Q: I have bipolar disorder, along with ADHD and OCD. Recently, I have started going to see a psychiatrist about my issue. But when I go to her, I feel as though she doesn’t ask ME how I am, she asks my mother. There are so many issues I need to tell her, but I simply do not feel like I can. I am worried about myself. All I want to do is lay in bed. Please, tell me what I need to do to tell her about my issues. I tried writing them down to tell her, but I did  get the chance, because she only had a 2min session with me, after talking to my mother. Help!

A: It’s all right to ask for some time alone with your psychiatrist so you can talk with her directly and share what’s really going on. It makes sense that she’s including your mom in the initial session since you’re still a minor, but not in every session. I’m curious if the psychiatrist is prescribing medication only, or doing medication management and therapy? If she’s doing meds only, you may want to get a psychotherapist who will go into more depth with you individually.

Take good care of yourself!

Julie Hanks, LCSW

Q: I have been seeing my therapist for almost 2 years, and I just had my first psychiatrist appointment 2 weeks ago (per my therapist’s referral). The psychiatrist wants me to come back every month, but I would much rather see my therapist more often. I think some insurance companies count the number of overall mental health visits per year and I don’t want to “waste” them. I am “real” around my therapist and I know that it will take a long time for me to open up to my psychiatrist. Can I mention this to my therapist next week or is that a bad idea since they communicate with each other? I guess my thoughts are every 2-3 months would be sufficient and my therapist could certainly tell him if my status changes for me. I know I shouldn’t, but I do put up a fake “front” in front of the psychiatrist. Any suggestions on what to do? This is all new to me!!

A: Great question! I want to encourage you to be bold and bring up your questions with your therapist and with the psychiatrist. Most mental health providers are open to explaining their rationale for treatment. Watch this video to hear more suggestions…

Take good care of yourself!

Julie Hanks, LCSW

I am a very blessed person with a great support group. I have depression and am on Celexa 20 mg 1 daily for it. I’ve been on it for probably 1 1/2 years. Lately I’ve been noticing more of my depression symptoms – lack of drive, crazy emotions, crying for no reason, illogical thoughts, fatigue and tiredness, lack of hunger, etc. I’m wondering if I should try to talk with my dr. to up my dosage or if I should try to work out a time to go see a counselor or what? I’m just very confused and distraught. Thank you in advance.

A. You should do both: talk to your doctor and see a counselor. It might be that you are on the wrong medication or the wrong dosage. Initial medicine dosages often need to be adjusted. Sometimes adding an additional medication is necessary. Those are all possibilities that should be discussed with your prescribing doctor.

To overcome depression it is often essential to participate in individual therapy. Group therapy can be effective but one-on-one treatment is often a necessary adjunct. Individual therapy will allow you to focus on your specific issues. The individualized attention also allows you to delve deeper into your issues, which may not be possible in a group setting.

Ideally, you should be participating in all three types of treatment: medication, group and individual therapy. It would be the most comprehensive and efficient approach to overcoming your depression. Please take care.

Dr. Kristina Randle

I was told by a psychologist that I had a paranoid personality disorder and was scizotypal. I have always struggled to be part of society and been depressed since I was a child, together with many other issues such as body dismorphia, eating disorders, social axiety disorder etc etc etc.

I told the doctors that the only medication that had done anything for me was paroxetine / seroxat and they reluctantly put me on 40mg a day about 18 months ago. Since that I have gone from being someone who stared at walls all day alone to someone who has started a business and has some sort of limited life. problem is: I desperately want to come off these tablets as I feel sort of ok now but my girlfriend says if I do then I will go down again as its a pattern she has noticed.

Thing is, I dont know whether to trust her, I am sure she is using me simply to get into my business. Also I have noticed that she has put weight on and the same thing happened with my last girlfriend. Why do women put weight on and stop wanting sex when they date me, what is it about me that makes this happen?

I dont know if I have any mental illness or not, I am convinced that most of them are made up and that it is simply an industry to justify a proffession and nice salaries!!!

I know I should come off paroxetine slowly but I dont understand whether paroxetine makes me something I am not or makes me the person I really am.

Without the meds I cant seem to have a life but with them i feel like a fake like its the meds that are my personality and not me.

Is schizotypal something real or just something made up by psychiatrists to justify their proffession? Please tell me what I should do…………can I now come come off these horrible tablets albeit slowly and will I be ok if I do or will I go back to being a freak again?

Thank you for listening, (if anyone is that is).

