I’m Dr. Vikas (M.D Psychiatry) and I’ll try to help you today.
Since when this is happening to you?
Have you ever consulted a doctor / Psychiatrist for this?
If yes, kindly mention your diagnosis.
Very long time
it started at age 15
and became alot worse as the years passed by
I have consulted many psychiatrists
was on and off medication
may I know about your exact diagnosis in that case
manic depression and anxiety disorder
and circadian rhythme disturbance
OK, you have already taken medicines but did you ever noticed improvement in your symptoms while taking medicines?
My first medication was an anti depressant called Prozac
i took it for 4 months
the first 2 weeks i was prescribed xanax 0.25mg for sleep
and then switched to seroquel 25mg 2pills a night for sleep aid
after 4 months my depression symptoms started to appear again
so my psychiatrist doubled my Prozac or fluxotine dose
4 hours later I had a pathalogical epilipsy
and was taken to the emergency room
and put in the ICU for heart and respitory monitering
I was 16 by then
and the reason was increasing in the dose or there was any other reason?
Fluoxetine usually dose not cause epilepsy.
doubling the prozac dose
what was the dose at that time?
my doctor told me to take 1 capsule in the morning after breakfast
that would be 7:00 Am morning
the second dose was to be taken 7 hours after
must be 20 mg
a few hours later my depression and anxiety reached a level i NEVER EXPERIENCED BEFORE
At the hospital
I was administered 5mg valium
and then 1.5mg xanax before sleep at the ICU
are you sure it was epilepsy or was an acute anxiety attack.
My heart rate reached 180 and my parents told me my legs and hands were shaking terribely
because SSRI antidepressant like Fluoxetine can initially worsen or aggravate the anxiety symptoms.
and I was semi conscious
but there was not frothing from mouth, bladder / bowl incontinence, tongue biting etc?
my arms were all tense
and my face would get red
and I would moan like as if I was in extreme pain
later on my psychiatrist told me I dis associated
for 2 hours
inside the ambulance
The next day the symptoms started to manifest themselves again in the hospital
so I was administered another 5mg valium
and 1.5mg xanax for sleep
and 1.5mg xanax befoe sleep
and the prozac was discontinued
I stayed 7 days under observation after moving out of the ICU the next day
yes, I am here
So i went back home however the epiliseys used to continue happening once every month
So i was sent back home on sick leave from school but the epiliseys would still occur once a month
still probably it was not frank seizure / epilepsy, what do you say?
your doctor diagnosed epilepsy/
my pychiatrist told me it was a pathalogical seizure casued by too much stress and strong emotions in the brain that made the electrical impulses in the brain go of balance
after that I was given zoloft
5mg a day
but still no medicine for epilepsy?
The epilepsy subsided and went on its own and no longer happens thankfully
I was 16 at the time
I took 2mg rivotril in the morning 1mg in the afternoon and 2mg at sleep
however the zoloft treatment did not work
When were you diagnosed as suffering from Manic depression?
it made the depression worse and suicidal ideation began
because antidepressant may worsen manic depressive illness.
1 month after going to the ICU
before that the pychiatrist diagnosed me with anxiety and short term clinical depression
You were diagnosed as manic depressive but still you were taking only antidepressant and benzodizepine?
when the suicidal ideation began and the zoloft was not working they stopped it
but was on rivotril
and also xanax
not exceeding 2mg a day
after that I was given lexotonail with seroqual 100mg
to withdrawal from the xanax and valium
during that I was also seeing a psychiatrist 3 times a week and a psycho therapist 5 times a week
after the withdrawal I was given Seroxat
now, can you briefly mention the name of all the medicines you have already tried?
Anti depressants: Zoloft, Prozac, Seroxat
Benzo: Rivotril Xanax Valium Lexotonail
not exceeding 100mg
I was also given Feldene after each seizure
and pill form
I developed chronic thoriac spine and constant pain behind the head
I was also told to take Omega 3-6-9 supplements 3 times a day
It is a bit strange because you were diagnosed as suffering from manic depression but were never prescribed any effective mood stabilizer except Seroquel which was also in a very low dose.
and one aspirin everyday
May be that is why, you never notice improvement in your symptoms and still experience rage, anger, dysphoric mood.
Iam not familiar with all the cychiatric drugs so I took what they prescribed
I have not suffered epilisey in 3 years now
no problem, you can still ask your doctor to prescribe you mood stabilizers like Sodium Valproate, Lamotrigine or Lithium which I believe can effectively control your current symptoms.
