I off my meds cause I want to get pregnant. Its been 2 months since I went off my meds. Me and my husband have been wanting to get pregnant for a while now. I really dont want to take any meds while pregnant. I was taking respridone but it stopped my period. Now ive taken dozens of different meds and the only one that worked was respradone. Anyways my psychosis is getting really bad. i have auditory and visual hallucinations and I’m having a hard time telling what’s real and what not real. I’ve never been off my meds for this long. I guess what I’m asking is can you lose yourself so much and not be able to get back to your normal self? Is there a point of no return?

A. Medication can prevent, decrease significantly or eliminate symptoms of psychosis. There is some research that suggests that stopping one’s medication abruptly can trigger a psychotic episode. That may be what’s happened to you. You should not have stopped taking your medication without informing your prescribing doctor. The fact that your symptoms have returned is evidence of the danger in stopping your medication, without informing your doctor.

I would strongly advise you to contact your prescribing physician and report your symptoms. It’s important that your symptoms are stabilized. I understand that you want to become pregnant but you should have made these plans with the assistance of your physician, who could have advised you about how to do it safely. Doing so without the help of your physician is dangerous to your psychological health and for the health of your baby, should you become pregnant.

Please contact your doctor immediately so that he or she can stabilize your symptoms. When your symptoms are stabilized, then you can begin pregnancy planning. You’d be ill advised to continue attempting to become pregnant in the midst of a psychotic episode. Please seek help immediately.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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.

A. 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

I hospitalized three times for attempted suicide. said bipolar 2 disorder, on meds for schizophrenia: I had what i term to be some sort of break down four years ago. I believed that the school system, my friends and family were trying to take my children from me. I would see random things like book titles that were laying around the house that led me to believe this to be true. I believed that songs that came on the radio were trying to warn me also. I quit showering, grooming and everything because I believed that there were video cameras that were placed throughout my house, in my car, and that i could be monitored throught the tv in my home or where ever i was by the police.Everytime i would see a police cruiser, i thought they were following me. I was seeing someone at the time,we were engaged to be married. I started believing my fiancee and my sister were secretly seeing each other and along with everyone I know and ever knew were trying to kill me by poisoning my food, drinks, or by doing/saying things to make me feel as is if I was loosing my mind. This lead me to barely eat anything for a period of three months. I tried talking to a few people as to what was going on, but only to have them think i was blowing it out of proportion, even my family doctor.I sat in my mothers living room at one time screaming and crying while home alone because i was surrounded by fire. I was convinced that my family was going to lock me in the basement and burn the house down to get my kids away from me. I would go outside and sit crouched facing the corner with a hood over my head just to smoke because i was so terrified. I tried to talk to my mom and aunt to tell them what was happening with me, to no avail. This lead me to try suicide on three seperate occassions within a year. I was hospitalzed on all three occassions being told i had bipolar 2 disorder. But one thing about that is, they had no clue of the things i was seeing/hearing. They never asked. Not one time. I have been placed on several different medications (9 at one time). we have tried depekote, and geodon but they just zombify me to the point where i can not function at all, just sleep. I fight insomnia but at the same time have days where i can not get to sleep. I have rapid thoughts that lead into anger and just break down and cry, even at work. My doctor has placed me on latuda to try and control the symptoms. But the research i have done says that this medication is for schizophrenia and is not approved for bipolar disorder. I dont really know much about schizophrenia and when i try to talk to my doctor about my diagnosis whether it be the bipolar or schizophrenia, he has just asked me why i would want to label myself. I don’t, i want to know more about the conditions so as to educate myself and how to control and recognize what the symptoms are to get a handle so i know what to do and how to recognize when im coming into a crisis situation, i do not have a support group, im on my own with this. My question is, does the bipolar 2 disorder have this sort of symptomology, or is this more leaning toward the paranoid schizophrenia? the Latuda does help control the delusional thinking to a point, but the paranoia is very hard to keep at bay. I just need a better understanding of what is going on with me. Thyroid has been ruled out, but the seratonin levels are all out of whack. Thank you ahead of time for your time and understanding.