A. Schizotypal is a real illness. The most comprehensive book available about schizotypal personality disorder was written by Adrian Raine. Reading about or studying the illness might lead to a better understanding of it.

I would discuss this matter with your prescribing doctor. Perhaps you and your doctor could create a plan for coming off the medication, slowly and over time. Part of the agreement could include a directive for resuming the medication, in the event that your symptoms return. It may be helpful to include your girlfriend in your medication plans. She would be an additional observer who might see or notice something that you might find important.

With regard to the problems with your girlfriend, you might be right about her using you but it is important to determine if you are right. A symptom of schizotypal personality disorder is suspiciousness. What evidence do you have to support your assertion? If there is no evidence, then your beliefs are very likely unjustified.

You complained about your girlfriend’s weight gain and wondered what it is about you that made that happen. Don’t assume that you are the cause. Complaints about weight gain are relatively common among couples who have been together for a while. One or both partners may “let themselves go” after becoming comfortable with their mate. She should be made aware of your unhappiness. Couples counseling could assist you and her in addressing this issue.

I want to commend you on your life successes. I wish you continued luck. Please take care.

Dr. Kristina Randle

For as long as I can remember I have had extreme anxiety issues. I have social anxiety, but the main source of my anxiety is my health. I can’t do anything, and I mean anything without worrying that I am going to die. For example, me and my family went to Disneyland the other day, I was having panic attacks and worrying that I would either just drop dead for no reason or since I had a little bit of a headache that day I was scared was going to have a brain aneurysm. Its always something everyday with my health, it’s exhuasting. All I want to do is sleep all day or just zone out in front of the TV so I dont have to think.

I also have other symptoms, but am not sure if they are part of the anxiety or not they are: feeling like I am in a dream or like a spaced out feeling, weird “what if” thoughts (ex: What if I killed myself or someone else?) and by no means do I want to do this or even have the urge, but since I thought it I get anxiety about it, thinking I am crazy for thinking such things or I am afraid I might sleep walk or something and do it out of my control.

I dont have a job right now and no health insurance, I am just trying to figure out whats going on with me. I am sick of feeling like this. I just want to feel “normal”.

I should mention that I have been on Effexor XR since my daughter was born in 2006, I had Postpartum Depression. I am still taking the Effexor XR, which doesn’t seem to help much anymore, and I am taking 1mg Ativan as needed. I hope you can give me some insight and direction from where to go from here.

Thank you

A: Thank you for writing. The first thing to do is to go back to the doctor who prescribed the Effexor. The period of time that a postpartum depression generally lasts is long over. If you haven’t been back for a discussion about your symptoms and how you are doing on the medication, you should immediately make an appointment. One of the potential side effects of Effexor is anxiety. What you are taking for depression may possibly be contributing to your anxiety. If your PCP or OB-GYN has been prescribing your medication, I do suggest you see a psychiatrist to get a specialist’s take on whether you still need the medication or if you are taking the right one.

Meanwhile — you really should consider finding some therapy for yourself. Some cognitive-behavioral therapy could help you get your anxiety under more control so that you can enjoy life. I know you have no health insurance. Before you give up on the idea of getting any help, I do suggest that you talk with your doctor or spiritual leader about any free or low-cost resources that may be available in your area. Many private therapists also offer a sliding fee scale or low-income slots.

Please be more concerned about finding treatment and less concerned about finding a label for yourself. As you said, the important thing is to get back to feeling “normal.” You deserve it. Your daughter deserves to have a mom who feels stable and able to cope.

I wish you well.
Dr. Marie

My friend was diagnosed with schizophrenia over a year ago. to my understanding it is caused by releasing too much dopamine. hence he was put on dopamine blockers, “psychosis meds”. Now my friend is always depressed. The doctors just revealed that his condition may not be what previously was thought but maybe tick lime disease. This has made him even more depressed being on the meds he is on. What can he do? He is constantly asking me my opinion and is seeking advice. The doctors are being very slow and vague. what can i do to help my friend?

A. The cause of schizophrenia has yet to be determined. Excessive dopamine is one theory and there are others. Your friend has been experiencing depression since beginning his antipsychotic medication. That may be a side effect of the medication. It may also be a sign that he’s on the wrong type of medication or the wrong dose. Advise your friend to make his doctor aware of the fact that he’s not doing well on the medication. It is important that his doctor is informed about all potential side effects and problems with the medicine.

Your friend may want to seek the opinion of a new doctor. The fact that he received two very different diagnoses is concerning. I would recommend seeking a second, third or even a fourth opinion in this situation. Your friend should continue to search for a doctor with whom he feels the most comfortable. The goal is to choose a doctor who is willing to work with the patient to find the best treatment and to properly address the patient’s needs.

