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Medication related questions

Antidepressant Drug Options

by Kristina Randle, Ph.D., LCSW April 21st, 2023
written by Kristina Randle, Ph.D., LCSW

I was on Cymbalta (think 60 mg) for depression and anxiety. I was on it for over a year. A number of debilitating side-effects were persistent throughout my course of being on the medicine, including dizziness, intense fatigue, and significant hypotension. In addition, I eventually experienced strong insomnia, leaking urine, and harmful and suicidal thoughts. Cymbalta’s ability to relieve my depression also diminished during that time. I went cold turkey in Nov. 2008, went through terrible withdrawal symptoms and have not been on an AD since because of the fear Cymbalta gave me. My depression though has worsened since that time, and I am going to see a psychiatrist now (I’m already seeing a psychologist). Because of my severe problems with Cymbalta, what other AD options are there? I don’t want a repeat of Cymbalta, as obviously my body did not agree with the medicine. If most of the ADs work in a similar fashion to Cymbalta, I’m worried the side-effects are going to be worse than the benefits. As well, in 1991, I was on reglan after an endoscopy, and it took only 3 pills to cause serious central nervous system problems, including sensory “dementia” and hallucinations. With that problem in mind and what happened on Cymbalta, I’m worried there is a connection and that my neurological system is ultra-sensitive or something. I even get buzzed from pseudoephedrine, so if I use them for sinus problems, I have to take them at half dosage, or I end up wired for hours. I know this is a complex issue, but I need medical help for my depression and I’m not sure what even a psychiatrist can do to evaluate my tolerance for brain-altering drugs. Any advice or reassurance you could give me would be greatly appreciated.

There are different types of antidepressant drugs. Cymbalta is a serotonin and norepinephrine uptake inhibitor (SNRI). SNRIs target two brain chemicals thought to be associated with depression, serotonin and norepinephrine. Effexor and Effexor XR are also SNRIs.

The most common type of antidepressant drugs on the market are the selective serotonin reuptake inhibitors (SSRIs). SSRIs include medications such as Celexa, Prozac and Lexapro. SSRIs focus on only one specific brain chemical, serotonin (versus two with the SNRIs). Two other types of depression medications include Monoamine Oxidase Inhibitors (MAOIs) and tricyclics. Here’s a link to a webpage that further explains the differences between antidepressant drugs. Perhaps the type of antidepressant medication you had been taking is not a good match for you.

Usually finding the right medication is a trial and error process. It is the norm. It is the rare occasion that an individual tries an antidepressant medication and it works perfectly. Usually adjustments need to be made that may include adding on an additional drug, adjusting the dosage or switching to an entirely new medication. Medication that works well for other individuals may not be effective for you and vice versa. What might further complicate your situation is that you may be hypersensitive to medication. This is something you should explore with your prescribing physician.

You may also want to explore other types of medication. For instance, some individuals have been prescribed a low-dose mood stabilizer or antipsychotic medication in combination with the antidepressant medication. Perhaps switching to a different type of antidepressant medication or an entirely new class of drugs may produce a better outcome for you. You may have to try multiple medications to find the one that works best. You should be working in tandem with your doctor to assess which medication is a better match.

How should you proceed? I would suggest reading about the various types of antidepressant medications. Also, keep track of which medications don’t work for you and why. Work with a psychiatrist who is patient and willing to help you find the right medication. I would also recommend tempering expectations. Don’t expect to find the “perfect” medication. It may be more realistic to expect to find a tolerable medication. Almost all medications have some side effects. Some of the side effects are more endurable than others. Lastly, I would also suggest continuing therapy. It’s good that you are engaged in counseling but if it is not effective, consider a new therapist. How do you know if therapy is effective? You should feel better over time. If not, then you may not be getting the best help. Please take care. I wish you well.

Dr. Kristina Randle

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Do I Have Chronic Boredom?

by Dr. Marie Hartwell-Walker April 13th, 2023
written by Dr. Marie Hartwell-Walker

From a woman in the UK: I’ve had terrible feelings of boredom since childhood. It feels like I want to turn into myself, and make myself so small inside i want to disappear or escape from myself and shut down until it passes. it’s like a feeling of doom and dread. There is nowhere to escape. I can’t deal with this emptiness i feel.

When i was a girl I couldn’t watch tv programs that were old (like The Waltons) because they didn’t have tv, gadgets, things that are fun back then – if i watched these tv shows they might pull me in to the tv and I would have to live like this forever. In a very boring world. I would want to die. Even now I can’t watch tv shows like that. If I have to go to the country side, zoos etc i panic because there is no escape. Again, nothing exciting going on and i feel like I want to die. Not suicidal but can’t bare these feelings. It’s like being completely numb, in a vacuum-solitary confinement perhaps.

I’ve had depression for many years and social anxiety. Could this be autism? I don’t exhibit risky behavior, am very cautious and always aware of danger. If i don’t get out and see people/movement/life it’s like someone is strangling me almost, feel very dry inside and sick.

I explain it to people by saying it’s like I’m a child at a bus station far away from home, in another country. my mother has left me there and I don’t know where I am or where to go, I have no money so I can’t eat and everyone disappears and am left alone. forever, locked in my own dark world. No-one is coming to get me.

I’ve searched the internet for chronic boredom but can’t find anything or anyone that feels this way.

Please can you help me?  Many thanks

This doesn’t sound like boredom to me. Boredom is usually a response to a lack of stimulation and the inability to do anything about it. A person who is bored has plenty of energy but can’t find an interesting or satisfying activity.

What you describe is more in line with your diagnosis of depression. A classic symptom of depression is feeling helpless and hopeless to deal with one’s dark feelings. People who are clinically depressed often feel “empty” or numb. It’s possible that you have labeled these feelings as “boredom”. It’s more likely that you are experiencing a depression that has been present most of your life.

You say that you have had depression and anxiety for many years. I hope those diagnoses are the result of a professional assessment, not a search of the internet. You need and deserve a thorough assessment and treatment by a qualified mental health professional. You don’t have to struggle with this alone. You don’t have to live this way for the rest of your life.

Chances are, you will be asked to start with a thorough physical examination. There are a number of medical conditions that cause or contribute to feelings like you describe. If your physician finds nothing wrong, then it’s time to seek out or return to a psychiatrist and a counselor. You might benefit from taking an antidepressant. I always urge people to also see a talk therapist. Medication alone is seldom enough to change a person’s point of view about themselves when they have been struggling as long as you have.

I hope you will take this advice seriously and follow up. You deserve to have a better life.

I wish you well.
Dr. Marie

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Fearing hospitalization

by Dr. Marie Hartwell-Walker March 24th, 2023
written by Dr. Marie Hartwell-Walker

I’ve had severe depression for quite a while. I started receiving treatment (meds and counseling) a little over two years ago. I had some success and got my depression under control, to the point where i didn’t need meds. But over the last 6 months, my life has fallen apart. I’m back on the meds (even though I didn’t want it) and in counseling every week. My therapist is helpful and while i trust him, i feel like i’m not able to tell him everything that is going on. For the last month or so, I’ve had serious suicide ideation. I told my therapist my plan, but promised I wouldn’t act on it that week. But each week it’s getting harder and harder to make that promise. As the stress of the end of the semester builds up, suicide seems more and more like the answer. In my session yesterday, my therapist got worried because I had a difficult week dominated with suicidal thoughts. He said that I should consider hospitalization. But that scares me even more. I know I should do whatever needs to be done to be kept safe, but I can’t go to the hospital. No one knows how bad i feel and it would devastate my parents and family if they found out. I’m not sure what to do… Truthfully, I am scared of what I might do, but I think I’m more scared of what happens when my family finds out… What do you recommend?
Thanks for listening.

