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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2207
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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been taking amitriptyline (to aid in sleep) and have been feeling

Resolved Question:

been taking amitriptyline (to aid in sleep) and have been feeling psychotic. Cruel to my pets at times and thinking bad things towards people. Then I feel bad after for the way I have acted. Whats going on with me? Is this the meds or have I become sociopathic?
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Vikas replied 1 year 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 :

Since when you are taking Amitriptyline and in what dose?

Customer:

for a few months. started out with 10 mg to aid in sleep. wasn't strong enough so i boosted to 25mg

Dr Vikas :

OK, this medicine was prescribed by your doctor for insomnia?

Customer:

yes

Dr Vikas :

is there any history of past psychiatric illness in yourself or your family

Customer:

only some depression on my part

Dr Vikas :

Is it possible for you to try this short online quiz and let me know about your score.

Customer:

yes

Dr Vikas :

are you trying the quiz

Customer:

i scored an 18

Customer:

why am i experiencing a cruel side? i legitimately feel like hurting something for no reason. i have never been this way.

Dr Vikas :

thanks for trying the quiz. On the basis of this score, there is also a possibility of Bipolar 2 disorder in your case. Sometimes antidepressant may worsen the mood / destabilize the mood in a person suffering from Bipolar 2 disorder.


II

II

II
Dr Vikas :

although your are taking very low dose that is 10 mg or 25 mg only but this could be one of the possible reason.

Customer:

lovely. so i have to be bipolar for this med to do that to me?

Dr Vikas :

in my view, you should ask your doctor to screen you to rule out possibility of Bipolar 2 disorder.

Customer:

great. thanks.

Dr Vikas :

no I am not saying that you need to be Bipolar patient to feel like this.

Dr Vikas :

as I mentioned before, you are on a very low dose of Amitriptyline

Dr Vikas :

and amitriptyline usually dose not make patient cruel to pets.

Dr Vikas :

You are not becoming sociopathic because you are having excellent insight regarding your symptoms and feel bad after having such thoughts which is a very good sign.

Dr Vikas :

Most likely, Amitriptyline is not the cause behind all this.

Customer:

thats what i thought. something is wrong with me.

Dr Vikas :

but to be on the safer side, possibility of bipolar II disorder can be ruled out because antidepressant when prescribe to such patient can cause hypomanic or manic switching in such patients.

Dr Vikas :

:) I don't think there is something wrong with you. You appears to be perfectly alright and having an excellent insight regarding your symptoms.

Dr Vikas :

Have you ever tried any other medicine for sleep?

Customer:

tylenol pm

Dr Vikas :

no other medicine?

Customer:

benadryl

Dr Vikas :

Oh, you are finding it difficult to sleep while lying down or experience frequent awakening at night?

Customer:

both

Dr Vikas :

OK, in that case, a benzodiazepine like Lorazepam should be a much better choice in comparison to Amitriptyline specially since you have not tried it yet.

Dr Vikas :

Lorazepam can help in getting a good sleep for 6-8 hours and can also have a calming effect.

Dr Vikas :

if you think that Amitripyline is the reason behind your current symptoms, you can ask your doctor to prescribe you this medicine instead of Amitriptlyine.

Dr Vikas :

in most patients a dose of 1 or 2 mg is sufficient.

Dr Vikas :

once your sleep cycle becomes normal, your doctor can taper down this medicine and stop it.

Dr Vikas :

on the other hand, if your doctor thinks that you need a sedating antidepressant then Mirtazapine in low dose of 7.5 mg can also be a good option as a replacement to Amirtriptyline. Mirtazapine is also a very sedating medicine just like Amitriptyline but with different mechanism of action.

Dr Vikas :

are you there?

Customer:

i will figure it out. i just don't like the way i am right now and i don't know whats happening to me. i feel like a cruel person. I shouldn't enjoy causing pain. i have never been this way and i don't understand why i do all of the sudden. my sex drive is up, i don't want to be around people, and i have been mean to my pets who are small and helpless.

Dr Vikas :

see, these symptoms are indicating that Amitriptyline is destabilizing your mood.