Your friend is fortunate to have you in his life. The best way that you can help your friend is to encourage him to inform his doctor about all of his concerns. You can also advise your friend to search for a new doctor if he is unhappy with his current state of treatment.

I hope that your friend is able to find the help that he desires. I wish you and your friend the best of luck. Please take care.

Dr. Kristina Randle

I have suffered with severe depression for about 25 years now. At last someone has listened to me and I have been referred to see a psychiatrist as i feel that maybe there is more going on than just depression. I feel very suicidal, I self harm, I hear voices that no one else can here and I’m also seeing things. I am a bit worried about seeing the psychiatrist as I don’t know what to expect. I was told that they would assess me, what does this involve and will they be able to tell on the first visit what is going on.

A: I’m so glad that you’re going to meet with a psychiatrist for an evaluation. You’re describing serious symptoms that need to be addressed immediately. Watch the video below for my complete answer…

Take good care of yourself!
Julie Hanks, LCSW

I just recently graduated high school and I currently don’t have a job. I spend both day and night inside the house either babysitting, watching TV, or writing on my novel. I don’t really have anyone to talk to besides my family because all of my friends have left for college. I’m beginning to feel pretty alone. Starting last month I have been having indigestion, trouble swallowing, a little bit of nausea, and my thoughts race out of control. Do the symptoms that I feel have anything to do with anxiety or is my boredom causing my mind to create symptoms? The symptoms are starting to happen when I get into a car to the point where I flat out refuse to even get into one. I’m afraid that I have the beginnings of panic disorder. Is this all in my
head?

A: Thanks for writing in. The concerns you’re describing do sound concerning enough to warrant a mental health evaluation. Watch the video below for my complete answer…

Take good care of yourself!
Julie Hanks, LCSW

Now I’m starting to think I’m just crazy: I’m 20 years old and I find myself losing touch with the world more and more each day. All throughout my life I’ve always known I was different. Growing up, I understood things the other kids didn’t. I was smarter than the other kids and I was invincible. Things started going down hill for me around aged 12. I was still the smarted and different from everyone else, but I had lost friends. From this age onward I would only have 1 or less friends at a time. I started having troubling thoughts and began doubting my reality.

Now I am an adult and I realise how wrong I was. Although I still feel that way, even though I know it can’t be right. Otherwise why would i be doing so badly in life?

I’m too depressed to do anything productive. And I can’t stand other people, so I avoid them. Sometimes if I’m in public I feel like screaming and pulling my hair out just because they don’t understand. Because I think they are all stupid and I hate that they are doing so well in life and I’m not. I don’t feel they deserve anything (even though when I think about it alot of them do. It’s just first reaction to seeing someone, I think the worst of them). I’ve been talking to people inside my head more and more often as the years go by. Repeating people are a male and female doctor, and a parent that doesnt exist. Other times it’s just random peoples voices that never return though.

I often get paranoid and think people are listening in on my thoughts or trying to mess with them, so I quickly change my thoughts to 100 different things and try to act normal but then they know I know they are listening.

I also often fantasize about being a multi-billionaire or being extremely powerful/invincible physically. Then when I snap out of it and come back to reality I get so depressed because I know it’s the complete opposite.

Is there medicine I can take for this?

A. Your symptoms are unusual and concerning. You have feelings of grandiosity (i.e., feeling special). You also hear voices, experience paranoia, have trouble with social relationships, and have bouts of depression. With the exception of depression, your symptoms are characteristic of psychosis. Symptoms of psychosis are associated with schizophrenia, schizoaffective disorder and several other mental health disorders. Individuals who experience a milder version of psychotic symptoms might have schizotypal, paranoid or schizoid personality disorder. I cannot say with certainly if you have any of the aforementioned mental health disorders. Only an in-person psychiatric evaluation could make that determination.

To answer your question directly, yes, there is medication that could effectively treat your symptoms. Antipsychotic medications can decrease or eliminate the voices, paranoia and your grandiose feelings. Antidepressants can help to stabilize your mood. You may also want to consider therapy to address your social interaction difficulties.

You have been experiencing psychosis-like symptoms since adolescence. These symptoms should be addressed and treated as soon as possible. Undoubtedly, they are negatively impacting your life. If left untreated, they may become worse and potentially lead to a full-blown psychotic episode. Medication would greatly reduce that risk and it could significantly improve the quality of your life. I hope that you will consider having a psychiatric evaluation and beginning treatment. I wish you the best of luck. Don’t hesitate to write again if you have additional questions. Please take care.