I’m sorry you are having such a difficult time. I hope you can hold onto the fact that treatment helped you before. That is the best indicator that it will help you again. But — your therapist can only help you if you let him. We therapists aren’t mind-readers (although sometimes we really try hard to be). You do need to be straight with him.

However devastated your family would be if you go into a hospital, I’m sure you know they would be far more devastated to lose you. Yes, it is hard for many families to come to terms with someone they love being in such emotional trouble that it takes a hospital to keep them safe. But bottom line, they do want their family member to get the help he or she needs. Often family members relax once they realize that psychiatric hospitals aren’t like what is often depicted in movies and on TV. Good hospitals simply provide structure, some intensive therapy, and a safe place to work out the right medication for the patient. Often, there is a family therapy component to help family members know how to be more helpful and supportive. You can give your therapist permission to explain to them what a hospitalization is like and what could be accomplished there.

I think you’ll find that you will feel a little better just by finally making a decision to go ahead and allow an admission. Once that big decision is made, you can turn your attention to dealing with the depression – which is the point, after all.

I wish you well.
Dr. Marie

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Is This Anxiety or Maybe Something Else?

by Dr. Marie Hartwell-Walker March 3rd, 2023
written by Dr. Marie Hartwell-Walker

From a graduate student in the U.S.: I have been in constant stress and feeling worried for the last 3 years. I have constant chest pain and extreme depression episodes where I cannot get out of bed or stop crying. I have no friends because I am embarrassed of myself and my decisions and dont want to expose myself as a fraud to anyone. I am also deathly afraid of being judged by others about my decisions. I have worked a little but struggled in that environment because i cannot concentrate because i feel others are saying or thinking bad things about me.

I am doing a graduate program and although i find it interesting i have not manage to get any relevant research or work experience because fear of exposing myself.I also taken just easy way out of getting credits and bullshit. I did this because I just want to go home and do an easy job to reduce the stress in my life. I dont go to classes because of fear of having to talk to other people. I dont take the classes i want because of fear that I am not smart enough due to my mental state. oh and Im undecisive.

I have anxiety since I can remember. At 13, I suffered from episodes of panic attacks and feelings of detachment from my body. I thought that life wasnt real and that I was in some sort of Simulation. Nowadays I think about this as a source of comfort as I wish to escape the situation I am in.

I also feel constant disorientation and confusion. I constantly get lost going to places,i dont notice things,i forget what i am doing as i am doing it(while driving i can get lost in my thoughts), losing things, breaking things(extremely clumsy), forget peoples names that I have known for years. Its like im almost always zoned out and mentally slow yet I cannot seem to turn my brain off. My thoughts even disturb me through in nightmares.

I want to know if there is a way for me to get rid of these symptoms. Am I simply an airhead or is my anxiety somehow related to my inability to think logically? Is there something else that could be causing the problem? Would medication help me with my anxiety/panic? I am to afraid of going to the doctor.

The feelings you described are consistent with a diagnosis of social anxiety. It can be debilitating — something you know only too well. You wrote an articulate and organized letter which tells me you can probably do fine with graduate work if you could only get your anxiety under control.

I do understand why you are afraid to go to a doctor. Most people with social anxiety are afraid of interactions with just about everybody and a doctor is no exception. But doctors are exactly who you need to see. In fact, you need to see 3 different helpers to get the help you need. Please have some optimism. Most professionals are just that — professional. They don’t want to judge you. They just want to help you.

First, if you haven’t had a complete medical check up in awhile, do get one. You want to be sure that there isn’t something medical going on as well as the anxiety. Once that’s been done, you need to see a psychiatrist for some medication to settle things down enough that you can start to use some therapy. Right now, you are just too, too anxious. Finally, you need to make an appointment with a cognitive-behavioral therapist to learn how to cope with social situations, including classes, and to manage your intense feelings. There is nothing at all wrong with being a bit anxious. Everyone is. But your anxiety is so intense that it is getting in the way of your life. You need to learn some skills for toning it down — and for feeling more in control.

While waiting for appointments, I do suggest you get a copy of Feeling Good by Dr. David Burns. Read it carefully. It will give your therapy a jump start.

You have suffered in isolation for far, far too long. You deserve better. Please, let the helpers do their job and do your part. You can get much better.

I wish you well.
Dr. Marie

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Weight Gain and Invega

by Kristina Randle, Ph.D., LCSW January 20th, 2023
written by Kristina Randle, Ph.D., LCSW

I have Borderline Personality Disorder & Bipolar Disorder Type II, with transient psychotic episodes. I was prescribed a brand new anti-psychotic, Invega (3 mgs.) about two & a half weeks ago for: distorted thinking, amplified emotions, & daily crying spells. As opposed to the same class of more recent anti-psychotics, such as Seroquel, I am tolerating this one very well — with the exception of weight gain. I have been dieting & exercising in an effort to eliminate or decrease this side effect, but have still already gained 5 pounds! I’d like to know if this side effect will subside as my body gets acclimated to it, or with time. I discontinued the others because this is the one side effect which I will not withstand. I discontinued the others due to this reason. If the answer is no, then should I try the older anti-psychotics, such a Haldol? Do they cause weight gain, too? Will the other drugs help my symptoms? I’d appreciate your opinion. My psychiatrist says he isn’t sure about my concern, since the medication is so new. Thanks in advance.

Most of the antipsychotic medications seem to contribute to weight gain. Some are worse than others. Zyprexa and Risperdal, for example are some of the worst offenders. Invega, as you mentioned is a relatively new medication. As your doctor has indicated, Invega’s true effects are not well known because it’s so new.

From what I know about Invega, those who take this drug seem to tolerate it better than some of the other antipsychotic drugs. There seem to be fewer side effects. One client who recently switched from Haldol and Zyprexa to Invega said she feels less “drugged” and less drowsy. She feels that her thinking is much clearer, and not “muddy” or “cloudy” like she used to have when she took the other two drugs.

Concerning weight gain, you might want stay on the Invega for a while longer to see if you gain any more weight. If all you gained on the drug was five pounds maximum and your symptoms remained under control, and you had no other side effects it might not be worth the effort it can sometimes take to find another medication that works as well.

Drugs.com website has listed some of the side effects of Invega, and weight gain is listed as one of the more common ones:

“More Common

Absent, missed, or irregular menstrual periods
difficulty having a bowel movement
fear or nervousness
headache
inability to sit still
nausea
need to keep moving
sleepiness or unusual drowsiness
stopping of menstrual bleeding
vomiting
weight gain

Less Common

Back pain
belching
blurred vision
changes in appetite
dry mouth
fever
heartburn
indigestion
lack or loss of strength
muscle aches
sore throat
stomach discomfort or upset
stuffy or runny nose
swelling or soreness of the breasts in both females and males
swollen tongue
unexpected or excess milk flow from breasts
upper stomach pain”

Also remember that your weight can vary approximately two to five pounds each day. Depending on when you weight yourself (e.g. after a meal, after a large glass of water, before a bowel movement, the first day of your period) your weight can vary. It is possible that you didn’t actually gain the weight. Consistently checking your weight, using the same scale each time over the course of at least two weeks can tell you if you did in fact gain weight.