A. It is difficult to know precisely which disorder you may have. It’s possible that you have schizophrenia but another possibility is schizoaffective disorder. Schizoaffective disorder is loosely a combination of bipolar disorder and schizophrenia. In many cases, finding the right treatment is more important than pinning down a diagnosis.

What may be happening in your case is that you withheld information from your prescribing doctor, and were given an ineffective medication. To the best of your ability, it’s important to report all of your symptoms so that you can receive the most appropriate treatment. My advice is to contact the prescribing physician, report every symptom and be as honest as possible. Given new information, your doctor may prescribe a different medication which could significantly reduce your symptoms. Having the right medication could be the difference between having controlled and uncontrolled symptoms.

You also stated that you have no support. Is there a support group in your local community? Are friends and family willing to assist you? At this point in time, you need as much support as possible.

You’ve been through a lot. You have been battling significant mental health symptoms for at least four years and you refuse to give up the fight. I admire your determination and persistence. Having the proper medication could greatly assist you in reducing or potentially eliminating your symptoms. Talk to your doctor and hopefully, a change can be made immediately that would bring you relief. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice

Son being content with no outside life ;no work no friends does not go anywhere/ He was diagnosed at 18 with schizophrenia.. he could not hold a job down.. he self medicated got caught went to prison and since prison no meds he is quite content just exercising and listening to head phones..he thinks when his parole is over he can in the army my fear is… Is that going to make him finally realize he is sick or will it cause him to go back to psychosis or depression ..I am just trying to prepare myself..

A. He may want to join the army but if he’s actively symptomatic he may not be eligible. At this point, it’s unclear what will happen to your son. Without more information, it is difficult to know.

Generally speaking, among individuals with schizophrenia, changes in life circumstances can trigger psychotic episodes. For instance, a death in the family, moving, beginning college, and other stressful situations have been associated with an increased likelihood of psychotic episodes among individuals with schizophrenia. Not taking medication can also increase the likelihood of psychotic episodes.

Many people with schizophrenia live successful, productive lives but it is a struggle. Given his diagnosis, and his refusal to take medication, he is at risk for psychosis. Individuals with schizophrenia who do not participate in treatment have more psychotic episodes than individuals with schizophrenia who actively participate in treatment. In that regard, you should be prepared for the possibility that he will have additional problems.

Continue to encourage him to accept treatment. It would also be advantageous to connect with others who have schizophrenic family members. People in similar situations can provide emotional support and may be able to share strategies to help with your son. You should also educate yourself about the disorder. I would highly recommend the book “I’m Not Sick I Don’t Need Help” by Xavier Amador, and other similar materials. The book might help you to better understand why your son refuses treatment and what you can do to help. If I may be of additional assistance, please don’t hesitate to write again. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

I am 48, divorced with two grown boys and a granddaughter. One might think what a wonder life. Its not. I have been in medical chronic pain for over 8 years now. My medically issues continue to grow causing a now total of three chronic pain issues. All are different, all three are extremely painful. My life is in my bedroom. there is no cure for what I have.

I love my kids, and I have a boyfriend who supports and helps me. But I am not myself. Being in pain every single day has finally gotten me to the point of considering my quality of life. I spend hours in a day dream or something thinking about how I could take my life without it hurting my family or rather not having my boyfriends or kids walk in on my death.. this is crazy right?

Let me explain. I thought about going into the back yard leaving my dogs in the house, and cutting my wrists allowing the blood to go into buckets so there is no mess for my family to see. I think about taking my car and going super fast and ramming it into those cement things holding up the over pass. Quick, fast instant death that would not only releive my pain, but total the car so my boyfriend doesn’t have to worry about the payment anymore.