Dr. Kristina Randle

My issue is complicated. I was diagnosed with different several mental disorders between the ages of 17 and 22. By about the age of 21 I was diagnosed with Schizoaffective disorder. This is the label I continue to carry; despite being in complete “remission” for several years and off all medications. I no longer have access to a psychiatrist (& could spend several months waiting to see one).

I’ve continued to see a fantastic counsellor through my university who has been helping me through all of my past issues. However, I’ve found myself in a completely unusual situation which has even my counsellor stumped. I’ve been having intrusive flashbacks to my past traumas that seem almost real. However, I’ve also been experiencing hallucinations which mostly consist of hearing voices and seeing bizarre images (most of which somehow relate to my past traumas). It all started when I began feeling extremely low a couple of weeks ago & my condition quickly deteriorated to where I started hearing and seeing things.

I have no desire to revisit medications as they severely impaired my level of functioning. My question is whether there are alternative ways of learning to deal with these horrifying experiences. I have reason to believe that they’re simply manifestations of the recollection of my past…but even so,I do not know how to manage them & stop these hallucinations from persisting. Any thoughts would be greatly appreciated.

A. I realize that you do not want to take medication. Many people feel the same way. They don’t like the side effects and medication alters their personality. However, you are experiencing serious symptoms that are disrupting your life. Hallucinations, if left untreated, generally become worse. The risk is that you will experience a full-blown psychotic episode. You don’t want to take that risk.

Medication may be necessary but only temporarily. It seemed to have worked for you before, to the point where you no longer needed it. You may have to repeat that process.

Another option to consider is taking a low dose of medication or a different combination of medications. All of these options should be discussed with a psychiatrist.

You have to deal with the reality of your situation. Yes, medications can be unpleasant but they have a proven track record of treating your symptoms.

You are also experiencing flashbacks. One particular treatment that many people have found to be effective for reducing flashbacks is eye movement desensitization and reprocessing (EMDR). EMDR is a form of highly structured psychotherapy that is used to treat symptoms associated with past traumas. Hypnosis may be another option.

If you choose to pursue either option, you may want to consult a specially trained trauma therapist. Perhaps your current therapist could assist you in deciding whether or not those treatments would be appropriate for you. Please take care.

Dr. Kristina Randle

Hi, I have been dealing with depression, anxiety, and eating issues since I was in grade school, but I always maintained a normal body weight. I finally sought treatment for depression in college, and have been taking anti-depressants (effexor) for the past 3 years. It took a long time to find a medication that helped, and all of them reduced my appetite. Finally, I have been diagnosed with EDNOS this year after losing 32 lbs in 3 months by restricting and exercising excessively. I recently read that anorexia can be caused by high serotonin levels, and starving helps regulate this. But I also read that anti-depressants increase serotonin levels… Could the anti-depressants have caused my eating problems, in my body’s attempts to regulate itself?

Thanks for your help.

A. I cannot say with certainty whether antidepressants are the cause of your eating disorder. Having said that, it does not seem as though medication is to blame. You stated in your letter that you have lost 32 pounds in three months “by restricting and exercising excessively.” Medication may be a factor but diet restriction and excessive exercise are likely the reasons for your significant weight loss, and thus your eating disorder.

I would suggest discussing this matter with your prescribing physician. There may be more information about your situation that was not provided in your letter that would lead to a different conclusion. It is important to explore all the possibilities as to why you have developed an eating disorder. Eating disorders are very serious. They have the highest mortality rate of all mental health disorders. Nothing is more important than assessing why the eating disorder has developed and receiving treatment. The sooner that you begin treatment, the sooner the eating disorder can be eliminated from your life. I wish you the best of luck. Please take care.

Dr. Kristina Randle

Every time my girlfriend and I have sex I just cant orgasm. and I don’t really mind but I care because she’s really really hurt and I often find her crying about it and I don’t want to hurt her. I am on Prozac, I don’t know if that affects anything at all.

A: I appreciate the fact that you are sensitive to your girlfriend and want to fix this. It sounds to me like you need to have a discussion with your medical doctor about this. Sometimes antidepressants like Prozac can have side effects, and sometimes the depression they are used to treat can be the culprit. In any case start I would start with a discussion with your physician.

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

I dont know what to tell you really but saw your articles and needed to speak to you.

I have been WEIRD since I was a kid.