It’s good that you are dieting and exercising. These activities can surely help to keep possible weight gain at a minimum. If you find that you continue to gain weight despite your healthy efforts, then it’s probably time to talk to your doctor about trying a new medication. Take care.

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Is this OCD?

by Dr. Marie Hartwell-Walker January 2nd, 2023
written by Dr. Marie Hartwell-Walker

From a young man in the Netherlands: I love order, and structure. So every time I lose track of it, I start over. I can’t help myself. I think I’ve made more than 20 email addresses, had more than 16 diaries, I have had multiple accounts on Twitter, Facebook and Instagram, and I keep resetting my MacBook to factory settings every couple of months.

For some reason it empties my mind. When I get rid of everything it clears up the sky. But it can be a pain. All goes well as long as I can control it. I need structure in my phone, every contact has to have a photo and it needs to be a nice one. My diaries have to have nice handwriting, and my MacBook a good folder structure etc. When I start getting sloppy, or I start receiving too much spam mails, I’ll make a new account. Right now it’s come so far I even spent hundreds of dollars buying the same software on new Apple accounts or Adobe Software, just so I can get everything on ONE emailaddress (the latest one I made)…

How can I accept the fact things will get messy out of control sometimes (like spam mail) and is there a word/explanation for this? Do people recognize it? It was never a problem, but the internet is getting crowded with inactive accounts when you Google my name, and I’m running out of possible e-mail addresses.

Thank you for writing. This is a hard way to live, I know. The difference between a “quirk” of personality and a mental illness is whether the behavior interferes with social, occupational, or daily functioning. The amount of time you are spending with examining, managing, and fixing every account to perfection probably is getting in the way of more important tasks.

Although I can’t make a diagnosis on the basis of a letter, your description of your behavior is consistent with a diagnosis of Obsessive Compulsive Disorder (OCD). OCD is an anxiety disorder. The individual with OCD falls on some behavior(S) that seem to relieve the anxiety. Often what starts as a harmless diversion takes on a life of its own. When the person gets anxious about recurring thoughts or sensations or ideas (obsessions), they come to believe that the only thing that will relieve it is to do something or some combination of things (compulsions).

Compulsions can take many forms. What you describe is a kind of “checking” behavior. You check and double check and triple check to make sure something is correct and perfect. If untreated, OCD can get progressively worse — as you have experienced.

My guess is that the obsession has something to do with perfectionism. Your answering compulsion is to try to make things as perfect as you can. Of course, “perfect” is unattainable so you get caught in a loop of overconcern about how good something is, trying to make it better, being unsatisfied, trying again to perfect it, etc.

OCD does not go away on its own. But the good news is that it is treatable. Cognitive Behavioral Therapy (CBT) has been found to be very effective. CBT is a problem focused treatment that helps you change your patterns of thinking (obsessions) and find other ways to relieve your anxiety. Sometimes some medication is also prescribed to help bring the anxiety down.

If the pandemic has limited your ability to get out to see a therapist,  consider making an appointment with an online therapist.

If you can’t find a CBT therapist right away, do consider purchasing a workbook on managing OCD. There are a number of really useful workbooks available for you to use as a way to start helping yourself.

I wish you well.
Dr. Marie

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Therapy Is Not Working, What am I Doing Wrong?

by Dr. Marie Hartwell-Walker February 4th, 2023
written by Dr. Marie Hartwell-Walker

From the U.S.: Hi, I have been dealing with depression and anxiety for nearly half my life, I have been on medications and went to see different doctors, but nothing yet has worked. Now, my anxiety is getting worse. I am starting to display what I would call “social anxiety” symptoms. I don’t leave the house unless I have to for work, I avoid going to parties, I avoid meeting friends for lunch or dinner, I even show up late for family Christmas parties.

I started seeing a therapist, but I think I may have had the wrong understanding of what therapy is. I thought therapists work in conjunction with other mental health professionals, i.e., Psychiatrists, to make sure your medicine is helping, and Psychologist, to make sure the patient is being treated for the right diagnosis. My therapist did not, in fact I was taken aback when the therapist kept asking me, what I was “doing there”, and what I was “going to do to change my life”! I thought that’s what I was there for, was to work out those questions with a therapist. So before I go searching for another therapist, do I have the wrong impression of what therapy really is?

Thank you for your time, and consideration.

No, I don’t think you have the wrong idea. I think it’s unfortunate that over the last few decades, the helping professions have become very separated with psychiatrists, psychologists and medical doctors dealing with their patients separately. That leaves the consumer with the responsibility for coordinating their own care.

I suggest you look for a practice that has an interdisciplinary team. That means that there is a psychiatrist working alongside the various talk-therapists (psychologists, social workers, mental health counselors). When you call a practice or clinic for information, be sure to ask how much the disciplines in fact collaborate.

As far as your experience with a therapist: Not every therapist is a good “fit” for every individual. In my own work, I encourage people to “shop” by interviewing several therapists before signing on to do therapeutic work. As one of my colleagues pointed out (with no disrespect intended), finding the right therapist is like finding the right pair of jeans. You try several on until you find the one that fits you. In your case, you need to be working with a talk therapist who is more active/directive and who has a working relationship with your prescriber.

There are also a number of strategies you can employ that may help your time in psychotherapy sessions with your therapist in the future.

  1. Be open and honest: It is important to be open and honest with your therapist about how you’re feeling and what your goals are for therapy. This can help your therapist better understand your needs and tailor their approach to better suit your needs.
  2. Ask questions: If there’s something you don’t understand or if you have any concerns about your therapy, don’t be afraid to ask questions. Your therapist is there to help you and should be willing to answer your questions and address any concerns.
  3. Set achievable goals: Having specific, measurable goals for therapy can help you stay motivated and focused. Work with your therapist to set achievable goals and track your progress.
  4. Practice what you learn in therapy: Psychotherapy often involves learning new coping skills and strategies for managing emotions and thoughts. It is important to practice what you learn in therapy in your everyday life to help strengthen and integrate those skills.

Remember, psychotherapy can be a long-term process and it’s important to give it time and effort to see results. If you feel like your therapy isn’t working, it’s important to discuss your concerns with your therapist and work together to find a solution that works best for you.

Please don’t be discouraged. There are many, many fine therapists in the world. You just have to give yourself the time (and the self-respect) to do your homework and find the right one for you.

I wish you well.
Dr. Marie

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I Think I Have Some Kind of Bipolar Disorder

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP December 20th, 2022
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I started taking a medication that has several purposes but my reason was for precautionary measures after a single seizure. It’s Lamictal and you very well know it’s also used to manage bipolar disorder. I’ve been on it since February and it’s September now, so it’s been 7 months. My dosage is 200mg a day.

As soon as I started taking it in the beginning I began to notice a gradual stabilization in my mood. Before I would become depressed and apathetic and have moments of restlessness and hyper motivation. Thoughts of suicide have crossed my mind for years but I’ve never acted on them because I know I’d probably think differently later.