I honestly do not want to die, but with no cure, I can’t bare thr thought of living like this for the rest of my life. I can not take the pain anymore. Its always on the high end of the pain scale. Yes I am given pain medication but only just enough to barely take the edge off, its not enough! I’ve cried, screamed, spoken rational to my doctors but its like I am invisable. Wy can’t they hear me that I can’t take it anymore. Doctors are so afraid to give me proper pain control because of the crack down on drug abusers. If I didn’t have pain, I wouldn’t even consider taking this stuff. So I am suffering because a doctor is worried about his license? What about me? Don’t I matter? Are they just keeping me around to bill my insurance? I’m angry yes, mad, yes. Tired of hurting, yes.. I need help! I told my doctor my ideas about suicide, she said, do you think you’ll really do it? I said I don’t want to, but what other option do I have? She took this as I am having suicidal idealation. To me once again, no one takes me seriously. What can I do? Even my boyfriend has said. Honey I am so sorry, I don’t know if I could take what you deal with everyday, but I am so glad your strong. I’m not strong, I can’t even walk without help. Please can you help me?

A. I am sorry to hear about the pain that you have been experiencing. The fact the you are considering suicide as a “way out” is indicative of how much you are suffering.

You are in a gripping depression. Your decision to end your life is being clouded by this depression and your extreme pain. It is important that you seek professional help immediately.

There may be other options that you have not considered with regard to relieving your pain. Hypnosis can provide effective pain reduction. Find the right hypnotist and you could experience a significant reduction in pain.

Other people have reported achieving significant pain relief through the use of medical marijuana. Research the laws in your state. Perhaps your pain physician could provide a referral. If medical marijuana is not permitted in your state, then perhaps you could move to a state where it is legal. In many ways, this is a matter of life and death. Moving to a new state may mean a reduction in pain and thus regaining your life.

If you were to commit suicide, it would mark a negative turning point in the lives of your family. It could be the worst experience of their lives. They may even blame themselves for your suicide. It could affect their lives in other negative ways. Studies have shown that individuals who have had a family member who has committed suicide are more likely to commit suicide themselves.

Many people believe that the only choice for them is suicide. In many cases, they’re experiencing immense psychological pain. In your case you’re experiencing both psychological and physical pain. Persons with suicidal ideation are making assumptions based on desperation and irrational thoughts. The time to make an important decision is not when you’re ill or in mental or physical pain.

Consider exploring the options that I have mentioned above but don’t do this alone. Utilize the support of mental health professionals. They can help and support you at a time when you are most in need of this assistance. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

I married into my husband’s family who is relatively closed about mental illness. I now know his two sisters (both over 45) have schizophrenia. My mother in law is 76 and keeps them home. One daughter can sometimes be violent and the other daughter constantly talks to herself (I think she is hallucinating). Supposedly they are both medicated, but I’m not sure if my mother is keeping them medicated. I have two questions. Shouldn’t the anti-psychotics stop her voices/delusions if she’s on proper meds? Also, my mother in law fully expects us to keep them out of homes when she passes? They require so much care. How do families handle this?

A. It is possible to continue experiencing mild psychotic symptoms when taking antipsychotic medication but generally it is a sign that the dosage needs to be adjusted or that the patient is not taking his or her medication. The fact that one or both of his sisters continue to have incidents of violence and continue to experience significant psychotic symptoms in all likelihood means that there is a problem with medication.

Approximately 50 percent of individuals with schizophrenia do not believe they are ill and refuse to consistently take medication. It is immensely difficult, and in many cases impossible, to force individuals to take their medication. Even patients in heavily supervised hospital settings are able to avoid taking their medication.

Your mother-in-law’s expectations are unrealistic. She made a decision to care for her daughters in her home but you are free to make a different choice. Ultimately, the choice is yours. Their disorders are not well controlled. They require the treatment of trained mental health professionals who have the knowledge and experience to properly care for individuals with serious mental illnesses. It is unrealistic to believe that you could properly care for them. I would strongly advise against it. Please take care.

Dr. Kristina Randle

I’ve been on Prozac for over a year now. After a series of misfortunate events i resorted to self harm, and substance abuse to “ease” me depression. Now a year later i find that i am very happy with my life and feel it might be time to get off this medication. I’m terrified i will feel like i did prior to the medication and go back to my old ways. I hated who I was and don’t want to go back to that low place, but don’t want to be dependent on medication either. What’s your opinion?

