Afraid of psychiatrist, please help

[OliverB]

I am a female in my early 20s diagnosed with CPTSD (ICD-11) and who knows what ????. I was born in a disfuncional family, left when I became 18 and entered college (pharmacy degree). In the past I have been diagnosed with: ASD (I think it was more "traumatized child syndome"), mood disorder, panic disorder, psychotic disorder, bipolar disorder, schyzotypal disorder, .... Lets say I have anxiety-mood-psychotic-like-issues. I am only sure about the PTSD. I have 0 outside support

.In January I start my internship at a hospital.... I am afraid of taking meds because of cognitive side effects and sedation. I do not want to take them, but my therapist encourages me to give them another try (he got me an emergency appointment with a psychiatrist, so I guess he things it is not a joke. He seems to think I may benefict from medication). I do not want to be locked up.

I cannot tolerate AP I cannot tolerate SSRI and similar (they made me manic/hypo) I can tolerate small amounts of a tryciclic antidepressant and tianeptine, but they do not work long term. Valproic acid made me complete emotionless.

My problem is my emotions are crazy: I feel OK while wanting to cry, I feel depressed while wanting to go running because my body is full of energy, I get racing thoughts and voices while feeling too tired to do anything, I get SH urges while feeling like I had taken LSD because then It looks like something fun to do (as if I were in Wonderland). These are the reasons why I was diagnosed with mood disorder/bipolar in the past. 

Insanely they are not caused by anythubg external, the only thing that is caused by sonthing external is paranoia, some voices, anxiety an panic due to PTSD. Prazosin helps with this, which usually gets worse when my mood is not stable.

I am seen a new psychiatrist on 30 december (if my paranoia doesnt prevent me to go). I am afraid she would think I am lying and pretending to be psychotic or bipolar, I doubt I am either, I think I may have some sort of mild cyclothymia/psychotish flavour(could be caused by PTSD, by being hit in the head as a child, by stress...). I think I could deal with It by my own if I had therapy at least once a month (I see him once 3/4 months...). Rigth now the thing that most bothera me is being afraid to go outside during the day, I am afraid of people watching me. Social life is my most affected area, I have 0 (I can deal with studying, I cant with saying "Hi")

Anyway, It is not that bad. I have passed all my examns. After I finish my Internship and final year project I will be graduated (pharmacy). I do not get why psychiatrist are so mean and often want to lock me up in hospitals. I do not want to get caugth. Disclosing the content of my voices could lead me IP? I wont harm myself even of it told me to, even if it looked OK.

Any tip?

Edited December 21, 2019 by OliverB

[saintalto]

Psychosis requires medication to improve, therapy on its own isn't going to make much of a dent. As long as you are not a threat to yourself or others, a doctor isn't going to lock you up. When you see one you need to be honest because they can't help you otherwise.

[Iceberg]

1 hour ago, OliverB said:

I am a female in my early 20s diagnosed with CPTSD (ICD-11) and who knows what ????. I was born in a disfuncional family, left when I became 18 and entered college (pharmacy degree). In the past I have been diagnosed with: ASD (I think it was more "traumatized child syndome"), mood disorder, panic disorder, psychotic disorder, bipolar disorder, schyzotypal disorder, .... Lets say I have anxiety-mood-psychotic-like-issues. I am only sure about the PTSD. I have 0 outside support

.In January I start my internship at a hospital.... I am afraid of taking meds because of cognitive side effects and sedation. I do not want to take them, but my therapist encourages me to give them another try (he got me an emergency appointment with a psychiatrist, so I guess he things it is not a joke. He seems to think I may benefict from medication). I do not want to be locked up.

I cannot tolerate AP I cannot tolerate SSRI and similar (they made me manic/hypo) I can tolerate small amounts of a tryciclic antidepressant and tianeptine, but they do not work long term. Valproic acid made me complete emotionless.