I’ve done my research on mental illness since I was 14. I’ve always had some strange attachment to them, specifically the types of bipolar disorders, borderline, and avoidant personality. I display a lot of symptoms for AvPD that I wouldn’t doubt I’d at least qualify for an evaluation. Oddly enough, I am able to manage myself because I’d like to avoid criticism as much as possible. And I have found fairly successful ways to manage my anxiety. But that’s not the point of my question. I realize my details are pretty vague and it’s basically impossible to be evaluated through text. But I do feel there is something wrong with me. I sometimes get careless with taking my medications because I feel it’s unnecessary. So I’ll go a few days to a week or so without it and then my anxiety gradually returns along with depressive thoughts, irritability and carelessness. Ive gone on some spending missions, luckily I grant myself a limit. So there is some personal control there. I’ll stay up late planning things I want to do and so on.

To sum it all up, I need to know how I can make sure I stay on this medication without having to go to a psychologist? My neuro doctor planned on weaning me off after a year and that year is up in 5 months. I like the stability. I’ve gotten so used to it that I worry I’ll crash hard when I’m completely cut off from lamictal. I feel the only way to stay on it is to somehow figure out what caused my seizure 7 months ago and trigger it again.

I deeply appreciate your thoughtful description of resilience and ongoing coping with your symptoms. It takes a lot of courage to manage, and throughout your description I notice how much grit, self-control, willpower, and self-regulation you bring to the table.

I do have a suggestion about the medicine, but I want to highlight your extraordinary coping skills. These are essential ingredients for your well-being going forward.

The physician prescribing The Lamictal is well aware of its other properties as well. I think I would show him or her this detailed letter and explain your stability that has come from taking the medicine. I believe this type of consultation is invaluable in your case. The physician is then in the best position to offer feedback about your options.

Wishing you patience and peace,
Dr. Dan

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Am I Lazy, Depressed, or Having a Burnout?

by Dr. Marie Hartwell-Walker December 16th, 2022
written by Dr. Marie Hartwell-Walker

From Indonesia; I’ve been on AD last month and I only took it for 8 days. Then I stopped taking it. Not because I couldnt bear the side effect, but simply because my parents no longer allow me to take it.

Now I’m in college, 2nd year, 4th semester. I’ve been a high achiever since my primary school. I had the highest GPA until my 3rd semester among my batch, but now I’m changing and I don’t like it.

I used to do all my works and courseworks diligently, trying my best on everything: quizzes, courseworks, attendances, everything. But now, I cannot do those things anymore. I cannot concentrate on my tasks for even 10 minutes. I’m easily distracted and cant focus or concentrate. I’m no longer motivated, and assignments really feel like a torture for me. I still do them, but something inside my head and heart just doesn’t like it and I cannot pour my heart onto my works. While my friends are having an improvement on their academics, here I am, having a deterioration on my academics. My scores are not as high as they were before, my works were not as maximum as they were before.

I think I’m being lazy, or maybe I’m having a burnout, or maybe it’s the depression again. I just don’t know. I’m lacking interest in almost every aspect in my life, but I’m still trying to hang out with my friends if I get the time. I wake up tired and never feeling refreshed: my body, especially my back aches so badly.

I need help to figure out what’s happening to me because I don’t like me being like this, I don’t like having a low score for everything I do, because I used to have high scores and achievements and tried my best.

I’m concerned. I’m not at all sure this is a mental health problem. Being so over-tired and having a backache suggest that there may be something medical going on. Please stop calling yourself lazy. It doesn’t help and it may be preventing you from going to see a doctor.

Seeing a doctor is exactly what I’m going to suggest that you do. With such serious symptoms, you need to make sure that the problem isn’t medical. I don’t know what “AD” is but if it was prescribed for you, it is your doctor who should be explaining to your parents why it is necessary.

It’s also possible that you need a break from academics. Achieving at a high level is stressful and exhausting. When a student loses interest, it is sometimes because they aren’t working toward a goal that makes sense to them. They have lost sight of why they are working so hard. Maybe you need to talk to someone about what your life goals are and whether your academics are relevant to those goals.

You made an important first step by writing to us here at LifeHelper. The next step is to make an appointment with your doctor. Please follow through. You deserve to feel better.

I wish you well.
Dr. Marie

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Why Can’t I Remember Most of My (Relatively Happy) Childhood?

by Dr. Marie Hartwell-Walker December 9th, 2022
written by Dr. Marie Hartwell-Walker

from the U.S.: My earliest, clear childhood memories began at about age 10-11. From what I’ve read, blocked memories are most often associated with some kind of traumatic event, but what I can recollect of my childhood was, while certainly not perfect, generally happy. (Although I suppose the whole point of this is that if there was trauma and I’ve blocked out the memory, of course I wouldn’t remember it…? It’s all a little frustrating.)

My parents divorced when I was 4, but my father has, from the beginning, been a non-entity in my life and I lived with my mother, who I continue to be very close with, so I don’t think their separation would have been much of a change for me, much less a wrenching trauma. I grew up poor, but well-loved; an only child, but surrounded by similarly aged cousins/extended family who treated me like their own; I consistently did well in school.

It’s not an empty section of missing memory, as if I blocked out a specific time in my life; it’s the entire first decade or so, populated only by a handful of the vaguest impressions of memories. Even with these, I’ve learned that they’re not to be trusted. For example, when I mentioned to my mother my recollection of how we got a family pet we had for many years, she seemed surprised and told me that my version was entirely untrue.

I’ve come to realize, through conversations like that with people who were adults during my childhood, that several of my fuzzy “memories” are self-invented fictions; however, even knowing they’ve been debunked doesn’t change how real they feel to me.

I have not had any further memory problems. I remember a concert I went to when I was 16 with total clarity, while I only have a dim impression of one hallway in the school building I attended K-5th grade.

I’ve tried herbal supplements and memory exercises. The idea of hypnosis makes me a little nervous, since I’ve heard of false memories being accidentally generated, and the fact that I’ve done so on my own makes me worry I’d be susceptible to that. The cost of long-term therapy is prohibitive for me. I’m rather at a loss as to how to get my childhood back.

You are correct to be cautious about hypnosis with this complaint. The mind does hate a vacuum, and it is not at all unusual under hypnosis for an individual to come up with creative “memories” that are not true. Complicating things further is that although the truth of the memories is questionable, the person’s confidence in such “memories” is high. High confidence in false memories has created a great deal of pain in some families.

You are also correct that having so few memories is unusual. Most people’s continuous memory starts around age 4. But unusual doesn’t mean never. There are a number of reasons that people lose their long term memory. Severe abuse is one cause of “blocked memories,” but it is not the only reason. Here are a few more:

  1. Sometimes life changes so markedly for a kid at some point that it’s as if the child starts the memory bank over again. The child comes to believe that the prior memories are irrelevant. History before the change becomes fuzzy at best.
  2. It’s important to be checked for a seizure disorder. Not all seizures are dramatic and visible. Some are very quiet and momentary. Seizure activity can cause confusion and memory loss.
  3. Head injury. Have you ever suffered a blow to the head? Have you ever had a concussion?
  4. You did not mention if you have a sleep disorder. That’s another possible source of memory deficits.
  5. Some medications and some street drugs disturb memory.