A. Stopping your medication may not be a good idea, at least at this time. As you stated, you’re “very happy with your life.” I understand your concern about not wanting to be dependent on medication, but it doesn’t make sense to make a change when things are going so well. Stopping the medication may be risky.

You are in an envious position; you’re happy and symptom-free. You may not always need the medication and you may not need it now. However, you need to realize that how you are feeling now is at least in part due to the medication. You may be just fine without the medication. There is no way to know for sure. With the help of your prescribing physician, you could try to slowly reduce the amount you take, while being closely monitored. If all goes well, you will eventually be medication-free.

I would recommend consulting your prescribing physician about your dependency concerns. He or she may have an alternative view of the situation and help you to better understand the necessity of medication or help you to come off the medication. Please take care.

Dr. Kristina Randle

My doctor wants me in hospital. I am middle aged and morbidly obese. I am also bi polar and have been medicated for the last 11 years. Before medication I was thin and healthy. I was a bit crazy and reckless and sometimes got into trouble. After I was medicated I gained 150 pounds and now have a number of health issues. I was scheduled for weight loss surgery and met with the surgeon 2 days before the surgery. He canceled the surgery because I was too unhealthy and it would be too risky.

I feel like I’m going to die soon and I need to do something drastic. I’ve decided to stop taking all my medication and do what I have to do to restore some of my health. I canceled my appointment with my pdoc and did not reschedule. He called me and said I should not go off my meds and I should go straight to the hospital. Of course I refused because there was no need to go. He has forced me to go to the hospital twice before, against my will. Can he force me to go now because I’m not taking my meds?

A. I do not have enough details about your situation to provide you with a definitive answer about forced hospitalization. Generally speaking, an individual cannot be forcibly hospitalized unless there is strong evidence that they are intending to deliberately end their life or harm others. Individuals typically are hospitalized against their will when it is believed that they are a danger to themselves or to others.

It was a mistake to abruptly stop taking your medication. Your doctor may have suggested going to the hospital because he was concerned about the possible side effects associated with stopping your medicine. Your doctor is correct to be concerned. If you intended to stop taking your medicine, then you should have done so with the assistance of your doctor. Sometimes, abruptly discontinuing medication can lead to illness relapse, among other problems. By not following the advice of your doctor, you are putting yourself at risk for dangerous health consequences.

As part of their medical training, physicians intensely study the body and how medicine affects the body. Consider them experts on the subject. As patients, it is important to work in collaboration with our doctors but they are the experts.

You should take the advice of your doctor and go to the hospital if he deems it to be the most appropriate intervention at this time. At the very least, return to his local office so that he may evaluate your status and monitor your progress. That is especially important because you have a diagnosed serious mental illness. The concern is that the illness symptoms will return and you may require his expertise in knowing how to handle this outcome. Please take care.

Dr. Kristina Randle

I’ve been diagnosed with purely O OCD last month but I don’t know if my thoughts are obsessions or already delusions. I don’t know if I’m losing my grip on reality but just a good few hours ago, a random thought popped into my head: “What if everyone were cats or aliens and I’m just imagining them as people?” It never stops to bother me now and even though I know it’s completely ridiculous, I just can’t help but worry that I might start to believe it and see people that way. It’s like my belief systems are being challenged cause I don’t have a set religion as of yet. (i.e.: my OCD’s caused by some entity) and I don’t know what to do. I’ve always had faith in science and now it’s hit me that there’s probably some supernatural forces at work in my mind even though that sounds a bit absurd. I’ve found solace and comfort in the company of people when I have OCD panic attacks so maybe my brain did this for me to become more miserable. I just don’t know what to believe anymore. I’ve been on two meds and they helped me feel like myself again for two weeks but then it’s back to this situation as soon as I dabbled with the idea of something paranormal working against me. I just fear losing control and becoming clinically insane and non-functioning. :/ Do you think I’m slowly slipping into schizophrenia or insanity? Are these just obsessive thoughts or already delusions? I worry that I might convince myself into believing/doing these things and that horrifies me. Everytime I talk to someone now, a thought pops up in my head and says ‘Why am I talking to this alien?’ I know it’s too ridiculous but I don’t know what to do anymore. Please help ASAP! Note: I’m currently on Lexapro and Rivotril.