My problem now is depression
It is a good thing that you have not suffered from epilepsy since last 3 years and you can consider yourself very lucky and fortunate :)
depression with dysphoric, irritable, angry mood, mood swings, difficulty in sleeping
thank you my psycho therapist taught me how to control it
after taking seroxat
I improved alot
and was able to continue school
and be able to enjoy life and have a social life
it was a 25mg controlled release tablet
after 6 months I discontinued all medication from consultation by my psychiatrist
But now I feel my depression has relapsed
and my anxiety is very disabling
I sometimes am unable to sleep for two days straight
are you currently taking any medicines?
no anti depressants
only 1mg rivotril for sleep
perscribed by my psychiatrist
I began taking it just 1 week ago
and right now you are experiencing, depression with dysphoric, irritable, angry mood, mood swings, difficulty in sleeping
I can only sleep for 6 hours a day now
I feel good after waking up
however the depression and anxiety begin during the night time
Is it possible for you to try this short quiz and let me know about your score.
ok just a minute
I scored a 36
OK, see, on the basis of this score, your diagnosis appears to be correct that is manic depression. Now antidepressant alone when prescribed in a patient suffering from Bipolar disorder may further destabilize the mood and can lead to frank manic or hypomanic episode.
In your case, a combination of antidepressant with a mood stabilizer is necessary in my view.
Yes this is why I refuse to take any antidepressants now
they used to alter my personality too much
However my problem I cannot take any medicines
see, Antidepressant are required to control your anxiety symptoms but since antidepressant alone can destabilize your mood so adding a mood stabilizer by your doctor should be very helpful in my view.
medicines are very helpful in controlling and preventing the future depressive or manic / hypomanic episodes.
without medicines the chances of worsening of current symptoms and the probability of future relapse will increase manifold.
Is their something I could do other than strong medicines
you do not need strong medicines but a right combination of medicines like an antidepressant with a mood stabilizer.
which can also help you in sleep
and can control your anxiety and mood symptoms.
My main problem is that I cannot get sleep or any restfull sleep to function during the day
other than medicines, the other option left is Cognitive Behavior therapy which you can try in addition to medicines.
with bad anxiety during the day
The problem doctor is my entire family have a history of some kind of depression
hopefully, you will find it useful.
You responded well to Seroxat earlier, so your doctor can restart Seroxat and at the same time add a mood stabilizer like Olanzapine to be taken at night. Olanzapine is very sedative and is also an effective mood stabilizer.
My entire family have some kind of history with mental disorder
my doctor says it is genetically for the most part
Seroxat can control your anxiety and depressive symptoms and Olanzapine can help in stabilizing your mood in addition to help in sleeping properly at night.
this again shows that you should continue medicines to prevent future relapses.
however my problem is I cannot take these drugs when attending the establishment Iam entering in
see, in my view, medicines are necessary in your case but if you want to avoid them totally, you can try Cognitive Behavior Therapy and see if it helps.
have you ever tried CBT?
yes but do not fully understand what it is
OK, I am giving you a link below to know more about it. This link is from the Royal college of psychiatrist, London.
Doctor I have also read about a treatment of using ketamine for treating depression
now there are websites where you can try online CBT from your home without going to a therapist.
would you recommend this as an option?
I will come to that, first I am giving you link to free online CBT which you can try at home. Cognitive Behavior Therapy can bring long lasting benefit in your thinking pattern and the resultant depression and negativity.
oh I have done all of that
you can try online CBT via these websites
but this time you will do it online yourself.
with a psycho therapist through weeks of therapy I apologize forgot what it was called
OK, no problem, you can try them again
I really tried but they do not really help change anything from the outside causing my depression
now regarding Ketamine, it is too early to comment on its usefulness in treating depression. The initial results are encouraging but are transient and the relapse is very high.
In your case, right now a combination of mood stabilizer with an antidepressant is more appropriate option in my view.
as you have already tried CBT.
Is their a cycho therapist on your website which can help me through talking?
I don't think so, because psychotherapy will not be possible via this website. Psychotherapist will again recommend you CBT which you have already tried.
you should try those website which I recommended earlier.
No I mean a type of psychiatrist which discusses the patients personal problems with
and help think them through
sorry to say, but it is not possible via this medium. You should consult a psychiatrist in person near you for this.
I hope you understand the limitation of this medium.
Most doctors in my area are not very helpful in this area of discussion and are only in the occuppation for the making of profit instead of helping a person understand why he feels this way
sorry to hear that.
