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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2223
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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Before i start i want to make clear i want my question answered

Resolved Question:

Before i start i want to make clear i want my question answered by a psychiatrist thanks~
Hi, im writing to ask about whats going on with me in the hopes that i can get some help from someone who understands what im gonna ask. I have written in the past a long time ago but this question is different. I am on seroquel 575mg , abilify 20 mg, paxil 15 mg, epival 750 mg, take synthroid and vitamin b12. I also take 4 capsules of omega 3 a day(one when i wake up two an hour later and 1 at bedtime). My entire life ive been very self concious of myself because of a horrible time in school. Now, i have been told by someone here about two years ago i think to get off one of the antipsychotics, get off epival also and that my symptoms should be well managed after. I havent done this yet as i dont know enough to do so(neither does my psychiatrist). What i do know is that, if i take too much or too little of seroquel and abilify i feel the difference fast enough, meaning i dont feel good, however the next day that i retake the right dose i feel normal again (normal meaning like i feel with normal dose of the drugs).
The combination of seroquel and abilify seems to be just enough to keep me free of being self conscious of myself.(or at least it was "just" enough a few years ago, now im much more self-confident in every way).

Im not going to go into too much more detail as i could write an extremely long message, so heres the minimum i can tell you: Because of the abuse i endured daily in high school it accumulated negative thoughts asleep in my mind. After high school i started talking to a psychologist about my problems and i felt better and better, however the better i felt the more anxiety i got(wich makes sense as the negative thoughts were awakened progressively). Now today the negative part of my mind is much bigger than the positive part(as confirmed by my psychiatrist) and basicly every time i take a seroquel pill it makes a space in the negative thoughts area. This makes it much easier for me to think, since i have far less negative thoughts with seroquel. Now abilify is a bit different, it seems to simply stop all obssessive, self conscious thinking(especially about obssessing over appearence, even though i look good i still have some of that). Now its like my system has adjusted itself to the doses of pills im taking. Like i said if i for example, take a dose of 25 mg of abilify instead of the usual 20 i actually feel worse, until i take the right dosage again.

To finish up ill explain last important things, i got a psychosis NOS 5 years ago so that burned lots of brain cells. This is why i first started to take omega 3s with my psychiatrists guidance, and i feel 100 times better today, the omega 3s also stimulate the positive side of the mind wich in turn push away the negative and makes me feel very good when i take them every day. If i miss a single omega 3 i feel the difference in an hour at most, i just feel like my mind is much slower/more negative. I have a diagnosis of extreme anxiety, i have been depersonalized and derealized in the past, i possibly have what my doctor thinks is asperger's. I also feel quite light headed and i dont really feel he weight of my body at all. Its like im not in the "moment", this changes tho as sometimes when i rarely feel good i feel heavier, feel my body and my five senses are much more normal and acute( when that happens i also feel more "connected" to my thoughts, feel more like myself, and feel bursts of happiness,energy,motivation that comes and goes) wich is a wonderful feeling. To be clear, i take epival because it slows down obssessive thoughts, and i take paxil because it actually interupts and "stops" obssessive thinking and helps with anxiety. Those two seem to be doing the same thing to my normal thinking too tho.. Now heres my question:

Am i on the right medication, or should i talk to my doctor to make some changes. Also, i have done evrything to try to feel better by attacking my anxiety head on, i however think the anxiety i have, however tremendous it may be, is more a symptom of the Real problem i may have. Its all about my thoughts, as i still think negatively towards myself unconsciously from what i realized recently. When i feel good i get a rush of positive thoughts in my mind and i feel fantastic, however this never lasts more than a few minutes at most and almost never happens(happens like once a month if im lucky). I have even tried a weighted blanket, wich reduces my anxiety a bit but i still feel the same(unlike when i feel good where i have normalized evrything including anxiety and my positive thinking.)
Thanks for the help if you have any questions let me know!
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Vikas replied 2 years ago.

Dr Vikas :

Hello ! Thank you for your question, I’m Dr. Vikas (M.D Psychiatry) and I’ll try to help you today.

