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psychcns
psychcns, Nurse
Category: Mental Health
Satisfied Customers: 79
Experience:  Advanced Practice Psychiatric/Mental Health Clinical Nurse Specialist with Prescriptive Privileges
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I have had GAD for 15 years and have taken on a stressful teaching job in an inner city sc

Resolved Question:

I have had GAD for 15 years and have taken on a stressful teaching job in an inner city school. I have 37 days of class left.....I've had chest pain on and off for 2 months and have been to the ER twice (once from school in front of my students). I'm a science teacher with enough chemistry background to understand what is being prescribed... It hasn't helped and now he thinks I have adult ADHD and had me fill out a survey and ask my parents about my childhood. I've always been sharp and after taking the two inventories I don't believe I have the condition. I have never had trouble focusing, never had behavior issues with authority or class or society, never had a problem focusing on anything - interested or not. I do have figeting and emotionality off my anxiety medication. Now we are mixing xanax and adderall which makes no sense to me and adding ambien with all of the potential side effects. I'm just concerned I'm a walking pharmacy..
Submitted: 2 years ago.
Category: Mental Health
Expert:  psychcns replied 2 years ago.

psychcns :

Hello.

Customer:

hi

psychcns :

How long have you been on the Cymbalta?

psychcns :

Does it help?

Customer:

16 months

psychcns :

Same dosage or increased recently?

Customer:

yes, but what I really think I need is to increase the 60 mg dose

Customer:

I've mentioned it twice and my dr. hasn't done anything with it

Customer:

same

Customer:

he instead doubled the dose of xanax XR, also 16 months

psychcns :

That was my first question, what you were on to treat the symptoms in a more long term manner, not just put out fires with short acting meds.

Customer:

and added xanax just regular at .5 mg, then 1 mg a month later when it wasn't helping

Customer:

that's what I wanted but I'm just a science teacher and he's a new psychiatrist for me - insurance change due to school district change

psychcns :

Studies show dosages higher than 60mg didn't yield significant improvement...However, that being said, I've had several individuals who have responded better to higher dosages.

psychcns :

Max dosage is 120mg..but would go up in increments of 30mg only at a time.

psychcns :

Are you seeing a general practitioner or Psych?

Customer:

I'm quickly running out of options to try besides cymbalta

Customer:

psych, my GP ran out of knowledge 18 months ago

Customer:

after a hospitalization for exhaustion when the anxiety and sleep meds were not working and I went nearly 4 days without restful sleep they messed with my meds and sent me home on 3 times the adult dose of clonopin and the infant dose of trazodone

psychcns :

What have been your dosages of Effexor XR and Zoloft? It is not uncommon that really anxious people need maximized dosages and anything other than that is not really giving it a fair trial. But, I'm with you, since you are on Cymbalta, have had partial positive improvement, and tolerating it well, would recommend increasing it first.

Customer:

worked with patient advocacy and another physician at a different hospital to fix that 16 months ago (2 weeks after the zombie experience post-discharge from the hospital)

Customer:

started low and raised each over 3ish years on each one before changing to the next one

psychcns :

Have you been assessed for BiPolar?

Customer:

moved from SSRI to the dual neurotransmitter kind 5 years ago

psychcns :

okay...max on Zoloft is 200 and on Effexor XR 300mg

Customer:

yes and no manic episodes

Customer:

depressive yes, history of PTSD that has be 'resolved' according to the new dr.

Customer:

200 on zoloft sounds right but that was the first one I was on in jr. high....and 300 is accurate - that was what I was on up to 16 months ago

psychcns :

Sometimes people have what I call the "garden variety" type of manic or hypomanic symptoms, irritability, edginess, decreased sleep, racing thoughts, agitated, etc.

psychcns :

okay...on the previous meds.

psychcns :

So, you have responded better to the snri, Cymbalta, then to regular SSRI's?

psychcns :

Your primary symptoms right now are anxiety and panic attacks, is that correct?

psychcns :

How about depression?

psychcns :

Ever tried Klonopin?

Customer:

most of those only happen during panic/anxiety attacks, the sleep has been a problem since 4th grade - started the 'gifted and talented program' and my brain turned on and hasn't ever really shut off. Not to sound narcisistic (can't spell) but I am in MENSA and a genius which doesn't help my brain turn off

Customer:

SNRI

psychcns :

I see.

Customer:

yes - I believe I have depression instead of ADHD

psychcns :

what are your symptoms of depression?

Customer:

the klonopin they put me on at the hospital when they discharged was WAY too high - I don't remember the better part of the 2 weeks I was on it

psychcns :

I see.

Customer:

I don't want to get out of bed, go to work, I'd rather lay here, sleep all day, cry....I'm hitting apathy with teaching. If the students don't care then why should I? Why spend time, energy, money on kids who don't care

Customer:

I have cats and they help calm me down and give me a reason to get out of bed.

psychcns :

Do you force yourself to keep going or do you miss work often because of your symptoms?

Customer:

I'm in the process of applying to the 'catastrophic sick leave bank' at work in case the medications do something completely weird. Xanax and adderall and ambien scare me on principal

Customer:

no, force myself to keep going. I live alone and I have to have health insurance and a paycheck so I HAVE to go to work...

Customer:

motivation has suffered a lot...creative lessons are all but gone

Customer:

Inner city jr high....not the best fit

psychcns :

Understandibly...they are all controlled substances with abuse potential.