I have spent a considerable sum of money trying to find this type of psychiatrist
would you be able to recommend those?
if you know any
See, it appears to me that you are more interested in psychotherapy instead of medicines which I do appreciate but manic depressive illness respond well to medicines and psychotherapy only has a supportive role. It is assumed that manic depressive illness occur because of neurotransmitter imbalance and medicines can not only correct it but can also prevent future episode. Without medicines, the chances of future relapses, worsening of symptoms increase manifold.
If it was depression alone, I would have recommended psychotherapy although again it is mainly useful in mild to moderate depression as per several studies.
but you diagnosis is Bipolar disorder and psychotherapy has a limited role in it in my view.
Would you mind if i explain my personal situation to you so you may have a clearer view
OK, please go ahead.
I am currently clean of any medication in my blood stream and I have a medical examination next month to attain a first class medical degree
If i take any medication
I will fail the mental part of the examination immediately
making it immpossible to start next month in the flight academy Iam sponsored to go to
see, medicines can only be detected in blood and the tests are usually for benzodiazepines if I am correct.
The problem with the first class medical degree you are prohibited in using any substances which effect the brain
moreover if you still think that it is not appropriate to take medicines right now, you can always start them later on once you pass all the tests. Psychotherapy of any type by any psychiatrist / psychotherapist will not help much in bringing a quick relief in your symptoms.
I have passed my apptitude test but the medicines will not allow me to pass my medical license which needs to be renewed each 11 months and it will effect my focus dexterity and balance and physical fitness
resulting in me being an obselete candidate for being a cooperative pilot
that will further make me depressed hence it is one of my main goals in life
OK, I can understand your situation. In that case, you don't need psychotherapy right now as psychotherapy may take a long time to show its effect. You also found CBT not very useful in your case additionally which is the first line psychotherapy approach for Manic depression.
I know it sounds very complicated but I hope you can give me some kind of solution that pleases all parts
I believe, relaxation techniques can be helpful in your case specially for the anxiety and insomnia you are experiencing. They can help you in controlling your anger and rage also.
Have you ever tried any Relaxation technique specially Progressive muscle relaxation technique.
I believe my depression will lift once I enter the academy however I do not want my insomnia to follow
OK, then the best option right now is to try these relaxation techniques and see if they helps. Medicines can bring quick relief but you can't take them and psychotherapy will not help much in your current situation.
Do you recommend acupuncture or a proffessional message?
have you tried relaxation techniques before?
like yoga or meditation?
Progressive RelaxationToe TensingDeep BreathingGuided Imagery
no like the one I have mentioned above specially progressive relaxation and deep breathing.
Yes but i do not see much benifits for sleep
to be specific doctor
during the time I want to sleep
i feel very exhuasted both mentally and physically
however when I close my eyes
lots of thoughts rush through my head
and I cannot stop them
they tend to keep me awake all night till morning
I sleep alone in a dark ambient room and make sure the temperature is cool and everything i quiet
you try these links and the listen to the progressive muscle relaxation track in"Falling Asleep" CD.
or Listen to the deep breathing track " CD.
may be it can help.
Do you understand doctor the thing i DESCRIBED ABOVE
regarding acupuncture and professional message, they might help in relaxing and there is not much harm in trying them if there is no other option left :)
The thoughts rushing through my head
what causes them doctor?
is their a way to stop them
yes, your situation is very complicated but the only thing you can do right now is to wait and watch as you can't try medicines, psychotherapy can't bring quick results, you have already tried relaxation techniques.
there is technique known as thought stopping technique which can help in controlling intrusive, recurrent thoughts.
could you please explain further
I hope, you have not tried it already as I am running out of options :)
would you recommend me consulting with my doctor to go on another benzo
I take the rivotril 1.5mg 1 hour before bedtime
it induces some relaxation
but the thoughts will still be going through
What is thought-stopping?
How can you stop thoughts?
I actually read a book about it doctor
this technique can definitely help in stopping your unwanted thoughts.
my psychiatrist tells me my brain is too stubborn and does not adapt to changing its behaviour
then psychotherapy is not the right treatment in your case.
So would you recommend me consulting with my doctor for another benzo for short term usage?
well, there is no harm in doing that if you find them useful.
benzodiazepines are preferred. If you difficulty in falling asleep, in that case, the Z drugs like Zolpidem can be more useful.
Zolpidem can be taken 15 minutes before sleeping and is specially indicated in patients experiencing difficulty in falling asleep.