Customer:

you said earlier that amitriptyline couldn't be causing this. but yes my mood is way off balance.

Dr Vikas :

I agree with you that you can consider the option of stopping this medicine. Most likely, you will start feeling better again after stopping it. Just discuss with your doctor about these symptoms and ask him to stop it and replace with a benzodiazepine.

Customer:

sounds good. i will try that and see if this goes away.

Dr Vikas :

Any antidepressant can cause these symptoms including Amitripytline.

Dr Vikas :

yes, a good idea could be to stop it and see if it helps.

Customer:

okay thank you for your help.

Dr Vikas :

you are most welcome.

Dr Vikas :

Kind regards

Dr Vikas :

Vikas

Expert:  Dr. Vikas replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Expert:  Dr. Vikas replied 1 year ago.


Hello Carla,

Please may I know the reason behind your giving me poor rating for my answer.

 

I will try to answer any other query you have.

 

Kind regards

 

Vikas

Expert:  Dr. Vikas replied 1 year ago.
Carla,

I just want to inform you that if you don't intend to pay an expert, you need not to rate his or her answer as bad or poor service. You can simply opt him or her out once you get the desired answer.




Kind regards

Vikas
Customer: replied 1 year ago.

I am not bipolar. I have taken an official diagnostic test before answering honestly and at no time had it indicated bipolar. This cannot be the answer.

Expert:  Dr. Vikas replied 1 year ago.

Hello Carla,

Sociopathic traits / symptoms are visible in a person since his or her adolescence which I guess is not the case with you . Also, these sociopathic traits persist for the life time but you have noticed change in your behavior only after starting Amitriptyline so it is certain that you are not becoming sociopathic.


You are taking Amitriptyline and have started noticing a change in your behavior " i just don't like the way i am right now and i don't know whats happening to me. i feel like a cruel person. I shouldn't enjoy causing pain. i have never been this way and i don't understand why i do all of the sudden. my sex drive is up, i don't want to be around people, and i have been mean to my pets who are small and helpless. " which wasn't there before taking this medicine.

So, a possible reason behind your feeling this way could be this medicine. As you must be knowing, Amitriptyline is an antidepressant and majority of antidepressant may cause antidepressant induced mania or hypomania in a patient suffering from depression.

 

 


Antidepressant-Induced Mania Similar to Bipolar Disorder

I never said that you are suffering from Bipolar disorder. I simply mentioned a possibility that Amitriptyline can cause hypomanic or manic switching in a patient suffering from depression and may be because of this reason you are noticing a change in your behavior. You have become irritable, cruel to persons around you and mean to your pet. Your sex drive is up and you are not able to sleep properly. There are high chances that Amitriptyline is destabilizing your mood and that is why you are feeling this way.

Therefore, in my view you should discuss with your doctor about the recent change in your behavior after starting Amitriptyline and most likely he or she will tell you to stop it. Assuming that, Amitriptyline is the reason behind your current symptoms, you will start feeling normal again after stopping it.

For insomnia, instead of Amitriptyline, you can ask your doctor to prescribe you a benzodiazepine like Lorazepam in dose strength of 1 or 2 mg. Lorazepam will help in sleeping and in addition will also have a calming effect on you.

Please feel free to discuss further if you have any doubts regarding my suggestions or have any other query in your mind.

Kind regards

Vikas

Customer: replied 1 year ago.

Thank you for explaining that to me. I believe there are other issues here as well. I am not cruel to any people. I have just been taking anger out on my pets when they do something "wrong" (which isn't really wrong-they are just acting on animal instincts-so it would be wrong to punish them for just being them)


 


Lately, my fuse has been short with them, and sadly this is just a lack of good judgement/control on my part.


 


Two other issues are probably playing a big role here. One, I don't actually like one of my pets. I am trying to be patient and kind, but I can't seem to make myself like her. Have you ever met a person you just don't like? I feel this way about my pet (sadly did not realize this before I picked her out myself!) and it's ridiculous/ and neurotic but it's true. It's true that I can get rid of her which I probably will end up doing-she deserves an owner who will fall in love with her. I have no other explanation to offer except that I just dislike her for some reason. I am not crazy-even though this feels crazy to say all this. So naturally when she upsets me it's easy to go off on her. Please don't judge, I know how ridiculous this sounds already.