I suggest you see your doctor and perhaps a neurologist to get an evaluation. It’s always important to rule out medical causes for difficulties before deciding they are psychological.

Meanwhile, continue to talk to the people in your family you love and trust. Look at old picture albums. Perhaps stories and pictures will trigger memories for you.

I wish you well.
Dr. Marie

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Should I Take Medication?

by Dr. Marie Hartwell-Walker December 4th, 2022
written by Dr. Marie Hartwell-Walker

From a teen in Russia: Hi. I’m an 18 year old professional/competitive athlete[Runner/figure skater.] Past few months I’ve been feeling worse than ever. Well, bad might not be the word rather empty. I’m good at communicating so I don’t have anxiety or anything of the sort and I LOVE the way I feel after training, it’s when I don’t feel empty but rather alive. The only other thing making me “snap out” are dogs, which I cannot own due to the way things are in Europe. Ik this is American forum but I have nowhere else to ask.

I likely have of smiling depression and I’ve been combating that for ages. I always force myself to go cause I know I’ll like it but it takes so much will power of persuarsion and my family would rather have me focus on other , safer, things but I don’t like anything else. I’ve been going through injuries and as well as sleep and eating problems and now it’s causing a red flag for my career slowly.

I feel like no matter what I do can’t save me anymore and I don’t even wish to combat my head. The only things that help are training, dogs and ice baths all which my family ruins by suggesting each is bad and casual “Oh don’t go” or “don’t do”. I don’t know. Would medication help? Is this depression? Is it normal to feel that empty? I don’t know much about it but the symptoms seem to fit and I’m quite desparate. Please help, I feel like I’ll lose my whole life, sport, at the point I’m sinking to. Should I just try and combat it again, would medication be a bad idea? I’m very tired of battling it and it seems tempting to have it controlled, but I fear the bad side effects and I just no longer feel like continuing the battle. Because I’m always happy to everyone nobody even understands. I am just used to acting this way. I don’t know what to do anymore. Should I live with it always? Give everything up? Medicate it?

No, it is not normal to feel this empty. No. You shouldn’t live with it. I’m very, very glad you wrote to us.

I can’t give you a diagnosis on the basis of a letter but I can tell you that what you report is consistent with a diagnosis of depression. It makes sense to me that you feel better when you push yourself physically or take ice baths. Both produce endorphins, a natural “anti-depressant” of sorts. The dogs give you unconditional love and don’t expect anything of you other than your affection. It makes sense to me that being with them also makes you feel better.

All that being said, as you are finding out, it is not enough. What you need now is a professional evaluation by a mental health provider. That person can help you decide if medication might be helpful. You are not obligated to follow the recommendations. However, the conversation will help you understand what is going on and will offer you alternatives to help you feel better.

Usually the treatment of choice for someone who feels as you do is a combination of medication for a while and talk therapy. The medication may give you some relief once it reaches a therapeutic level, but you also need to learn other ways to feel good about yourself and just to feel good besides pushing your body to physical extremes.

Please follow up and get yourself an evaluation. Learning how to take better care of yourself emotionally as well as physically will set you on a path for a much happier and healthier future.

I wish you well.
Dr. Marie

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I Just Don’t Care

by Kristina Randle, Ph.D., LCSW November 20th, 2022
written by Kristina Randle, Ph.D., LCSW

It’s not like I’m depressed or anything, I’m not suicidal or self-harming, thats why I haven’t really sought out any help until now. I’m not sad in any way. I’m usually either really happy, or neutral. I used to do well in school. I’d try to ace all my courses, but recently I just really stopped caring. I feel almost like I’ve experienced everything but dying. I’ve been in most cliques at school, I’ve had major and minor surgeries, and I have a lot of medical conditions (that I was forced by my parent to visit the doctor and take care of). I still ,obviously, haven’t experienced everything though. I hardly pay attention to the actions I carry out and how they affect others , the way they react doesn’t bother me. Even though I should care about how they feel,I can’t and I realize it’s hurting my family and the people I’m around and I wish I could care. When my grandfather died a few months ago, I couldn’t even cry. I attended to my grandmother, but I didn’t feel like I lost anything; even though I was close with him. Late February, I adopted a pet, hoping it would pave the way to caring, it doesn’t feel like I’m cherishing the time with it though. It just feels like a responsibility that I must attend to regardless if I want to or not. I have no idea if theres something wrong with me, I just don’t want to live the rest of my life in this grey void. I’m not looking for a diagnosis, just advice.

You may be having a normal reaction to difficult life events.

You had both major and minor surgeries, “a lot” of medical conditions and recently lost your grandfather. These are all major life events and all seem to have occurred in close temporal proximity. Virtually anyone would struggle with these issues.

Your medical problems and surgeries could be affecting your mood. Your medical problems may require you to take certain medications, which may also be affecting the way you feel. Virtually all medications have side effects which could produce changes in your thinking and behavior and feelings.

Losing your grandfather may also be affecting your mood. Sadness after the death of a loved one is normal.

Medical problems, surgeries and losing a close family relative will undoubtedly have an effect on your mood and behavior. Therefore, it’s possible that these events are the reason why you are feeling the way you do.

It’s highly unlikely that you will “live the rest of your life in this grey void.” You’re experiencing a difficult time in your life but you will not always feel this way. I would encourage you to share your feelings with your parents. Ask if there’s anything they can do to help. They may offer advice or perhaps suggest counseling. During this difficult time, be open with your feelings and make it your goal to gain as much support as possible. The more support you have, the better you will feel. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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Torn about Diagnosis of Bipolar II

by Holly Counts, Psy.D. November 18th, 2022
written by Holly Counts, Psy.D.

Hi there, I’m torn between accepting or rejecting a diagnosis of Bipolar II. A clinical psychologist diagnosed me with Bipolar II a week ago and now I am under a primary care physician to receive mood stabilizing medication this week. I don’t think I have bipolar disorder though. Can personality not sometimes resemble bipolar? I am sometimes hyperactive and able to take on a 100 projects, feel super smart and pretty and am at the top of my game. I need little sleep and in fact find sleep an annoying timewaster. Then I have times, probably more often, where I feel sorry for myself, feel ugly, stupid and can barely clean my flat or look after my pets. When I’m hyper, I harm no one, I don’t spend too much or gamble or drink or do anything that could be considered damaging. I just work really hard, accomplish a lot (I work fulltime as a project manager, am a freelance educational writer and am in the third year of a science degree for which I have had 18 distinctions so far). When I am down, I do feel very sad and think of killing myself every now and then, but I would never kill myself as I know logically this would be stupid and that I always feel better again. In my mind, I am just a highly functional individual who is able to achieve a lot, use my time to the max, sometimes feeling on the top of the world and sometimes not. I’m used to feeling like this and I have all sorts of coping mechanisms around it. I am completely alone, no family and few uninvolved friends, so my state of mood never affects anyone. I also have no support structure should it really be bipolar and should I need help. I don’t understand why I should go on mood stabilizers and antipsychotics. I’ve had no breaks with reality, just a few very minor private breakdowns where I have cried a lot. But I got over those and I was just overworked and under a lot of pressure and it didn’t affect anyone other than me. What do you do when you are torn between accepting a diagnosis and thinking it is total nonsense? I change my mind at least 20 times a day. I can’t imagine I will be able to be compliant with taking medication or accepting help. (age 38, from South Africa)

Based on what you have described here, I tend to agree with the diagnosis that the psychologist has given you. It does sound like you meet the criteria. Most people experience some ups and downs, and yes, some personalities can include some opposing traits and tendencies, but the swings that you mention here do hit some of the classic extremes that are included in Bipolar Disorder and/or Cyclothymic Disorder.