A. Individuals with a specific type of obsessive-compulsive disorder (OCD) commonly believe that they are developing a mental illness, often schizophrenia, because it’s considered to be the most severe and they fear it the most. They might become obsessed with the fact that they are going “insane” or developing psychosis. It is quite common. The thoughts that “pop into your head” are likely obsessions, a symptom of OCD. My sense of the situation is that your symptoms are most likely associated with OCD and not the development of psychosis but only an in-depth, psychiatric interview, with a mental health professional, could provide a diagnosis.

The fact that you have been diagnosed with OCD, and are being treated for OCD (rather than schizophrenia) increases the likelihood that your symptoms are not indicative of psychosis.

It is a concern that you are taking two psychiatric medications, yet continue to experience significant symptoms. It may mean that your medication needs adjusting. Report your symptoms to your prescribing physician who can then adjust your medications accordingly.

If you are not currently in psychotherapy, you should consider it. OCD is a complex disorder which often requires both medication and psychotherapy. One without the other is generally not recommended. Please take care.

Dr. Kristina Randle

I’m going to be sad and angry to the end of my days. I’m 44, female, divorced and getting fatter and lonelier by the minute. I’m employed but I suspect that some people (the ones with power) want me out and will push me out. They think I’m weak, disorganized and stupid (and I think I am as well). I’m a disappointment to my mother who only wants me to be married – she really wanted me to have kids but I screwed that up as well (i.e. I have no kids – one miscarriage and one abortion though). I’m taking wellbutrin, i’ve talked to doctors but nothing ever seems to change. Part of me would just like someone to be there for me but that would require me to be there for them – and I just don’t have the energy to do that nor the skills or ability – I would just ruin their life as well as my own.

Will things ever change?

A: Writing us here is the first step toward making a commitment toward change. Change happens when we change. What I noticed in your description is that you see yourself as a disappointment at work, with your mother, and a potential disappointment to a partner. This is a pattern of thought that creates a belief system that becomes a self-fulfilling prophecy. The work is in changing your belief system so you stop from going into this downward spiral. One of the best books on the subject is by The Resilience Factor by Karen Reivich and Andrew Shatte. This will help you challenge your thinking, for starters. It is superbly written and based on research. It will walk you through the steps of changing these belief systems. Second, I would begin working with a cognitive-behavioral therapist. You can find one in your area by clicking on the find help tab at the top of the page.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

Going on 4 years ago my ex brother in-law commit suicide, I was then told that I had depression which I assume was a result of his death, I took myself off anti depressants about a year ago and I am starting to feel the same way I did when I had depression, I feel lonely, sad, somedays angry and all for no reason. I take all of my feelings out on my partner of 4 years and its getting to the put that it is now putting a wedge between us both. Things have been like this for about 2 months, I\’m not sure if I should go back on anti depressants.

A. You should first begin the process with a psychiatric evaluation. It has been nearly four years since you began experiencing depression symptoms. Many aspects of your life have likely changed since that time.

You might benefit from antidepressant medication but you should also consider psychotherapy. It is important to address the underlying issues driving your depression. Your symptoms might stem from the loss of your ex brother-in-law but there may be other causes. Psychotherapy would afford you the opportunity to better understand why you are depressed.

It is especially prudent to treat your depression at this time, because it is negatively impacting your relationship. Every fight with your partner has the potential to harm the relationship. In many ways, treating your depression could improve your relationship with your partner.

You have known life with and without depression. There is no reason to suffer when treatment is available. Even medication alone has brought you relief from your depression. Perhaps that’s all that you need but therapy, in addition, might provide a more permanent solution to your depression.