 


Another issue I have been battling is drinking (at night only before bed-2-3 drinks which is about 3-5 ounces of alcohol) to get drowsy enough to fall asleep. This has gone on for almost two years since my return from Iraq and a really heartbreaking end to a relationship. I realize this is a habit I have formed and it's quite hard to kick. which is why I started taking amitriptyline to not drink anymore. The amitriptyline takes at least a couple hours to kick in, so I naturally would have a drink or two to hurry it along so I could just fall asleep, and then i oversleep for hours! The aggression did not start until I began taking amitriptyline. I actually didn't have a problem with just alcohol strangely. And my sex drive was pretty low before. Now all of the sudden I have one?


 


At any rate, I just feel like a monster for being harsh and rough with my pet that I hate. I have experienced rage before, but never acted on it. Sadly I got a rush from it and then immediately felt remorse. (that's where you came in) This does sound ridiculously bipolar. I admit I am temperamental, but not bipolar. So I have resorted to tylenol pm, but can't totally shake the drinking. I still hate my pet. All this boils down to how could I be mean to an animal? It's just disgusting me to no return that I felt a desire to hurt it and acted on it (I squeezed her pretty hard until she squeaked-but I really wanted to hurt her). Other than this I am pretty happy about my life(which sounds laughable considering I drink almost every night to fall asleep.)

Expert:  Dr. Vikas replied 1 year ago.

Carla,

Thanks for your reply and explaining it in detail. I was not aware of this fact that you are taking alcohol with Amitriptyline.


See, Alcohol is an CNS depressant and it is not at all recommended to take it with any other medicine which can cause significant sedation like Amitriptyline. Also, alcohol itself can worsen depression or manic symptoms by itself, specially in a patient with a history of depression in past. In some patient it can precipitate psychotic symptoms too.

To add further, when taken for long term, Alcohol itself can cause insomnia and therefore should not be used as a medicine for sleeping.

Alcohol and Depression

Therefore you can see that combination of alcohol and Amitriptyline can have serious adverse effect on your mental health.

It is very much likely that the combination of alcohol with Amitriptyline you are taking currently is behind your feeling irritable and acting out in rage. Please note that this combination has more chances of further destabilizing your mood.

I hope your doctor is aware of this fact that you are taking Amitriptyline with alcohol, if not, you should tell him or her about it.

In current scenario also, Benzodiazepine like Lorazepam or Clonazepam can be very helpful in treating your alcohol abuse and will also help in sleeping.

In addition to medicines, psychotherapy specially Cognitive Behavior Therapy can be a very good option in your case if you have not tried it yet.

What is CBT?

 

You can try free online CBT via some websites. I am giving below the link to one of them.

 

MoodGYM: Welcome

Regarding your pets, I don't think that you are being cruel to them specially because you are aware of your feelings and feel bad later on.
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2207
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Dr. Vikas and other Mental Health Specialists are ready to help you
Customer: replied 1 year ago.

Isn't cognitive behavioral therapy for people with mood disorders? My situation seems to be chemically induced. I will give it a look to be sure. I will talk to the doc about Benzodiazepine, Lorazepam or Clonazepam. This seems to be the best route for now. Is it normal to feel like that toward a pet? It seems like the angry guy who comes home and beats his wife after knocking back a few beers. Then he feels bad. I worry that this is my situation. And I was just exhibiting a severe lack of judgement due to drinking-though that never happened until taking the med.

Expert:  Dr. Vikas replied 1 year ago.

CBT is specially indicated for depression but is useful in all other psychiatric disorders. In your case, it can be very useful for controlling the negative emotions and thoughts and can bring a long lasting improvement.


I totally agree with you in this that your situation right now is really similar to that of an angry guy you mentioned above :).

In your current mental state, it is not abnormal to feel like this against pets and other people in my view.

But don't worry, everything will be alright once again as soon as you start the treatment, and stop drinking alcohol.

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