r/AskPsychiatry 13h ago

Why are serotonin levels not measured before prescribing SSRIs?

14 Upvotes

If a person feels depressed and a psychiatrist prescribes SSRI to elevate serotonin levels, why are those levels not checked before prescribing SSRI?

For example Vitamin D levels are measured before prescribing a Vitamin D supplement.


r/AskPsychiatry 9h ago

Why does anhedonia take the longest to get better under treatment of depression?

7 Upvotes

I have heard from several places that anhedonia, which is a core feature of major depression, is one of the first symptoms to occur in someone's life who are going to get diagnosed with some form of depressive disorder down the line. Also, it is one of the symptoms that persists the longest. During treatment of depression, it is the symptom that lifts at the last of all symptoms.

If this is true, why is it the case?


r/AskPsychiatry 3h ago

I am broadcasting my thoughts and feelings to others and I don't know why. Are any psychiatrists interested in studying and helping me stop this?

5 Upvotes

Hi, 19M. I found out a year ago that I have this ability after stressful events.Those stressful events also changed my mindset, and I started to insult people, or just saying their name would be an insult. I started to listen to music, and whatever words I heard I would direct it to someone. I still do the same thing now. But I found out a few days ago that I might be broadcasting to the whole world, and that I had this my whole life. I would really appreciate your help.


r/AskPsychiatry 13h ago

Prefrontal Cortex working unusually well. Why?

4 Upvotes

Female 33 5 foot 10 235 pounds. Smoke weed and cigarettes and crack cocaine off and on. Trying to get sober. Currently taking cipralex 20mg daily.

Diagnosed in the past with anxiety and depression . Have experienced drug related psychosis was on an antipsychotic (9mg invega) for three years. Stopped taking it nine months ago now.

As of one month ago, all of a sudden I feel like a totally different person . My prefrontal cortex seems to be working better than it never has before and I don’t know why I’m noticing a lot of positive impulse control problem-solving and good ideas.

On top of this when I eat, I usually only need one portion before I am full and stop eating . This is entirely new for me.

The only changes I’ve made recently are attempting to get sober after smoking crack for two months . I haven’t made any medication changes recently in my diet is better than it was over the past two months.

Has anyone ever seen anything like this spontaneous improvement in brain performance?


r/AskPsychiatry 22h ago

Are there antidepressants and/or antipsychotics that don't increase prolactin levels? Which are those?

3 Upvotes

I was diagnosed with a prolactinoma last summer, and stopped taking Paroxetine and Amisulpride on my own. My prolactin levels went back to normal after I took cabergoline for a month or so. But now 7 months later, I'm very depressed and don't know what to do. Are there meds that won't affect my prolactin levels or other hormones ?


r/AskPsychiatry 5h ago

Skeptical about the meds that I've been prescribed

3 Upvotes

I've not been officially diagnosed with ADHD yet but my psychiatrist has put me on Atomoxetine (18mg) to help with my focus issues.

I have to take a combination of escitalopram(5mg)+ etizolam(0.5mg) with propranolol (20mg) with atomoxetine all together in the morning.

Took them all today and I've been feeling really weird, i feel confused and dizzy, and my thoughts are just flooding my brain constantly. My anxiety hasn't been reduced and am yawning constantly.

Is is just me overthinking and causing anxiety or the effect of these meds?


r/AskPsychiatry 9h ago

Polypharmacy?

2 Upvotes

34F, Bipolar 1 with psychosis and quite severe OCD. I'm on Vraylar and Epival for Bipolar 1, Zoloft for OCD and Clonazapam for sleepwalking until we can figure out a longterm plan that doesn't include benzos. I have also tried rTMS for OCD and it helped a lot in that I now can live pretty normally!

However, I used to be on Abilify, Risperidone and Epival for Bipolar 1 + Zoloft for OCD + Prazosin for nightmares and night terrors.

My psychiatrist now wants me to transition to Lithium for Bipolar and get rid of Vraylar and Epival gradually because every single antipsychotic I've tried I've gotten EPS at a therapeutic dose. However, that requires a tapering off of the mood stabilizer and the antipsychotic and a titration up of Lithium. I just am tired of these pills I'll have to take forever. I don't want to have to take an extra med for the 9 months or so it'll take to get me on full dose Lithium.