Many people access mental health treatment by asking their primary care physician for a referral. You are a perfect candidate for psychotherapy. I hope you will consider it. Please take care.

Dr. Kristina Randle

I graduated from college last year but I moved to a new country and haven’t got a job yet. Hence I spend most of my time at home alone. I have bipolar 2 disorder diagnosed 2 years ago. I am on daily medication(Valproate 750 mg). My illness is well controlled on the whole. I haven’t had hypomanic episodes after i started medication. However, I have been feeling low and don’t feel like doing anything for the last few months. I have been taking a language course for the last 1 month so that was keeping me busy in the mornings. I feel normal when I’m out around classmates or with my husband. However once I’m back home and alone, I feel depressed and lonely. I don’t have real friends here. Just a handful of people I hang out with once a week or once in 2 weeks.

Now that my course is over, I just feel depressed all day. Don’t feel like studying, doing house chores…nothing. I just eat(I also want to binge) and watch TV all day. I feel like im sabotaging and self-destructing myself but can’t help it. I feel safe and comfortable just lying on the sofa all day. The only time of the day I feel better is when my husband is back from work and I have him around.
This feels so much like the depressive periods I used to have years ago before I got diagnosed. However, it isn’t as serious as before. I don’t know how to get out of this vicious cycle.
I also haven’t visited a psychiatrist here and it’s going to be complicated since I’m in a new place.

Do you think it’s my Bipolar or the loneliness or stress of moving/not having a job?
What can I do to help myself?
Thanks

A: Thank you for writing. You have made many changes in the last year that are causing you stress. Please don’t scold yourself for it. Many people would find your situation challenging. That being said, it’s time you took better care of yourself. You are taking serious medication without any support of monitoring from a psychiatrist. It may be that you need a change in dose or a change in medication. Please identify a psychiatrist today and make an appointment.

And, yes, you may be quite lonely and at loose ends. As difficult as it may be to think about, you need to do more to connect with people and make some new friends. A job will help. So will finding an activity or club (book club? art lessons? political work?) that puts you in contact with people who share some of your interests. It’s a time of winter sports in your part of the world. If you don’t know how to ski or skate, think about taking some group lessons. You will get out of the house and you will meet some people. As you know, some strangers are just friends you haven’t met yet. Gather up your courage and get out there. With more to do and more people to do it with, you will soon feel more comfortable in your adopted home.

I wish you well.
Dr. Marie

I am 50 years old, the age where loved ones get sick, need care, and die. I am currently caring for one relative in my home who has in curable cancer after having cared for a different relative (only a few hours per week) who died over a year ago. I also am dealing with a parent in a nursing home with dementia. I had cancer about two years ago but it was cured and I am slowing getting my strength back. My marriage has been on life support for several years now. Up until a few weeks ago I felt like I was coping pretty well with everything. Yes there were some moments during which I wasn’t exactly pleasant but all in all, I felt like I was doing okay, considering. So I decided to quite smoking. I hate being a smoker but staying quit is so hard and takes so much daily, minute by minute effort.

Two weeks ago I quit smoking and last week my husband lost his job, totally out of the blue. And that was the last straw. I just can’t take any more. I want to cry, but can’t. The tears form and then dissipate without falling. I think of crying and I feel shooting pains in the shoulders, chest, wrists and hips, but no tears. I want to scream and yell and stamp my feet but don’t have the energy and know it won’t change and darn thing. I try to grasp onto gratitude, thankful my children are healthy and are doing well, but then I’m consumed with fear that something will happen to them if I focus on them being healthy. I’m starting to feel like I’ve been cursed for having been a pathetic coward for so long, staying with a man I don’t love and being too afraid of the effort it takes to quit smoking. I don’t believe in curses or fate, really. Stuff happens in life, sometimes we caused it and other times we didn’t but in either case we gotta deal with it.

