murders, suicides, childhood abuse, etc, were involved. Its all speculation on my part as to why, perhaps it was nothing to do with that and they just were having a bad day.

Are patients not supposed to share private/sensitive details about their life? My main takeaway is that I should be much more careful about opening up to a therapist or psychiatrist in the future because they will view it subjectively and perhaps misinterpret things I have written.

I know this maybe breaking the rules here as a "soapbox" and maybe will be banned for posting this, but where else can I discuss my experience with mental healthcare professionals?

I just wanna know what are my rights as a mental health patient, and what am I allowed to discuss with a psychiatrist, what am I not allowed to discuss? how can I be more careful in the future?

My teen family member has been diagnosed multiple times over the past 5 years with bipolar disorder with psychotic features, chronic, severe. These diagnoses came from psychiatrists at 10+ inpatient stays, as well as from their previous psychiatrist who they’d had for years but recently retired.

Their new psychiatrist is dialing back the diagnosis to protect them. That’s the doctor’s exact words, protect. The new diagnosis is now DMDD: Disruptive mood dysregulation disorder.

Teen is still on lithium and monthly aripiprazole shot. During monthly appointments with new doctor teen is still being referred to as having distinct hypomanic and manic episodes, doc mentioned cycle seems to be about every three months.

We don’t understand why the new psychiatrist is acknowledging the symptoms, and providing that medication while dialing back the actual diagnosis on official documentation.

If anything, wouldn’t a step down be called unspecified mood disorder, instead of DMDD?

Family is concerned this doctor may cause issues for future care by naming it incorrectly for “protection” reasons.

Are our concerns for accurate diagnosis valid?
Is the psychiatrist doing the right thing?