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jeva39

Issues with anger, rage, irritability, varying affect weeks after beginning mirtazapine - doubts about current dx

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I have been trying to determine the most likely dx based on my past hospitalizations, episodes, symptoms, etc. in light of recent adverse symptoms following mirtazapine 7.5 mg as well as the the fact that whenever any new med is introduced i become liable to fly off the handles, less stable overall such that i wonder whether i should be hospitalized.

during these mood swings i feel a need for relief due to the ovewheliming distress and ultimately usually wind up being told to take an extra ativan. yesterday however, i wound up taking 3 mg of ativan total throughout the day just to function. the fact that the dose of ativan seems to be escalating over time and my symptoms involve not just worry or jitteriness but also rage and extreme discomfort suggests to me that in my treatment the wheels are beginning to fall off.

 I wonder if the introduction of mirtazapine a few weeks ago is triggering manic like symptoms in me. and if so, what would that mean with regard to dx and future treatment plans? I understand the doctor should have most of the say on this matter, but my current doctor is actually a PA not an MD. i am currently looking through the book Manic Depressive Illness Bipolar drisorders and Recurrent Depression by Goodwin and Jamison that i picked up at the library recently in effort to discern the most likely dx based on what iv experienced in the past  (which included blackouts, delusions, psychomotor retardation, flat afffect, depression, derealization/depersonalization, social anxiety/phobia, isolation, difficulty communicating)  and then issue my ideas to a competent professional

right now i'm trying to remain stable but i am nontehelss feeling very wired even though im getting 3 mg of ativan total throughout the day and was told not to take any more than that during a 24 hr period.  I would simply ask my PA what to do next but i have doubts about any suggestions he might make and id like to be sure that i'm going the best possible route. if i could see a specialist of some kind for a second opinion that might be best, but id like suggestions from anyone here. it seems the really good doctors/therapists are not accepting new patients or are completly booked for months. in any case, any suggestions at all would be really helpful. thanks :)

Edited by jeva39

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I'm on a phone so I can't see signatures. Are you on a mood stabilizer?

For me bupropion, mirtazapine at the same time sucked. Mixed episode glaore

Adding a weak mood stabilizer, gabapentin to the combination above made things quite good.

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@jeva39, if you feel comfortable sharing, do you live in the U.S., or another country?

It does seem to me that you are in need of a second opinion from a qualified psychiatrist (an MD).

Do any doctors in your area have waiting lists?.....It might be a good idea to call around and see if you can get on a wait list for a psychiatrist.

Would it be an option for you to voluntarily admit yourself to a psychiatric facility?

Edited by CrazyRedhead

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11 minutes ago, argh said:

I'm on a phone so I can't see signatures. Are you on a mood stabilizer?

According to sig, on Lithium 750mg---Effexor XR 225mg,----Ativan 2-3mg perday----Seroquel XR 100mg---Vvyanse 30mg---mirtazapine 7.5 mg,--Concerta 27mg

Edited by CrazyRedhead
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21 minutes ago, jeva39 said:

I have been trying to determine the most likely dx based on my past hospitalizations, episodes, symptoms, etc. in light of recent adverse symptoms following mirtazapine 7.5 mg as well as the the fact that whenever any new med is introduced i become liable to fly off the handles, less stable overall such that i wonder whether i should be hospitalized.

during these mood swings i feel a need for relief due to the ovewheliming distress and ultimately usually wind up being told to take an extra ativan. yesterday however, i wound up taking 3 mg of ativan total throughout the day just to function. the fact that the dose of ativan seems to be escalating over time and my symptoms involve not just worry or jitteriness but also rage and extreme discomfort suggests to me that in my treatment the wheels are beginning to fall off.