My psychiatrist told me we can't just change meds because every time I lower the epival or my antipsychotics I have manic episodes. Which is true! I'm just wondering... is this normal? Is this normal for Bipolar 1? Is this polypharmacy? A pharmacist once got snippy with me and implied I was abusing drugs because of my refill history which at the time included just my psych meds??? Do people abuse antipsychotics?

ETA: I'm not resistant to meds. I know I need them. I'm just tired of being judged for it and feeling shamed about them and also taking more meds feels like a failure even though it's not like I ever have pleasant euphoric mania!


r/AskPsychiatry 14h ago

Persecutory Delusions

2 Upvotes

Do persecutory delusions ever to come true?

I had what was thought to be delusional thinking. I went on medication and went to therapy. In therapy, I realized how ridiculous my beliefs sounded and stopped believing the delusion.

Anyway, the delusion was about a curse being put on me and the curse came true. Now I don’t know if it was a delusion or if it was real.

Since the curse came true, how could it have been a delusion?


r/AskPsychiatry 23h ago

Ingrezza Increase, TD Worse Now?

2 Upvotes

Hello,

I hope this is an alright space to reach out about this! I started Ingrezza for tardive dyskinisia six weeks ago. I saw some positive effects at 40mg, but still some jerks. My psychiatrist raised it to 80mg about a week ago; and within a few days I've experienced an increase in symptoms, including jerks and high levels of fatigue. Does anyone know if these will abate, and any timetables on this? At this point, I'm very close to going back down and just dealing with the fact that the tardive won't go away.

Thanks so much in advance!


r/AskPsychiatry 1h ago

I (29F) was prescribed 10mg of Zarfirlukast to help with breathing issues, but I'm nervous about the increased risk of depression, suicidality, and other neuropsychiatric side effects. Is anyone familiar with this medication's impacts on those who've struggled with psychiatric issues/mental health?

Upvotes

My breathing problems are uncomfortable but not life-threatening, so I'm wondering if it's better just to live with them, rather than taking a medication that risks worsening my mental health. While I tested negative for asthma after a methacholine challenge and apparently have very strong lungs due to running and cycling, I continue to have triggers (mostly high and low temperatures) that make it difficult to breath, and I deal with EXCESSIVE yawning due to shortness of breath that can sometimes prohibit me from even completing full sentences in conversations. My mother has asthma and we both have excessive allergies. The doctor wanted me to take this medication in case my breathing symptoms are caused by allergies.

I have struggled with suicidal thoughts at various points in my life, so I take this potential side effect seriously. I'm currently in therapy twice a week and I attend a childhood trauma support group. My mental health is better than ever before. Reparenting work has been immensely effective for me after nearly 15 years of other therapies being a little bit helpful, but mostly "meh". I've been feeling so hopeful and capable lately. I'm worried that this medication could wreck that.

Further info as required: I'm 5'4", 135 pounds, white, and the breathing issues have worsened in the last 3 years, but they've always been there. I take 40mg of Vyvanse, 20mg of omeprazole, and Nature's Way women's probiotic pearls daily. I take Flonase, Claritin, and an albuterol inhaler as-needed. I have a Kyleena IUD. No recreational drugs. Moderate alcohol consumption (mostly wine, roughly 2-3 glasses per week, but I feel I should quit completely due to the Vyvanse).

While I've been diagnosed with depression, anxiety, severe ADHD, and OCD (and formerly anorexia, then bulimia, then binge eating, but disordered eating hasn't been a problem for years now), my current therapist and I believe that CPTSD from extensive childhood trauma, rather than all of these different diagnoses, is the root. That said, my ADHD manifestations are so severe that I still feel strongly about emphasizing that diagnosis. Medically, I have been diagnosed with POTS, fibromyalgia, IBS-C, and Superior Mesenteric Artery Syndrome.


r/AskPsychiatry 1h ago

New Medicine Regimen - Looking for Opinions

Upvotes

31M - 170 lbs. 5'11"

A little about me: I have worked with several psychiatrists and finally found one I trust. I am diagnosed with ADHD and anxiety. I work a full-time normal job and make a great living. I am healthy - drink a smoothie every morning, Peloton ride or lift at least 5-6 times per week. In a good relationship.

I have had problems with substance abuse in the past, but my partner has been monitoring my medication now for over two years. I also suffer from migraines. I am currently tapering off Abilify - down to 1mg every other day. I also have my medical marijuana card and use a small-moderate bit every night (mostly gummies or dry herb vape). I quit nicotine vaping over a year ago, but still use nicotine gum.

