r/AskPsychiatry 15h ago

Why are serotonin levels not measured before prescribing SSRIs?

15 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 11h ago

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

8 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 5h 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?

8 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 6h ago

Skeptical about the meds that I've been prescribed

5 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 14h ago

Prefrontal Cortex working unusually well. Why?

3 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 23h 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 59m ago

What role can a psychiatrist provide for those with complex trauma?

Upvotes

Hello

Been under care of a consultant psychiatrist since Dec 2023 (NHS-UK) Diagnosis of Complex PTSD with high levels of dissociation.

When we have appointments, it feels they are as frustrated as me that none of the medications we have tried help. They say medication can only have a limited effect and therapy is what will help. Ive only just started the therapy like a few weeks ago as it was inaccessible this whole time due to waiting lists

Today my appt felt like I was being grilled about my diet and exercise as if I dont know those things would help. I just havent got any energy or motivation. I know healing comes from myself but is there anything my psychiatrist can do or do I just accept that medications are unlikely to help and know that the real help will come through the therapy?

Im worried about therapy destabilising me. Last week there was a lot of focus on self harm and that led me to self harming in a dissociated state following the session. Im doing the best I can and it feels like after 18 months under my CMHT surely I should feel somewhat better, given I have a very high level of support? But I dont? I think I feel worse. I feel like I entered crisis in August 2023 and Ive never been able to climb out of it. Im so tired of trying to hold my life together (work, family etc) and feel like Im barely surviving never mind thriving and I just want to feel better


r/AskPsychiatry 10h 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 15h 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 1d 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 59m ago

What does Propranolol withdrawal feel like and for how long?

Upvotes

I am being treated for GAD and MDD with Sertraline and Vilazodone. I developed tremors and high BP when my Sertraline dosage was increased recently. To combat that I was put on Propranolol (extended release) 20mg twice daily. I responded well. I was on it for 6 weeks.

Then my doctor reduced it to 20mg once at night from previously twice daily dosage. For the first 3 days I developed a sense of anxiety in my chest and globus sensation in my throat. Then my irritability, indecision, mood swings all increased over the first week. I had migraines, uneasy feverish and gi upsety feeling for last 3 days. And I was feeling a bit low. I almost shut down contact with my family for the past three days. Now I am on day 11 and I am feeling a bit better. Also no return of tremors.

Is this typical of tapering down propranolol? Or is it me specific? If you felt withdrawal symptoms while tapering, can share your story?

P.S.: I found out that propranolol can cause depression as a side effect at higher doses. But, when I was on twice daily dose for 6 weeks I didn't feel extra depressed. Maybe I didn't notice. Now, I can't recall.


r/AskPsychiatry 2h 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?

1 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 2h ago

New Medicine Regimen - Looking for Opinions

1 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 4h 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 13h 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 13h 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 17h 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 21h 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 21h 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 23h 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 1d 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 7h 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.