 I wonder if the introduction of mirtazapine a few weeks ago is triggering manic like symptoms in me. and if so, what would that mean with regard to dx and future treatment plans? I understand the doctor should have most of the say on this matter, but my current doctor is actually a PA not an MD. i am currently looking through the book Manic Depressive Illness Bipolar drisorders and Recurrent Depression by Goodwin and Jamison that i picked up at the library recently in effort to discern the most likely dx based on what iv experienced in the past  (which included blackouts, delusions, psychomotor retardation, flat afffect, depression, derealization/depersonalization, social anxiety/phobia, isolation, difficulty communicating)  and then issue my ideas to a competent professional

right now i'm trying to remain stable but i am nontehelss feeling very wired even though im getting 3 mg of ativan total throughout the day and was told not to take any more than that during a 24 hr period.  I would simply ask my PA what to do next but i have doubts about any suggestions he might make and id like to be sure that i'm going the best possible route. if i could see a specialist of some kind for a second opinion that might be best, but id like suggestions from anyone here. it seems the really good doctors/therapists are not accepting new patients or are completly booked for months. in any case, any suggestions at all would be really helpful. thanks :)

I agree look for another opinion. Meantime, what about increasing seroquel? Can help agitation and anxiety 

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Also what’s ur lithium level? At 750 you might have room on that too. Oh and what’s your current official Dx from PA?

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6 minutes ago, Iceberg said:

Meantime, what about increasing seroquel? Can help agitation and anxiety 

I agree....100mg Seroquel is a pretty low dose

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8 minutes ago, Iceberg said:

 Oh and what’s your current official Dx from PA?

According to sig, dxs are:

MDD recurrent, severe with psychotic features,---GAD----Social Anxiety Disorder,----Avoidant Personality Disorder

Edited by CrazyRedhead

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i dont know if thats the current official dx.. but its along those lines

regarding the meds, should be accurate aside from the Vyvanse, i dont  take that anymore, just concerta 27 mg

35 minutes ago, CrazyRedhead said:

@jeva39, if you feel comfortable sharing, do you live in the U.S., or another country?

It does seem to me that you are in need of a second opinion from a qualified psychiatrist (an MD).

Do any doctors in your area have waiting lists?.....It might be a good idea to call around and see if you can get on a wait list for a psychiatrist.

Would it be an option for you to voluntarily admit yourself to a psychiatric facility?

I would really like to see a specialist of some kind, not just any psychiatrist. I'm in the US.

I dont feel that checking into a psych unit is necessary right now, but availability and scheduling issues with my THERAPIST means that i havent talked to anyone for weeks now, plus my PA is on vacation this week. its been really difficult to deal with. im thinking of seeing a new therapist as well. one that specailizes in codependency issues with narcissistic/mentally ill mother along with severe/chronic mental illness (i'm not sure if i struggle with one or the other or both tbh)

Edited by jeva39

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2 minutes ago, jeva39 said:

i dont know if thats the current official dx.. but its along those lines

regarding the meds, should be accurate aside from the Vyvanse, i dont  take that anymore, just concerta 27 mg

Have you ever been above 100 on the seroquel? 

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i don't think so.. my PA put forward the suggestions that i try a 3rd generation dopamine balancer like rexulti vraylar or abilify, however i probably wouldnt do something like that unless i were taken off the stimulant and effexor lowered.. cause right now i feel overactivated 

 

the only thing about raising mood stabilizer/aap dose means that id probably become sluggish, flattened affect, slow word recall etc. at which point im  essentially non functional..      how can i strike the right balance??? is such a thing possible?

 

----going to take a break, any replies are welcome, and il get back to them sometime later on today.

Edited by jeva39

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Just now, jeva39 said:

i don't think so.. my PA put forward the suggestions that i try a 3rd generation dopamine balancer like rexulti vraylar or abilify, however i probably wouldnt do something like that unless i were taken off the stimulant and effexor lowered.. cause right now i feel overactivated 

If you were definitely BP I would suggest latuda instead which helps depression but is often less activating... but think that the results aren’t as great for MDD. However, I guess it could be worth a shot if you’re having psychotic symptoms. Also, do you think that dropping the stimulant may help regardless? Maybe it would cut down on the nastiness that ADs are bringing you. Unfortunately, those newest APs have been a really big fat YMMV as far as which doses can be sedating or activating. My personal suggestion would be to look at rexulti, but that’s my own bias. Rexulti was the best out of the 3 for my depression and I didn’t find it overly activating 