Dr Vikas :

On the basis of what you mentioned, you are currently on 2 antipsychotic (Abilify & Seroquel),1 mood stabilizer (Epival), 1 antidepressant / antianxiety / OCD medicine (Paxil.).

Dr Vikas :

If you are noticing improvement in your symptoms / felling better with Abilify and Seroquel, there is no need to change or modify the dose of these two medicines because the ultimate goal of treatment is that patient should notice improvement with treatment. Dose of Epival is also low and can be continued in my view.

Dr Vikas :

Paxil is a medicine which is specially useful for OCD, anxiety, Depressive symptoms and you are currently on a comparatively low dose of Paxil. The usual dose range is from 20-50 mg per day and you are currently taking only 15 mg per day.

Dr Vikas :

In my view, you can discuss with your doctor about increasing the dose of Paxil further if you still experience significant anxiety or OCD symptoms while taking these medicines. Your doctor can increase the dose of Paxil to 20 mg and after a week to 30 mg per day if required.

Dr Vikas :

Other than this the treatment regime appears fine to me.

Customer: replied 2 years ago.

Hi, thanks for the answer. I was wondering, with evrything i described in my background what you would think would be a better treatment for all this im going through? Im wiling to try any medication or therapy that could possibly help me. If you need more information just ask me and ill answer right away. Ideally it would be nice to have an idea of a med that could help me in a similar way as the ones im on now.

The thing is, while i have "extreme" anxiety, i think its more a symptom of whats going on with me(like a runny nose when you have the flu) but to be honest im not sure what is causing the anxiety in the first place, since i dont fit in any anxiety disorders at all.

Expert:  Dr. Vikas replied 2 years ago.
Hello Alex,

Honestly speaking, your case is a bit complex. You have received multiple diagnosis including OCD, Anxiety, Psychosis NOS therefore your current medicines are appropriate in my view specially because you are stable on these medicines.

The first line medicines for treating OCD, anxiety, depression symptoms are SSRI antidepressant like Paxil. You are currently on a very low dose of Paxil and in my view, increasing the dose of Paxil by your doctor should be helpful in your case.

Instead of Paxil, another SSRI antidepressant, Fluoxetine (Prozac) can also be a better option specially for treating OCD symptoms. The usual dose range of Prozac is from 20-60 mg per day and we prefer it over Paxil for treating OCD and anxiety symptoms.
Customer: replied 2 years ago.

Ok i understand, i just wanted to make it clear i have "obsessive" thinking but i dont have OCD., as strange as that may seem. The only reason im hesitant to increase paxil to 20mg( ive been on 20 before)

is because when im on that or higher, i feel extra lightheaded, disconnected from my surroundings, not in the moment. Basicly what happens is when i do breathing techniques that calms your mind and lowers anxiety (yoga/qigong breathing) i feel better and i dont feel so "light"/ lightheaded as when my thoughts are in chaos. However with paxil at 20+mg it seems regardeless of how much breathing and relaxation techniques i do i still feel very light(i dont feel weight of my body) wich is an awful feeling that i have almost 24/7 while on higher doses of paxil, even when i take it at bedtime. So id like to know if you had some general idea of what i could do about this "not feeling my body" feeling disconnected while taking paxil.

Thanks for takin the time to reply all my questions i apreciate it very much! By the way this is most likely last thing ill ask as i know ive taken alot of your time :)

Expert:  Dr. Vikas replied 2 years ago.
Alex, for both Obsessive thinking (Obsessive rumination) or OCD, treatment part remains the same. SSRI antidepressant like Paxil or Prozac are used in both the cases.

Paxil can cause giddiness / light headedness as a side effect and many patients are not able to tolerate Paxil well in comparison to other SSRIs like Zoloft or Prozac.

So if you are not able to tolerate Paxil well, you can ask your doctor to shift you directly on other SSRI antidepressant like Zoloft or Prozac. Most likely, you will not experience the same lightheadedness with these two medicines.

Both of these medicines are very useful in Obsessive thoughts and anxiety symptoms.
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2223
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
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