I’m not dealing very well right now; can’t sleep (have had sleep problems for a while but now its even worse) can’t cry, can’t gather enough energy to even plan ways to economize or get a job. I’m numb. I trust this too shall pass, but I’m afraid of how long it will take and how bad it will get before it gets better. I wonder if maybe right now is a bad time to also be struggling to staying quit. In the past few days I’ve cheated each day and smoked. It didn’t make me feel better but once I made the decision to go ahead and light up, that one little bit of stress fell away and then I was okay the rest of the day, comparatively speaking that is. I am taking Chantrix and I know there are some concerns about mental status changes, so I don’t know if the depth I feel right now is completely situational or has it been pushed deeper by the Chantrix?

I hope you can help because clearly, individual counseling is out of the question without insurance.

A: The safety information listed on the Chantix website states: “Some people have had changes in behavior, hostility, agitation, depressed mood, suicidal thoughts or actions while using CHANTIX to help them quit smoking” and advises that you call your doctor right away. I agree. I’m very concerned about your inability to cry and the pains you are experiencing.

Different people respond differently to medications. I realize you were trying to do something positive for yourself by quitting smoking but you may not be able to tolerate this medication. Yes, quitting smoking is good, but not at the price of your physical and mental health.

Please give yourself some credit for dealing with as much as you do. As my grandmother used to say, “Getting older isn’t for sissies.” She was right. You are dealing with multiple losses, changes in your own physiology, and now the financial and emotional stress that comes with your husband’s job loss. You may at times wonder why you are still standing up.

I understand that therapy may be impossilbe right now due to not having insurance but I do think you need some support. I hope you have some good friends or family members to talk to. Some mutually supportive whining is absolutely fine as long as you don’t get stuck in it and can balance all the stress with some good times. If you don’t currently have friends who can provide that, please consider finding a support group for caregivers. To locate one, contact your local hospital, senior service, or your doctor’s office for information.

Don’t give up on your goal of quitting smoking. Do wait until your life settles down and find a way to do it that doesn’t give you so much distress.

I wish you well.
Dr. Marie

Thank you. A month ago (or so) Dr. Kristina Randle helped me answering my question. (Misperceiving reality without medication). After reading the answer I decided to contact my former psychiatrist (the one I used to trust) and started a treatment with her.

I was feeling so much better and wanted to write just to say thank you, was not fine yet, but better, lot better. So thanks :D really.

I understand you answered my question, and don’t want to continue bothering you, but I’m in a little despair. My delusions diminished a lot, I think my official diagnosis is Bipolar Disorder with Psychotic features (or something like that), my mood was fluctuating, but was ok.

The thing is that 3 days ago I started to think of myself dead, uh… not sure how to say it. Like I see me killing myself in my mind (hope makes sense), was not feeling depressed or sad, actually I was fine, just this idea, and it started to invade my thoughts and now I just think in it. I don’t want to really kill myself, despite everything, I love my life, my plans. It has been hard to achieve certain stability, and I like being functional, but there’s this image that don’t leave me alone.

Then I started to listen other people’s thoughts (again), but I usually heard the thoughts of one person at a time, and now are a lot of thoughts of lot of people, so I can’t distinguish everything and my head is aching all the time because of the constant noise.

I wrote to my doctor explaining, I try not to call unless is a real emergency I don’t like when I am demanding, anyway I wrote to her, and she told me I have to give time to the med to kick in.

I know I have to be patient, but I can’t concentrate, or work, and I have datelines, and now I am starting to feel desperation, and don’t know how to deal with this until the med works fine, what if the meds don’t work? What if I’m not fine again?

And I ask myself if I really can’t control this or why am I doing it? Why a person would be like imagining things? Listening or seeing things that really are not there or happening? Am I just a freak? Should people be afraid of me? Should I stay away from people, to avoid hurting them?