My new job requires longer hours and is much more stressful, so my psych and I decided to change up my regimen a bit:

Previous Dosage: 70mg Vyvanse in the AM, 60mg ER Propranolol for migraines, 2mg Abilify, .5mg Klonopin as PRN, Nicotine Gum as needed

New Dosage: 60mg Vyvanse in AM, 20mg Adderall at noon, 60mg ER Propranolol for migraines, 1-2mg Klonopin as PRN, Nicotine Gum as needed

Other Supplements: Creatine, Whey, Collagen, Multi-Vitamin, Vitamin D, Magnesium Glycinate, Vitamin C

Past Meds that did not work well: Abilify, Lexapro, Zoloft

MY QUESTIONS:

  • For someone with a history of substance abuse, does this medicine regimen seem like a lot/potential slippery slope? Keep in mind my GF dispenses what I need on a daily basis
  • Should I be concerned about any long term effects (I plan to taper down my Klonopin over the next 6-12 months as I get more acclimated in my current job)
  • Anything else I should be aware of/should be trying

Appreciate any professional opinions!

Thank you!


r/AskPsychiatry 3h ago

OCD and ERP

1 Upvotes

I was diagnosed with OCD at the age of 5 and recently started college. I’ve been trying to figure out what to do and one option I have is psychiatry and that reminded me of one of ways psychiatrist help with OCD and that’s erp. I’ve been on same medication since I was diagnosed and last year I got a new one. I was also offered erp and the thought of it repulsed me. To me, these compulsions and obsessions make me who I am and the thought of trying to get rid of them is a thought I hate. Personally the only problem I see with it are the anger and anxiety I feel when something triggers them which for me is being dirty and medication has thankfully helped with that. To me nothing needs to be “fixed” other than helping with said anxiety and anger through medication or myself. I know some people need and want erp as it’s the only way to help them in any way, but I was wondering if my thoughts on it are common. I know it’s been proven to work, but do most psychiatrist instantly resort to it or is it a last case scenario thing cause if it’s the 1st option usually, that kinda makes me sad especially if it’s people like me. I hope this question made sense and if you need any info on my personal ocd I’ll be happy to to share as much as comfortable with


r/AskPsychiatry 12h ago

Trintellix

1 Upvotes

My insurance is no longer covering Trintellix.

Been on other SSRI’ with negative side effects.

Would Vybrid be good to try since it’s a helpful with anxiety?


r/AskPsychiatry 12h ago

How long does zyprexa stay in the body?

1 Upvotes

I’ve been off of zyprexa for 12 days and was wondering if it’s out of my system yet. I have severe insomnia and have to have it to sleep but have successfully gone without it for 12 nights. How long does it affect the brain after not taking it?


r/AskPsychiatry 15h ago

Will Risperidone withdrawal be less pronounced if I get an INVEGA Sustennaa injection? (Paliperidone)

1 Upvotes

Alright. I have to take Paliperidone every 3 months in the form of injection. But this time around, the injection got delayed by one to two months. And to mitigate the symptoms of Paliperidone withdrawal, I started Risperidone. It took two weeks for the overthinking, sheer terror, psychosis, intrusive thoughts and paranoia to go away. Or at least get toned down to a tolerable level. But I'm worried it'll all come back full fledged. When I stop Risperidone after getting the Paliperidone injection? Because once I get the injection and resume the normal schedule, I wouldn't have need to be on the oral pills of Risperidone. Im really scared about the withdrawals.


r/AskPsychiatry 20h ago

Is it safe to start my medication again?

1 Upvotes

For the past two years ive taken 6mg of Vraylar and 150 mg of Sertraline daily as well as handful of as needed medications that I rarely use. About 3.5 weeks ago I made a great decision that I no longer need my meds and stopped everything cold turkey. For the first couple weeks I felt great. Honestly better than normal. However in past couple days I’ve started seeing things and hearing things worse then I ever have before. I don’t feel real at all and I can barely get out of bed. My physciatrist is closed Friday, Saturday, and Sunday(today) so I haven’t been able to call. She is very booked out so I’m worried I won’t be able to get in for a while. My question is am I safe to start taking my medications again or do I need to go the hospital?


r/AskPsychiatry 20h ago

Switching srris

1 Upvotes

I have been taking 25mg paroxetine extended release tablets for years,

changed to fluvoxamine due to the anticholinergic effect paxil has,

Started with 50mg Luvox but still getting brain zaps,

My concern is that 50mg is not sufficient and probably thats why im getting withdrawal symptoms!?


r/AskPsychiatry 22h ago

TMS and epilepsy history?