However, just because you meet the criteria for a disorder does not mean that you need to be medicated for it (or even treated). If you feel that you truly have the coping skills already in place to manage your mood and energy changes, you don’t have to pursue further treatment. But the fact that you consulted with a psychologist in the first place and state that you don’t have a support structure to rely on, indicates that you could at least benefit from the help of a therapist.

Most people with Bipolar love their highs and hate their lows, so you are not alone in this aspect. Deciding how much the mood changes impact your life and your ability to function, as well as affecting your “quality of life,” will help you with the decision to medicate. Mood stabilizers will not change your personality, they will level out the highs and lows so that you have more consistency in your state of being. But you have every right to seek a second opinion if you are still struggling with the decision whether or not to pursue further treatment. I hope this information helps.

All the best,

Dr. Holly Counts

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I Am Lonely and No Longer Able to Function

by Dr. Marie Hartwell-Walker November 17th, 2022
written by Dr. Marie Hartwell-Walker

From a 14 year old in the U.S.: at the age of nine I experienced scabies with my family. it was isolating and traumatic, and left me with mild but long-lasting and persistent ptsd symptoms. I’ve had solid depression since then and it took over my life. my general feelings of anxiety became a disorder about halfway through 7th grade.

I feel alone, I’ve never had a best friend. My friends leave me or ignore me without explanation, and my parents don’t know Im a lesbian. everything is exhausting and I find myself unable to complete homework. mental health has been such a problem in my life that I don’t even know who I’d be without them. they’ve taken the place of that much development.

I’ve had sleep disorders similar to insomnia my entire life and they have only worsened with age. It takes me hours (minimum of 2.5, on good nights and 5+ on bad nights) every night to fall asleep, without exception. I’m a mess, haha no wonder my friends leave me. but in all honesty, I’m a good friend. I say it along with other things I take pride in without shame because I hated everything about myself with a passion for 5 years and I’m tired of it.

I always made time for my friends and if they needed to talk I dropped everything, with consequence to myself. I had two passionate and close-to-year-long crushes, and neither were mutual or even ended ok. Ive had dozens of s*****al episodes (no direct attempts) throughout the years and self h****d infrequently starting at age 10. whooof okay, not that all my history is out on the table, my current situation.

ive been begging my parents for therapy/medication/a diagnosis for 4 years and have researched dozens of therapists in the area covered by our healthcare. my mother thinks meds are poison and she clearly has no interest in outside help. shes all into natural stuff, and thats not bad, but she takes it to an extreme. she thinks that garlic supplements and being on the swim team are the only real cures. I know they’re both good but I can’t function and this is the time for final resorts. our financial situation is not perfect, but we can definitely afford treatment and we have insurance. help?!? hahaha help

None of this is a laughing matter. You are hurt and hurting. If garlic and exercise would do it, they would have done so already. You have a sleep disorder. You may have anxiety, depression, or PTSD. I say “may” because you are diagnosing yourself. A professional might have a different idea.

I do agree that therapy, or at least a good evaluation by a therapist, would be helpful. You need an advocate to help you talk with your mom about it. I encourage you to talk with your school counselor, your doctor, or a trusted adult who your mother will listen to.

They (and you) need to reassure her that an evaluation comes with recommendations, not a decision about treatment. A good evaluation will provide information for everyone to think about. If your mom is convinced that medication isn’t an answer, a therapist will offer other alternatives. It’s important that you be open to exploring other options as well.

I wish you well.
Dr. Marie

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Crying Is Causing Me to Avoid All Social Interactions

by Dr. Marie Hartwell-Walker September 10th, 2022
written by Dr. Marie Hartwell-Walker

From the U.S.: For about 7 years now I can barely get through a conversation without crying. It’s humiliating and is uncomfortable for everyone involved. Anything can trigger it but I seem to have narrowed it down to three general triggers. All of these triggers are things that I normally would never give a second thought let alone burst into tears about. 1) Any large group activity – baseball games, choir performances, kids school performances. If a group is together and I’m part of it, at some point I cry. 2) When anyone shares anything the least bit sentimental. For example – a friend of mine was talking about her son’s kindergarten graduation. His teacher taught the kids the sign language sign for “I love you” so that the next year that would be their secret signal around the school. Cute right? Cute. She was telling me this and I burst into tears! To the point I couldn’t speak. This happens all the time. 3) Anytime I have to speak about anything spiritual. I’ve almost stopped going to church. I can’t talk about any of it – not even planning a simple kids activity without crying at some point.

I have searched for an answer. I’ve never been one to be sentimental or publicly emotional. In fact, I used to be a pretty decent public speaker and enjoyed training large groups, teaching in my church and social situations. I avoid all of these situations at almost any cost. I am however, a mother, a wife, a friend, an employee – I have a life. I feel like I’m losing it though. I have to figure out what is going on before I turn to total isolation.

I don’t cry a lot otherwise. If I’m truly sad about something I do cry and feel that I cope pretty well with stress. I can’t think of anything that’s happened that I haven’t dealt with. I love my family and my friends. I used to be really secure with myself until this started. I feel like my anxiety and depression are a result of this – not the other way around. I’m at a complete loss and just don’t know where to start to find answers.

It must feel terrible to feel so out of control of your feelings. It appears that you feel the most vulnerable around the things you care most about.

When a glass of water is already full, it takes only a drop to make it overflow. It’s as if your nervous system is already just about overloaded and then these important issues push you over the top.

I do suggest that the first thing to do is to see your medical doctor to determine if there is an undiagnosed medical issue going on. There is sometimes a link between emotional symptoms and medical problems. Take a look at this article here at LifeHelper: #/lib/involuntary-emotional-expression-disorder/

Another possibility is a medication side effect or medication interactions. If you are taking any medications, you should also talk to your doctor about whether they are contributing to your emotional sensitivity.

If you are medically fine, then an evaluation by a mental health care professional is in order. Emotional symptoms are often the result of untreated anxiety and/or depression.

I wish you well.
Dr. Marie

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I’m Tired of Thinking My Life Is a Waste

by Dr. Marie Hartwell-Walker September 4th, 2022
written by Dr. Marie Hartwell-Walker

From the U.S.: Well, here it goes:

I hate myself and don’t like most people. I’ve pushed my friends away/out of my life. I feel I can’t talk to my own family about my real feelings. I haven’t been in a romantic relationship in 20 years (since high school), which only magnifies my self-loathing. I have zero self-confidence. I’m in a career that pours machismo, which I have none. Most every day I have thoughts of the “s” word, and this has been consistent since Jr. High.

My social anxiety has spiraled to the point where I never leave the house (I peer through the window before I even get the mail or take out the trash). No social media because my heart beats out of my chest making a simple comment. It feels like the universe throws every possible obstacle in my path. I always end up feeling worse.