Is this medicine have more sedative properties?
your doctor can prescribe you Zolpidem, its effect is for short durations.
What do i tell my doctor for him to perscribe me these benzo?
5 or 10 mg is sufficient in most cases.
another problem I face is my age hence Iam young most pychiatrists think Iam seeking drugs for recreational use
Zolpidem is not a benzodiazepine and your doctor can prescribe you this medicine easily if you say that you are having severe insomnia.
How can I convince him to perscribe this?
even your GP or any Physician can prescribe you this medicine.
should I visit a sleep specialist Instead then?
a good idea.
first consult any local GP or Physician first and see if they are willing to prescribe you this medicine.
If I take zolpidem can I also take rivotril for my anxiety?
but you said that you can't take medicines as you have to pass the medical test.
benzodiazepines can be detected in blood.
its next month
still, a time gap of few days should be there.
how long does it take for it to diminish from the blood?
approximately 7-10 days as rough guide.
may I be a bit sincere doctor?
your physician or sleep specialist can guide you better in this.
Most my inner conflicts are a result of a failed relationship with another
thats why I get irritable and angry
some how I cannot let go of the past
If their was some how i could move on I would be much better
see, manic depressive illness can be precipitated or aggravated by stressors like this but the treatment still remain the same and medicines are the better option.
but i find alot of difficulty
I know that these stressors off sets the brains equilibrium but are you aware of any methods for these kinds of stressors specifically?
in your case, medicines along with psychotherapy can be helpful but the best option right now is to wait and watch till you are able to pass your examinations.
Psychotherapy is the only option.
but you have already consulted a psychotherapist.
will to be more specific
so right now, medicines are the only possible option left in my view. for which you have to wait.
my psychotherapist did more harm than good
then, you can see a new psychotherapist.
She mostly focused on me reliving memories and making me remember things I do not want to
you can always change your psychotherapist.
which hospitals offer the best psychotherapist world wide?
would you recommend any to me
Traveling is no problem
honestly speaking, there are no such best psychotherapist or best doctors. Any psychotherapist or doctor with which your are comfortable with is best for you.
it has been very difficult to find a suitable one
the ultimate aim to see improvement and it is not necessary that the best doctor or psychotherapist will also prove to be the best for you.
but right now, it should not be your priority.
you should think of passing your test and then can search vigorously.
I am specifically looking for a psycho therapist that treats patients like normal people instead of patients
will not be of much help, you need to fix your priorities first.
For the sleep I forgot to say
may be getting selected in your exam will alone help in controlling your symptoms and anxiety and you won't be needing any doctor again.
my GP adviced me taking some melatonin
yes, it can be tried
so i took a melatonin 3mg with tryptophan 5 and suntheniene
30min before sleep
but unfortunately it turned out disastrous
it made my anxiety worse
and I did not sleep at all
if you didn't found it useful, just discuss with your GP about Zolpidem this time.
Would you consider ambien?
i HAVE NEVER TRIED IT
that is the brand name of Zolpidem.
can be useful in your case.
its sold over the counter in the US right?
is it considered okay for usage during a medical test?
it is for controlling your insomnia right now.
with your doctor prescription, you can take certain medicines and your GP can guide you better in this.
Should I continue the rivotril with the ambien then?
can be tried if your doctor is willing to prescribe you .
but seperately ofcurse
May I ask which country are you from doctor?
I am from India, was in U.K few years back.
your better than most doctors in Saudi arabia
One more thing
thanks for your kind words.
I read about an experimental treatment
in europe and parts of asia
where certain brain proteins which hold memories would be isolated and eradicated to hange a persons behaviour or thinking characteristics
which would result in better results on cognitive behavioural therapy
Do you think that is a good thing to look into?
see, these experiment are only experiments and you would not like to be a part of experiment, do you.
it is not an establish mode of treatment
not approved by AMA or FDA yet
how about general anesthesia?
not useful in your case :)
not many options out their then
are you aware of any future pills or treatments you would recommend maybe a few years later?
just wait till you are able to pass your exam
Because I know that this will be something i WILL SUFFER PROBABLY THE REST OF MY LIFE
we as a doctor can only recommend treatment which are well tested and well tried.
ok ay then doctor
thank you for your sincerety
you are most welcome.
I really enjoyed working with you – please feel free to request me again when you come back to ask another question. You can Bookmark my profile link in your browser. ( http://www.justanswer.com/mental-health/expert-drvikas/ )
i guess i will visit the GP and ask for some ambien
Thank you farewell.
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