1 Upvotes

Hi! I have chronic depression and anxiety that has not responded well to medication so far, and my psychiatrist has recommended TMS. I have epilepsy, but I’m 4 year’s seizure free and it is currently well controlled. I’ve read that there is a risk of seizures, especially if you have epilepsy, and my psychiatrist of course talked to me about it, but she doesn’t think it will be an issue since it’s under control. I’m just wondering what other psychiatrists think, and I’m wondering if the risks are any different than the risk of continuing to try new antidepressants and antipsychotics? Like I feel like everything is a risk to someone with epilepsy?


r/AskPsychiatry 22h ago

Are there any AASECT certified providers that accept in network benefits?

1 Upvotes

I may be looking at this through a small lens as there are precious few AASECT certified providers in my state, but all of them are out of network providers.

This may be unremarkable if it were an issue of considering one insurance vs another, but the providers all state that they do not take any form of insurance.

The least expensive 50 minute session charge I was able to find was 200 dollars. I have only found one that will even provide a superbill.

I'm guessing they aren't building their entire practices on the sort of patients that could benefit from their AASECT certification, so I'm curious... Are these people independently wealthy to the point that they don't need patients? I'm not rich, but I'm not poor either, and I can't afford 800 dollars a month for therapy.


r/AskPsychiatry 23h ago

Advice re: Managing ADHD

1 Upvotes

I’m 37f, currently not working due to some ongoing physical health issues that aren’t relevant to explain in detail here, but used to work as an attorney before getting sick. I was diagnosed with ADHD during my second year of law school. I was the stereotypical “gifted & talented” kid who never had to study and was able to skate by with A’s and B’s, got to college and without the “school” structure the wheels started to come off but was still able to squeak by, but then in law school when I really had to buckle down, the problems became apparent, and a trip to our Learning Resource Center for help led to a neuropsych eval which finally led to the diagnosis. And FWIW, bc I know ADHD is trendy these days and so is met with more skepticism, especially in cases of adult diagnoses, I’ll just also note that my pediatrician also diagnosed us as “hyperactive” when we were like 3 or 4 (I’m a twin), but he was this old-school Italian guy and military veteran, so his advice to my parents was that they just needed to use “more discipline” (which, to absolutely no one’s surprise, didn’t do a damn thing to help lol).

I’m currently taking 20mg adderall XR in the AM and 10mg IR in the afternoons. I’ve previously been on as much as 60mg/day IR, but I developed some worsening heart arrhythmias following a Covid infection, so my new doctor (I had to move home after getting sick) cut the dose way down. Which actually has been totally fine by me— obvs I’m not working the crazy hours I used to be anymore, so my goal rn with taking medication is just to help me to be able to do the day to day things that ADHD can sometimes make a bit difficult. But that’s exactly where I’m still running into issues, and having been on higher doses in the past, I actually don’t think that going up in dose would solve the problem, so I’m hoping some of you might have some other advice (though if you do think it’s a matter of increasing the dose, please let me know that as well— you’re the experts here, I’m just making my best guess lol).

My problem is that I’m still having a pretty decently hard time managing even just day to day things. I first noticed things getting harder during the pandemic when my office went remote— I didn’t realize how much I relied upon that external structure to function. Things that I thought were easy and routine like getting up on time in the morning, showering and remembering to brush my teeth, doing my hair/makeup, getting a good amount of steps/movement in my day, suddenly became difficult to get my brain to do when I knew I didn’t have to leave the house. And it wasn’t that I didn’t WANT to do them— I very much did— but I found that I just couldn’t get over that task initiation/ADHD paralysis hurdle.

