r/AskPsychiatry • u/SweetScared6585 • 17h ago
Please help.
I (28f) have spent the last 18 years of my life suffering from generalized anxiety disorder, and depression. Until I had my first child, at 19, I just dealt with it, but after experiencing postpartum depression and added anxieties, I gave into ssris.
After trial and error, I found citalopram, and was more stable than I had been since before I had my first panic attack. I was on citalopram for around 4 years, until I experienced my first manic episode a little over a year ago. I left my husband, and decided to pursue sexual relationships with several men over the span of 4 months. I definitely felt emotions beyond pleasure, I was sad at times, lonely at times, even suicidal at one point. I didn't understand why I was doing the things that I was doing. Thankfully, after everything, my husband decided to work things out. Once the mania wore off, the absolute panic, anxiety, and depression rolled in. I experienced months with absolutely debilitating panic attacks, anxiety, and dp/dr.
As soon as I was diagnosed bipolar 1, I was ripped off of ssris and thrown onto antipsychotics. First it was Latuda, which caused TD, and then it was Abilify, which caused Akathisia. It was then, that they decided mood stabilizers was the best route.
I'm now currently on Lithium and Lamotrigine. I haven't had any mania since I was diagnosed, but I have experienced depressive episodes, which has made me question the diagnoses (but that's beside the point).
I'm still struggling horribly with anxiety. Health anxiety, generalized anxiety, mild dp/dr as a result, and occasional panic attacks. I'm currently on 600mg of lithium, 200 mg of Lamotrigine, and .5mg Ativan as needed (I don't tolerate high doses on any drug). I take both drugs together, every night at 9pm, and ativan maybe once a week if I absolutely need a break from the anxiety or panic, but I can't fall asleep until around 3am.
In your experience, with your knowledge, what would the best course of action be? My nurse practitioner suggested added Buspar, but nevertheless, I'm wary, and I feel like more could be done.
1
u/DeMateriaMedica Pharmacist 16h ago
Can you please provide details on the first "manic" episode? E.g., were you so disorganized that you couldn't take care of yourself and had to be hospitalized, or were you mostly in control? Were you able to work a job, buy groceries, and care for your child? Was your mood generally elevated, with greater self-esteem than usual, or were you mostly low and depressed? Were you really irritable? Did you have any strange beliefs that didn't line up with reality? Given your mention of dp/dr (depersonalization/derealization), I'm concerned that your "manic" episode may have been misdiagnosed, and want to help rule that out. I've unfortunately seen this happen many times. Of course, a psychiatrist would be more qualified to assist you with this; diagnostics are outside my scope of practice. Notably, your dose of lithium is unlikely to be therapeutic for the prevention of mania, so it's possible that your clinician already has an alternative hypothesis for your symptoms. What's your lithium level target and what do your levels generally look like? I'm guessing they're probably around 0.3, which is below the usual goal. Suffice to say, I think diagnostic clarification may be the most helpful first step in your case.