My problem is my emotions are crazy: I feel OK while wanting to cry, I feel depressed while wanting to go running because my body is full of energy, I get racing thoughts and voices while feeling too tired to do anything, I get SH urges while feeling like I had taken LSD because then It looks like something fun to do (as if I were in Wonderland). These are the reasons why I was diagnosed with mood disorder/bipolar in the past. 

Insanely they are not caused by anythubg external, the only thing that is caused by sonthing external is paranoia, some voices, anxiety an panic due to PTSD. Prazosin helps with this, which usually gets worse when my mood is not stable.

I am seen a new psychiatrist on 30 december (if my paranoia doesnt prevent me to go). I am afraid she would think I am lying and pretending to be psychotic or bipolar, I doubt I am either, I think I may have some sort of mild cyclothymia/psychotish flavour(could be caused by PTSD, by being hit in the head as a child, by stress...). I think I could deal with It by my own if I had therapy at least once a month (I see him once 3/4 months...). Rigth now the thing that most bothera me is being afraid to go outside during the day, I am afraid of people watching me. Social life is my most affected area, I have 0 (I can deal with studying, I cant with saying "Hi")

Anyway, It is not that bad. I have passed all my examns. After I finish my Internship and final year project I will be graduated (pharmacy). I do not get why psychiatrist are so mean and often want to lock me up in hospitals. I do not want to get caugth. Disclosing the content of my voices could lead me IP? I wont harm myself even of it told me to, even if it looked OK.

Any tip?

I think you gotta try and give the new doc a chance. My first pdoc sucked, but I was afraid to change for some of the reasons you just mentioned. But the reality is, some of those symptoms probably require meds... maybe this doc will have a new strategy to avoid the problem side effects. Also, unless you are a treat, a pdoc won’t just lock you away. Most of them do everything in their power to not hospitalize patents unless really necessary. 

What APs have you tried? There are some newish ones that you may not have gotten to if you’ve been off meds or without a pdoc for awhile 

[OliverB]

I have tried risperidone, aripiprazole (abilify), haloperidol (haldol), ziprasidone, olanzapine, amisulpride, paliperidone and quetapine (seroquel). Lurasidone and asenapine are not available in my country.

SSRI/SNRI: paroxetine, fluoxetine, venlafaxine, sertraline.

 

[Iceberg]

1 minute ago, OliverB said:

I have tried risperidone, aripiprazole (abilify), haloperidol (haldol), ziprasidone, olanzapine, amisulpride, paliperidone and quetapine (seroquel). Lurasidone and asenapine are not available in my country.

SSRI/SNRI: paroxetine, fluoxetine, venlafaxine, sertraline.

 

Vraylar available? How did you do on haldol? There are other older “typical” APs that can be less sedating

[OliverB]

10 minutes ago, Iceberg said:

Vraylar available? How did you do on haldol? There are other older “typical” APs that can be less sedating

Haldol sent me to ER, I have a medical intolerance to them (really bad extrapiramidal symptoms at a low dose). It's probable I am a very poor metabolizer of CYP2D6.

 

I think Vraylar was approved this year in my country. Ugh, but until it's a year in the market most doctors do not want to prescribe them since they have to make extra paperwork. Anyway, I am really afraid of sedation, cognitive impairment and so on...

I think I am less afraid of lamictal...

 

Edited December 21, 2019 by OliverB

[Iceberg]

In my experience, and I know in several others, lamictal is pretty manageable side effect wise, but it’s purely a mood stabilizer so If the psychosis is independent of the mood it may not address it.

also, not to push the point, but if this doc felt the need to get you on an ap again, there are typicals with lower chance of EPS if you have to go that route... but I completely understand your hesitation - these meds can be a shit ton of no fun

[Undun]

Trust me, untreated/undertreated bipolar can destroy your life AND your cognition, eventually. I didn't see you mention lithium, the bp 'gold standard'? Where newer meds/therapy failed, it made a tremendously positive impact in the quality of my life (and without side effects). Please trust your new pdoc and give him/her a chance to help.