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I have treied latuda in the past and it was effective but the only bothersome side effect that caused me to stop taking it eventually was facial swelling. other than that it worked pretty well. i am going to in the meantime try to drop the concerta i have some 18 mg pills left over.. i may try rexulti to replace the quetiapine cause at the moment i feel very unlike myself, i'm stutering, slurring my words a bit, having difficulty speaking coherently, feeling tense, agitated.. even though i was fine week ago when i first started the mirtazapine. also like i said the fact that my benzo dose is gradually escalating since my PA has been away is very very cocerning to me as i dont wish to experience benzo withdrawal again last time i went through withrawal was followed by several hospitalizations involving delirium and self harm (still have the scars from that time). again this signals to me that my symptoms are more than anxiety related, but then again what the hell do i know

Edited by jeva39

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21 minutes ago, jeva39 said:

I have treied latuda in the past and it was effective but the only bothersome side effect that caused me to stop taking it eventually was facial swelling. other than that it worked pretty well. i am going to in the meantime try to drop the concerta i have some 18 mg pills left over.. i may try rexulti to replace the quetiapine cause at the moment i feel very unlike myself, i'm stutering, slurring my words a bit, having difficulty speaking coherently, feeling tense, agitated.. even though i was fine week ago when i first started the mirtazapine. also like i said the fact that my benzo dose is gradually escalating since my PA has been away is very very cocerning to me as i dont wish to experience benzo withdrawal again last time i went through withrawal was followed by several hospitalizations involving delirium and self harm (still have the scars from that time). again this signals to me that my symptoms are more than anxiety related, but then again what the hell do i know

Just be careful cuz as far as anxiety goes seroquel is probably more reliable than rexulti. However, if you feel you may be oversedated and the seroquel is partially the culprit than rexulti can have less sedation 

Edited by Iceberg

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Would a different longer action benzo be an option? If your taking round the clock klonipin is Often used because it can get ahead of the symptoms and be more preventative, possibly eliminating the need for dose escalation 

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I have brought up valium as an option, in my experience klonopin is way too strong. i will bring up rexulti as an option

 

as an aside i am wondering if anyone can answer: is there a psychiatric term for the belief that one's thoughts can negatively influence others or cause bad things to happen. almost like when i'm around others things easily go wrong unless i exert enough mental energy to cause my mind to go blank thereby preventing negative things from happening. yes i understand that sounds crazy, i dont believe it, but its a persistent thought that makes me feel as though thers something wrong with me beyond psychiatry.. and i havent come across a psychiatry term describing such a phenomenon...

Edited by jeva39

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23 minutes ago, jeva39 said:

I have brought up valium as an option, in my experience klonopin is way too strong. i will bring up rexulti as an option

 

as an aside i am wondering if anyone can answer: is there a psychiatric term for the belief that one's thoughts can negatively influence others or cause bad things to happen. almost like when i'm around others things easily go wrong unless i exert enough mental energy to cause my mind to go blank thereby preventing negative things from happening. yes i understand that sounds crazy, i dont believe it, but its a persistent thought that makes me feel as though thers something wrong with me beyond psychiatry.. and i havent come across a psychiatry term describing such a phenomenon...

that's psychosis. it's a false belief/delusion.

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it feels very real. i feel as though something is very wrong with me. i came up with various search results using terms related to what i'm experiencing and came up with "magical thinking" schizotypy" and "attenuated psychosis" - basically pertaining to near-psychotic or "psychotic-like or sub-clinical psychosis"  there's a term for being outside one's own body "heautoscopy" distinct from trauma based depersonalization..i dont know why i havent encountered these descriptions before.. i wonder if there's any association between attachment or developmental trauma and these kinds of phenomena

https://books.google.com/books?id=biicBQAAQBAJ&printsec=frontcover&dq=assessment+of+psychosis&hl=en&sa=X&ved=2ahUKEwigmMz13LzkAhUHtlkKHWC7BZgQ6AEwAXoECAIQAg#v=onepage&q=depersonalization&f=false

 

Edited by jeva39

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i think the point of a false belief is that you personally think it's true but it really isn't true.

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