And I feel so guilty and afraid for thinking of “me killing myself,” I know I like my life now (generally speaking), and was hard to get to this point. And people say that if you say it is just because you want attention, that people who wants to do it just do it. I don’t want to do anything like that, and also don’t want to have this images in my head, but don’t want to like to “call for attention.” How do I know if I have to say it to someone or not? How do I know if is real, and I should be worried or not? I used to want to die, I even try once and barely survived, and I am grateful I did, ’cause some years after my life improved and I liked it, but I feel ashamed as well (of feeling, saying and trying to kill myself and be alive) because it makes me feel like it was fake, that I was fake. Does that make sense? Should I ask for help or just wait until the meds work?

I’m sorry, I wanted to be just a thank you note, and I understand there are other people, and you have answered a question of mine before, so it’s OK if u don’t answer this time.

Thanks a lot for your time and previous advice.

A. I’m so glad to hear that you contacted your psychiatrist and have begun treatment again. I very much appreciate you writing back and letting me know how you’re doing. Thank you.

Please never feel that you are bothering me. I am glad to help you.

Your symptoms are obviously distressing but they are not your fault. No one would willingly choose to experience what you are experiencing. Those thoughts and images are essentially your brain playing tricks on you. It’s unfair, unpleasant, and frightening, and I’m sorry that this is happening to you. It will stop. It does take time. Be patient but also carefully monitor the suicidal thoughts that are occurring. If you feel that you might attempt suicide, you should call 911 or go to the emergency room. Keep your doctor informed about every change in your thinking.

You were wise to inform your doctor about your ongoing symptoms. Don’t feel like you’re a bother to your doctor. You are not. If you are a bother to your doctor, then she should find a new occupation. No good therapist would ever be upset with your providing the very information that they need to do their very best work. She needs you to keep her informed or she simply cannot do her job. What I am trying to say is you are being a responsible client. Without your self-reporting, she would not know how you are doing. As she noted, it may take time for the medication to “kick in.” Alternatively, your ongoing symptoms may be a sign that a dosage adjustment is needed. It’s important that you continue to inform her about your symptoms. It helps her to know whether your medication needs adjustment.

You may also want to consider the addition of psychotherapy. A therapist could help you to stay grounded in reality. For instance, he or she could help you to distinguish between what is real and what is not, teach you strategies for dealing with distressing hallucinations, voices, paranoia, and suicidal thoughts. During any distressing time, it’s important to surround yourself with a great deal of support. The more support you have, the better you will feel.

Thanks again for writing to let me know how you’re doing. Please consider writing back to keep me posted on your progress. I wish you continued success. Please take care.

Dr. Kristina Randle

Hello my name is Matthew and i have been taking 800mg gabapentin and 100mg zoloft for 2 years and i have quit taking them a year and a half ago cold turkey and since then i have just been angry all the time and been having mood swings from people saying a comment to me and just talking to me and i just get angry and burst out and i was wandering if these medications can do this to me and i was wandering if my primary doctor can do anything to help me cause im afraid my girlfriend is going to leave and take my 1 yr old girl and my 2 month old boy..

A. Hello, Matthew. Stopping your medications “cold turkey” is not recommended. Many people experience unpleasant and potentially unsafe side effects when they abruptly stop taking their medicine. You stopped your medications over a year and a half ago so it’s unlikely that your symptoms are associated with the side effects of withdrawal. However, not taking any medication may be contributing to your emotional instability. To answer your question directly, yes, you should consult your primary care physician about restarting medication.

You should also strongly consider seeing a therapist. In therapy, you can analyze your mood instability and uncover what is causing your anger. Anger doesn’t occur in a vacuum. A therapist can help you to address your anger in a healthy way.

Another reason to consider psychotherapy is your relationship problem. Relationship problems are a common reason why many people enter therapy. You stand to lose a great deal should your relationship end. Your willingness to enter therapy would show your girlfriend that you are serious about improving your psychological health.

Sometimes, people want a “quick fix.” They expect medication to essentially cure their psychological problems. They don’t want to take the time to thoroughly address their issues in psychotherapy. This is a mistake. Medication can reduce disorder symptoms but it’s generally recommended that psychological problems be treated with both medicine and psychotherapy. I hope you will consider psychotherapy. Please take care.

Dr. Kristina Randle