These are just a few of a long list of issues I grapple with every day. I tried to drink away my feelings during my 20’s which culminated in a 30-day stint in rehab by age 32. I have not had a drink since and I don’t take drugs, other than smoking weed since age 13.

I fear antidepressants because I don’t want to become dependent. On past doctor visits, even though it was on the tip of my tongue, I was too embarrassed to ask about depression. But I feel I’m at my wits end, which has led me to create an account and “ask a therapist”. The only thing I feel is in my favor is an incredibly strong sense of empathy towards everything, especially animals. Crazy, right?

Nope. Not crazy. Probably you are suffering from depression as well as social anxiety.

Stop kidding yourself, please. Yes, you are taking a drug. The weed isn’t helping you one bit. In fact, although it may make you feel a bit better, it is probably contributing to the problem.

You already know that you need help. That’s why you wrote to us. Now please follow your own good instincts and get the help you need and deserve. Start with a complete medical check up to make sure there isn’t an undiagnosed medical issue that is part of the problem. Do be honest about how often you are smoking weed.

Then ask your doctor for a referral to a licensed therapist. The first thing that will happen is a thorough evaluation. Then you and the therapist will talk about the therapist’s recommendations.

Medication may or may not be recommended, but it is at least something to talk about. (A course of prescribed medication will probably do more for you than marijuana.) But even more important will be getting to the root of your feelings and providing you support to take the necessary steps to change your life.

Please follow through. You are only in your 30s. You can have decades of good life ahead of you if you take care of yourself by getting the help you need.

I wish you well.
Dr. Marie

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What are the dangers of mixing antipsychotics & alcohol?

by Kristina Randle, Ph.D., LCSW August 4th, 2022
written by Kristina Randle, Ph.D., LCSW

My boyfriend is taking both Zyprexa and Seroquel simultaneously to treat the symptoms of his disorder. However, he continues to drink alcohol while on these medications. I have read up on both of them, and both say not to consume alcohol while taking either; nevermind both together… I understand that drinking while on these medications can emphasize the affects of the alcohol. What I want to know is: What is the worst case scenario of his continued drinking while on these medications? He is in danger of relapse, or alcohol poisoning? Any help would be greatly appreciated.
Thanks!

I cannot say specifically what could happen to your boyfriend if he continues to drink while taking antipsychotic medications. But I do know that it is extremely unhealthy and dangerous.

First, his continued use of alcohol can increase and enhance his psychotic symptoms. Second, the alcohol can inhibit the ability of the medications to work properly. Lastly, there is a considerable danger in using alcohol with any prescription drugs, and this is especially true with Zyprexa and Seroquel. These are two medications that already have considerable side effects and can cause heavy sedation. Mixing them with alcohol may only increase that sedation.

Alcohol.org cites common side effects that can occur due to mixing prescription drugs with alcohol. They include:

  • Behavioral and emotional changes
  • Stomach upset, nausea, or vomiting
  • Headaches
  • Drowsiness, fatigue, or excessive sleep
  • Fainting/dizziness
  • Blood pressure changes or heart damage
  • Trouble with coordination, causing accidents

 

According to Drugs.com, “Antipsychotics are a large class of medications used to treat symptoms of psychosis such as delusions (for example, hearing voices), hallucinations, paranoia, or confused thoughts. They are used for other mental health disorders as well. They work by changing the balances of chemicals in the brain. Antipsychotics have central nervous system (CNS) depressive properties and should not be used in combination with alcohol due to the additive effects. The combination of antipsychotics and alcohol can increase sedation, respiratory depression, result in poor decision making or cognitive impairment, lead to low blood pressure (hypotension), and put patients at risk for a fall and injury.”

If you mix a prescription drug with alcohol, either by accident or specifically to get high, there is a high risk of overdose or damage to the body.

Specifically with Olanzapine (Zyprexa), NAMI, on its website, states, “Avoid drinking alcohol or using illegal drugs while you are taking olanzapine. They may decrease the benefits (e.g. worsen your confusion) and increase adverse effects (e.g. sedation) of the medication.”

Livestrong’s website quotes AstraZeneca (the biopharmaceutical company that makes Seroquel), who state that “ingesting alcohol with Seroquel may cause alcohol intolerance. This means a person drinking alcohol and taking Seroquel at the same time may feel the effects of alcohol more acutely than usual.” Additionally, AstraZeneca conducted a clinical trial and concluded that “Seroquel caused people to have diminished motor control, and they were not as coordinated at operating machinery when under the influence of the medication. The clinical trial showed that mixing alcohol and Seroquel together made coordination worse.”

I cannot give you a worst case scenario, per se, but I can assure you that nothing good can result from mixing medications and alcohol. Taking antipsychotic drugs and alcohol together can potentially lead to liver damage. It is extremely dangerous, not only for his physical health but there is a definite chance of illness relapse with this type of continued behavior. Make sure you do whatever you can to put a stop to his behavior. As one project website says, “Chronic polysubstance abuse can, over time, lead to deteriorations of your physical and mental health, negatively affect your relationships, drain your finances, and decrease your performance at school or work.” You might consider calling his doctor or therapist to inform them of his alcohol abuse while using antipsychotics. It may be the only way to put a stop to his harmful behavior. Take care.

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Intrusive Thoughts, OCD & Paranoia

by Kristina Randle, Ph.D., LCSW July 31st, 2022
written by Kristina Randle, Ph.D., LCSW

I need help. I am plagued by near-constant intrusive thoughts of all three main types – violent, religious and sexual. It first started when I was about 17, of course it was smaller and easier to manage back then, so I just carried on with my life. I have never had it diagnosed, I am too ashamed and fearful of being ‘branded’. But I just don’t see what else it could be. I believe I have OCD and it’s getting worse and far more difficult to control. To make it much, much worse, every time I have an intrusive thought I get an overwhelming fear that I’ve said it aloud. I obsess over the idea that the people I live with have heard me and thus now see me as every bit the vile monster that I feel I have become. It drives me to the point of paranoia. I analyse every moment I’m near them, looking for signs of fear, hatred and disgust.If I don’t find any then I feel better for a while, but it’s only until I get another intrusive thought around them. If I see the slightest thing off about my interaction with them, I panic and assume the worst. When I’m quiet and I suddenly realise that I’m not thinking about it, I panic and think that I’ve said something aloud without realising and that they’ve heard me.Please tell me, is it possible for me to say my thoughts aloud without knowing I’ve done it?

It’s consumed my life, every waking moment is tainted by it. I wake up every day feeling as though I am going to have to face up to things I have not done nor would I ever do, knowing that today is going to be just the same as yesterday. It’s driving me to depression (as it has done in the past). I’m not suicidal, I absolutely want to keep on living and nothing will change that, but I want things to get better, I need them to. I just can’t contemplate living the rest of my life lonely because of this disease. I do not take medication, nor do I intend to, I simply refuse to live with the side effects associated with them. I need help, I’m trying to keep it together, but it’s hard on your own. What do you think?

OCD is a very treatable condition. Many treatments for OCD involve both medication and therapy. You stated that you “simply refuse to live with the side effects” of medication but you are assuming that there will be side effects. Some medications have negative side effects but others do not. It depends on the individual. Everyone experiences medication differently. What works for one person may not work for another. Among medications that commonly have side effects, many negative effects are very minor and hardly noticeable. You shouldn’t rule out medication. It could greatly decrease your symptoms and bring you immediate relief.