[OliverB]

Lithium? Oh oh oh, I doubt I would take it unless I became 100% psychotic and manic!.

I think I could give a try to carbamazepine or lamotrigine, but lithium is a too heavy thing.

 

The problems of typical AP with kess EPS is that there are much more sedating. Anyway, an AP migth not be needed if I am not psychotic.

[Iceberg]

9 minutes ago, OliverB said:

Lithium? Oh oh oh, I doubt I would take it unless I became 100% psychotic and manic!.

I think I could give a try to carbamazepine or lamotrigine, but lithium is a too heavy thing.

 

The problems of typical AP with kess EPS is that there are much more sedating. Anyway, an AP migth not be needed if I am not psychotic.

I was thinking of perphenazine - which typically doesn’t sedate much, and loxapine low dose which can be sedating to some but not all. 

In many ways, lithium is not as heavy as some of the previous meds you’ve already tried. Also , while lithium doesn’t necessarily treat psychosis directly it might be helpful if the psychosis stems from mood swings. However, it is known to be less effective for rapid cycling/ acute back and forth switching than it is for “typical” longer and slower BP mood changes. Of note - neither lamotrigine or carbamazepine are directly treat psychosis, like lithium it’s More preventative if the psychosis stems from the mood 

[Undun]

Everyone's different, but try to keep an open mind on meds for your own sake. I've worked in biomedical research for many, many years and I have to be sharp, but have never perceived a decline in my mental acuity with lithium. I wish you the best of luck of luck at your appointment!  😊 👍

[OliverB]

I also tried perphenazine, I forgot to list it.... I found it too sedating at 2mg.... (I had to split the tablet in four...).  

Well, lets see what happens next week.

 

I will try to stay open minded about meds

[Iceberg]

23 minutes ago, OliverB said:

I also tried perphenazine, I forgot to list it.... I found it too sedating at 2mg.... (I had to split the tablet in four...).  

Well, lets see what happens next week.

 

I will try to stay open minded about meds

Good luck with the appointment !

[mikl_pls]

What about trifluoperazine?

[Iceberg]

26 minutes ago, mikl_pls said:

What about trifluoperazine?

I mentally put that in the “likely EPS” category at the main med for psychosis dosage, but you really liked it at low dose right? 

[mikl_pls]

5 minutes ago, Iceberg said:

I mentally put that in the “likely EPS” category at the main med for psychosis dosage, but you really liked it at low dose right? 

Oh my bad. Yes, I loved it. I've only tried 6 mg/day long-term, but never got EPS from it. 1-2 mg/day might be more suitable for OP though, but I don't know how well it would work at that dose. It's metabolized by CYP1A2 though, so if OP is really a CYP2D6 poor metabolizer, it shouldn't cause any side effects if taken at a reasonable dose. 10-15 mg is more suitable for psyhcosis though I believe.

[Iceberg]

3 minutes ago, mikl_pls said:

Oh my bad. Yes, I loved it. I've only tried 6 mg/day long-term, but never got EPS from it. 1-2 mg/day might be more suitable for OP though, but I don't know how well it would work at that dose. It's metabolized by CYP1A2 though, so if OP is really a CYP2D6 poor metabolizer, it shouldn't cause any side effects if taken at a reasonable dose. 10-15 mg is more suitable for psyhcosis though I believe.

Especially if the OP can’t tolerate a whole cocktail and has to lean on it more 

[OliverB]

The appointment with the psychiatrist went really bad. I am seeing my psychologist in a week and half. I feel a bit better rigth now, still agitated while wanting to stab myself but without racing thoughts and sleeping 5h at nigth.

[Iceberg]

42 minutes ago, OliverB said:

The appointment with the psychiatrist went really bad. I am seeing my psychologist in a week and half. I feel a bit better rigth now, still agitated while wanting to stab myself but without racing thoughts and sleeping 5h at nigth.

What happened at the appt?

[OliverB]

She threatened me and accused me of lying. I haven't asked for a second appointment.