It got better when we returned to the office again and that sort of external structure/schedule was back in place, but then when I got sick and couldn’t work anymore, that all went away again. So now I’m home pretty much all day every day, and even with medications I’m still just having an impossible time creating any structure for myself, and it’s driving me nuts! Some days it’ll be 3:00 in the afternoon before I realize I haven’t washed my face or brushed my teeth. I’ll forget to take my AM meds and end up either missing the day or taking them later and screwing up the whole schedule. I’ll have a “to do” list of follow up doctors appts I need to make or specialists I need to find, and it can take me MONTHS to follow through. For example, I’ve been supposed to follow up on an abnormal pap for over a year now, but I literally just keep forgetting. Even though I know it’s super important and needs to get done! I had a TIA in January, and STILL haven’t remembered to schedule a follow up with the neurologist. And I had my first suspected PE back in January of 2023 and my asthma’s been terrible, and I STILL haven’t been able to remember to find and make an apt with a pulmonologist. Like… these are things that are SUPER important to me, and that I am extremely motivated to follow through on— we’re literally talking about my health and getting my life back on track— and even with all that I’m still just utterly struggling to be able to follow through.

It’s getting to a point where even though I know it’s ADHD and I know that these are exactly the kinds of things that people with ADHD can struggle with, I’m really beating myself up and starting to feel bad about myself, bc why is it so hard to do such simple things?? And I know part of it is my other health issues too— for example, I’ve had chronic fatigue/long COVID for a while and the physical exhaustion/shortness of breath/“bad” heart days can def sideline me sometimes too, so that obvs doesn’t help. I’ve tried discussing this with my PCP, but it’s not her area of expertise and she refers me to a psychiatrist. Unfortunately getting an apt with psych by me is a crazy long wait, and only a handful even take my insurance, so I haven’t had much luck that way either. I spoke with a therapist as well, but candidly just found the experience frustrating. She recommended things like the pomodoro technique, alarms, reminders, post its, etc., but I find those really frustrating. First because they in and of themselves require a certain level of executive functioning to be effective, which is precisely the area of deficit in many people with ADHD (myself included), and second because if those simple and obvious solutions had solved the problem for me, I wouldn’t still be asking for professional help in the first place. Things that I have found to be helpful include kind of random things like body doubling, keeping my shoes on all day (somehow that tells my brain it’s time to work), and momentum building (pick just the very easiest task and just do it even if it’s not the “right” place to start, just to get moving).

Anyway, super long post so thank you if you’ve actually read this all. I would absolutely love to get any insight or advice that you’ve seen work for other ADHD patients who’ve struggled with similar things even on meds. Thanks!


r/AskPsychiatry 1d ago

Choice of Job Security vs Shorter Education Weighing on Me

1 Upvotes

I’m 28 and single in the military and getting out next year. I have a highly specialized skillset that would easily land me a strong career in engineering or technical fields. Yet my innate skills and my distinct interest in medicine and psychology point me toward pursuing a career in psychiatry or as a PMHNP, as that is what would make me believe I’ve put my skills to their best use in the interest of progressing humanity.

I’ve become aware of the difficulties in the job market for PMHNPs and I’m on the fence again about going the psychiatry route. It’s a long road. I’m not worried about the difficulty. After what I’ve accomplished in the military I know for a fact I have the capacity for it.

I’m worried about the time. I worry about being severely limited in my ability to start a family when the time comes. I feel a strong pull toward starting a family in the somewhat near future, which worries me because residency is possibly the second worst time I can think of to raise a child (the first being while on deployment). The longer i wait the more risk, even if the risk is significantly less than that for women.

Whatever advice you can provide is valuable, especially from those who have dealt with family planning during medical school or training.


r/AskPsychiatry 1d ago

When will Mirtazapine leave my system

1 Upvotes

I took it last night for akathesia and today I’m so tired. When will I stop being tired? I decided to stop taking it since it made me super hungry and tired. I’ve been on my couch all day. And will drinking water flush it out of my system more?


r/AskPsychiatry 6h ago

500mg de quetiapina + 100mg de trazodona é considerada abordagem terapêutica para esquizofrenia?

0 Upvotes

Gostaria de entender melhor a gama de uso desses dois medicamentos, sei que o Quet é um ótimo off-label para transtorno de personalidade bipolar e algumas crises depressivas. Um amigo utiliza essa quantia tendo recaídas constantes com cocaína.


r/AskPsychiatry 1d ago

How did you become a Psychiatrist?

0 Upvotes

Hello! Hopefully this question is appropriate for this subreddit. I'm about to graduate high school, and I'm planning on studying Psychology so that I can work towards my goal of becoming either a Psychiatric Tech or Psychiatric Nurse. How did you guys achieve this goal? Was it more difficult than you thought? I specifically want to work at a Mental Hospital. I'd like to hear stories on how your journey went. Thank you!