OCD is an anxiety disorder. Without treatment, it tends to become progressively worse. You also have correctly observed that it’s a difficult illness to treat without professional help. I would agree and recommend that you consult a mental health professional. The mental health professional will evaluate your symptoms and determine the best course of treatment. Treatment may or may not involve medication. That’s a decision you ultimately will have to make.

Two non-medication based treatments for OCD are cognitive behavioral therapy and exposure and response prevention therapy. Cognitive behavioral therapy focuses on both your thoughts and your behavior.

Exposure and response prevention therapy is a treatment that places clients in direct contact with their fears. The purpose is to habituate the client to their fears and teach them to tolerate, rather than avoid, the anxiety that arises from their fears. It might seem like a counterintuitive form of treatment but studies show that it can be highly effective for treating certain anxiety disorders.

Delaying the acquisition of professional help may mean that your OCD will progress. It’s already “consumed your life.” It’s time to consult a mental health professional. It is what’s needed. I hope you will consider my recommendation. Please take care.

Dr. Kristina Randle

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Paranoia or Anxiety?

by Kristina Randle, Ph.D., LCSW July 24th, 2022
written by Kristina Randle, Ph.D., LCSW

My paranoia started when I was a child, when my father forced me to go to the theaters and watch horror movies. I still remember the horror scenes, and the times I was crying and laying in the seat so it would block my view from the screen because once I see the image, it is stuck in my brain forever. My brain is like a sponge, once I see it, it’s there forever. My paranoia when I was a child wasn’t suddenly, it gradually developed over the years. I am now 18, going on 19 in a month, which finally my paranoia has reached its climax to where it is hard to deal with it daily. I have to constantly tell myself that it’s all in my head, I believe that there is nothing there to harm me, that the horror movies is all fictional, there’s no “monster” or “ghost” coming to get me. I have anxiety attacks daily if the room is dark (I still sleep with a night-light), I check behind doors, behind my back, I make sure to turn every light on to any room I may go into. Sometimes when I am showering, I start to have a mild panic attack that there may be someone(supernatural) on the other side. I take sleeping pills to calm my mind, and I am still scared to have my feet noticeable in the sheets in the bed (paranoid of a “monster” to grab my feet), I sleep with pillows on each side of my bed so I can’t see the ground (or my face is protected from a “monster/someone” grabbing me). Sometimes, if I am left home alone, I starve myself (two story house) because I am too scared to go downstairs in the kitchen to grab something to eat. When I am completely paranoid, to where I can’t stop thinking about the horrible thought, my stomach hurts, my back aches, my heart races, and my adrenaline starts pumping to where I have to leave the area or call a friend. I can’t live with this anymore. Is this a mental problem? Or is it something I have to deal with for the rest of my life? The adults (my mother) says I will grow out of it because I am scared like a child would be! It is getting WORSE AND WORSE, I wonder sometimes about the future, what happens if I did live alone? I feel like I couldn’t if my life depended on it.

You may be experiencing an anxiety disorder. You described yourself as being paranoid but it might be more accurate to say that you are primarily experiencing fear and anxiety. You have had mild panic attacks, another indication of a potential anxiety disorder.

The fact that your symptoms are becoming worse means that you should seek professional help. Your mother thought that this problem would simply go away but it hasn’t. That is a sign that professional help is required.

Anxiety is a very treatable condition. Typically, if left untreated it becomes worse. This may be what is happening to you.

Anxiety is often treated with both psychotherapy and medication. Medication can be particularly helpful in reducing your panic attacks and overall feelings of anxiety.

You also mentioned that you are taking “sleeping pills.” I am wondering which sleeping pills you’re taking. Ambien, and similar types of sleeping medications, can exacerbate anxiety and fear. Some sleeping pills are prescribed “as needed” and not to be taken on a regular basis. It would be helpful to review your sleeping pill regimen with a physician to determine if they are contributing to the problem.

My recommendation is to seek professional help as soon as possible. With the proper help, you can expect to live an anxiety-free life. The sooner that you receive help, the better the ultimate outcome. Don’t wait. Please take care.

Dr. Kristina Randle

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Boyfriend Refuses Help

by Kristina Randle, Ph.D., LCSW June 19th, 2022
written by Kristina Randle, Ph.D., LCSW

Dear Psych central, I am a recent high school graduate and will be attending college in the fall. My boyfriend and I began dating a few months ago although we were close friends all throughout high school. I love him very much and am deeply concerned for his mental wellbeing. He currently acts entirely normal and can function as any other person could, however, he has what seem to me to be undeniable signs of schizophrenia and acknowledges them but rejects the idea of taking any medication. He will be turning twenty this year, however, right before his 18th birthday during his senior year of high school he entered into some form of psychosis which he attributes to smoking marijuana and salvia and as he refers to it as “never coming down from it” his trip lasted around two months I believe during which he explains he had delusions, hallucinations and extreme paranoia. Many of these delusions were religious in nature which I attribute to his strong religious beliefs. He was taken to a hospital and diagnosed with something relating to schizophrenia. He was given medication I believe although I don’t know what exactly. He was previously a heavy marijuana smoker and has since quit entirely as he attributes the smoking to the triggering of the trip. His 25 year old half brother was also recently diagnosed with schizophrenia and was in an institution until recently although he too denies having any real problem. Today he told me that while he was at work taking a customer’s order he began hallucinating and saw the man’s face change into something horrific and then go back to normal after a few seconds. I had never before confronted him about his illness because I know it is a touchy subject for him although he frequently jokes about how he is crazy and “schizo”. I suggested he get help now because he is at the exact age that signs of schizophrenia manifest themselves and he could potentially prevent things from getting worse but he sees his trip as a one time isolated incident that wont be progressing into something more serious. Additionally I think he has kind of a macho man complex and believes he can use his own will power to fight off the delusions and does not want to be dependent on any kind of medication. We will be going to separate colleges and I will not be seeing him on an entirely regular basis to detect signs of unusual behavior. What can and should I do? How do I get him help without pushing too hard? Like I said he functions entirely normally now and only had that one episode. Thank you so much for reading, I leave for college in three weeks and would deeply appreciate if you could get back to me prior to then!

Some people only have one psychotic episode and never have another. It’s concerning that some of his symptoms have begun to reemerge. Thankfully they don’t last long but your concerns are justified. Treatment could prevent his symptoms from getting worse.

His refusal to accept treatment is obviously problematic. As you have correctly noted, it could prevent the possible development of a severe mental illness. Without treatment, he is at risk for having additional episodes of psychosis.

It’s very encouraging that he is no longer using drugs. It significantly decreases, though does not eliminate, his chances of having another psychotic episode.

The only time an individual can be forced into psychiatric treatment is when they are an imminent danger to themselves or to others. Otherwise, they are free to decide not to accept treatment. That is a difficult reality for loved ones. They know that treatment would help and could prevent future problems but they are often powerless to intervene.

Are there family members who might convince him to accept treatment? What about a friend who he likes or respects? If there is someone who you think can help, contact them immediately and discuss your concerns. You would feel better if you knew that someone was looking after him while you are away at college.

Do everything that you can to help him but realize that your power is limited. You can’t force him into treatment. You should continue to encourage him to accept treatment but ultimately the decision is his. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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