Customer:

I am actively looking to move both districts and cities next year. We are ranked as the worst district and worst school...

psychcns :

Do you have a support system? Close by?

Customer:

I was assaulted by a student three weeks ago, blamed by administration, and went to the psychiatrist in crisis and that's when he doubled the xanax

Customer:

I have friends and family, yes. ranging from 10 minutes to 30 minutes away

Customer:

I have religious support too, though limited as I don't know many people in my congregation

psychcns :

Do you think if you were in a more rural school system your anxiety would be significantly decreased and manageable?

psychcns :

Did the assault flare up your PTSD symptoms?

psychcns :

Is that same student still in school?

Customer:

yes, or even just a middle income school

Customer:

yes - and the student has been moved to the alternative high school but I had to get the union involved for them to do that

Customer:

threaten a grievance over the safety of students and faculty - he threw a desk at another student then tackled me in the hall twice in front of the resource police officer....

psychcns :

Is this your first year in this school?

Customer:

yes

Customer:

and lat

Customer:

laswt

Customer:

last

Customer:

first full time year teaching

psychcns :

Sounds like decreasing the high stress environment will definitely go a long way in helping your anxiety symptoms....

Customer:

got a Masters in teaching and the district is pushing a teaching style on all of the teachers that goes against all of my training, my experience as a teacher prior to the degree, and my experience as a student

Customer:

yes

psychcns :

Were your anxiety symptoms under better control prior to this new job?

Customer:

I have a few days (spring break) before I hear back from a school about an hour away with better environment and student demographics

Customer:

yew

Customer:

yes

Customer:

I made it through leaving an abusive husband, moving out on my own, and getting an annulment without having to increase any medications a year ago

psychcns :

Do you have other opportunities in the type of school you would be comfortable in within a decent proximity?

Customer:

yes, and I have applied but no one has called back yet. I would still only be half an hour from my parents and close to friends I'd move from 45 minutes north of Salt Lake City Utah to a part of Salt Lake so it's all connected

psychcns :

It may be the snowball effect...that is still pretty fresh, than add the high stress of physical attack and inner city kids and all of their issues, all the anxieties come flooding back.....don't see how your PTSD would be resolved?

Customer:

I've done screening interviews in 7 school districts, from 20 minutes north to an hour south....waiting on individual schools. This one I'm waiting on is the first to call

psychcns :

You hadn't had time to settle down really from that major life event and change.

Customer:

it was from my house burning down in high school....lived in a hotel for 4 months, had to all but rebuild the house

psychcns :

and then this happens.

Customer:

yeah, I've been on a rollercoaster for 3 years of up and down and stress and happy and angry

psychcns :

I see.

Customer:

the PTSD was over 10 years ago

psychcns :

Yeah, but can be chronic and later life stressors, such as the ones you have recently experienced certainly can put miracle grow on symptoms and make it all come flooding back.

Customer:

I can be around campfires, fireplaces, candles....etc.

Customer:

I agree, the new Psychiatrist is the one who told me it was resolved. I still list it on my medical history as a diagnosed condition

psychcns :

Yeah, but PTSD is not just about what specifically happened to you to cause it...it's a group of anxiety and behavior symptoms that can continue for a long time.

Customer:

like having an exaggerated startle reflex

Customer:

that one has never left

psychcns :

yeah.

Customer:

For the first time in years last year I sat at a table in a restaurant and wanted to blow out the candle on the table. I haven't wanted to do that for easily 6 years....after the fire, for at least a couple of years, I had to blow it out and put it on another table just to be able to open the menu

Customer:

last week

Customer:

sorry

psychcns :

I would revisit your depressive symptoms with the psych and ask again about possibly increasing Cymbalta. I would not feel comfortable on that dosage of Xanax either. Has the stimulant helped you at all?

Customer:

not so far....I still have chest pain and the same level of agitation - it makes me want to tak the xanax as needed dose

Customer:

I take the XR daily and the other 'as needed'....the adderall just makes me want to take more xanax....

psychcns :

And, I would do everything in your power, which sounds like you are definitely doing, to get out of that high stress environment and into a more structured, less volatile environment.

Customer:

yes

psychcns :

I would write all of this info down in an organized manner and take it to your appt....as, I understand, when you get in there your mind is likely all over the place......

Customer:

even the upheaval of moving schools and apartments....hopefully this would be to a permanent area and situation with career potential rather than Title I for loan forgiveness

psychcns :

You've done a great job explaining this to me...

Customer:

I'll copy and paste it to a word doc. Thank you for your help. I really can function fairly well when I'm not at the school...

psychcns :

Professional Shortage area?

psychcns :

Are you locked into this?

Customer:

only till May - 1 year contract

psychcns :

Thank God!

psychcns :

I wish you the best of luck, ma'am. I know I didn't give you black and white answers, it's a process, but sure hope it has been of help. Take care.

Customer:

Low income school with delinquent students - I had grand ideas of making a difference, and science and math teachers can get up to 18000 in loans forgiven....which after grad school looks nice. But my sanity and health are worth even having a second part time job to make payments

Customer:

thanks for everything - it's nice to know my concerns are valid

psychcns :

Absolutely!

psychcns, Nurse
Category: Mental Health
Satisfied Customers: 79
Experience: Advanced Practice Psychiatric/Mental Health Clinical Nurse Specialist with Prescriptive Privileges
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