Never had a friend always been alone, only just got a woman at 50 an only then cos she is probably BPD. I was diagnosed a couple of years ago with paranoid personality disorder and being schizotypal. I am still not sure any of that is correct.

I definitely have paranoid tendencies and have never trusted anyone. That can be easily explained by bullying from a brother when young I feel and the hate from my mother and weakness of my father.

The problem I have is that when I am in new situations such as on holiday I see people that I think I know and I am convinced I know them and they know me yet my girlfriend tells me its impossible. This seems to be happening with increasing regularity along with olfactory sensations of death and decay.

I have seen psychiatrists and they just seem to despair of me…………………. I have always had suicidal feelings since I was a child but I take seroxat 40mg and that seems to keep me stable but I so desperately want to be free of tablets I dont know what to do.

A. One area of concern is your olfactory hallucinations, also known clinically as phantosmia. Phantosmia is a relatively uncommon symptom. According to Dr. Jeffrey Swanson of the Mayo Clinic, it is often associated with medical conditions such as head trauma, upper respiratory infections, temporal lobe seizures, epilepsy, sinusitis, brain tumors, Parkinson’s disease, migraines or strokes. Because phantosmia may be indicative of a physical condition, it is important to be evaluated by a physician. If you have not done so already, inform your treating psychiatrist about your olfactory symptoms. Your psychiatrist may refer you to an ear, nose and throat specialist.

It is difficult for me to comment about the situations (involving your girlfriend) in which you are convinced that you know someone and your girlfriend says that you don’t. I would need much more information about why she would say that you are incorrect when you are so convinced that you are. Either you are correct or she is correct. There is no in between.

Generally, comprehensive psychiatric treatments often involve both medication and psychosocial treatment but many utilize only one form of treatment with success. Since your goal is to eventually stop taking your psychiatric medication, I would recommend consulting a therapist. A therapist can assist you in developing psychosocial treatment responses to your symptoms. It would be unwise to simply stop your medication without having a plan to treat your symptoms. I hope that my answer helps. Please take care.

Dr. Kristina Randle

Hi. Not sure how to get out of this deep, dark hole I’m in. I want to cry all the time, and feel like a complete failure in all aspects of my life. I really want to give up and if I didn’t have my parents and a few others whom I believe love me, I would just want to check out. I hate life, I hate myself, and I just want all the pain to stop. I’ve tried some an anti depressant, but it made me feel even worse. I believe that I must be a really bad person, and must be just getting what I deserve. I can’t get out of this hole I’m in.

A. It is important that you seek professional help. You are not thinking accurately. Your judgment is being clouded by depression. Proof of this would be your self-critical, derogatory comments.

Antidepressant medication hasn’t helped yet but that doesn’t mean that a different one would not help. When it comes to finding the right psychiatric drug or combination of psychiatric drugs, “one and done” is usually not the norm. It often requires trying multiple drugs, or multiple combinations of drugs before feeling relief. In addition, many people begin taking a new medication and find that the first two or three weeks are particularly difficult. After the initial side effects diminish, only then do many individuals report feeling the positive psychological benefits of the medicine. Sometimes, you have to “wait it out” to gain the full benefit.

Getting “yourself out of this hole” will be difficult to do alone and that is why it is incumbent upon you to seek professional help. If not for yourself, then do it for those who love you, who undoubtedly don’t want you to continue suffering and who want you to feel better.

Writing this letter is a great first step. It is a recognition that help is needed. The next step is to make an appointment with a mental health professional or your primary care physician. The find help tab, at the top of this page, can assist you in locating a mental health professional in your community. I hope you are able to get the help that you deserve. Please take care.

Dr. Kristina Randle

I have a complicated history of childhood abuse and mental illness. I take antipsychotic medication and am diagnosed with Borderline PD with some contention as to whether my psychosis(?) is more psychological or biological. I don’t hallucinate, my problem is mainly surrounding delusions(?) I often experience persecution via ‘government’ agencies via a very complicated system of mind control. I get very angry about being targeted. One example is that they are currently they are repeatedly putting feathers into my mouth to try and choke me, to wind me up, but they engage in a whole myriad of techniques to torment me and exert their power over me. They also affect the way I am able to articulate my experiences, so it’s difficult verbalising them to a psychiatrist in person (though, admittedly, I am partially reluctant because I know people don’t believe me about these things). This has been going on for nine or 134 years, or all in this second. I feel very confused, like there is no boundary to reality. I find that, in my waking/daytime life, some content of experiences has the rather random quality of dreamscape, and so it’s difficult to know whether I am awake or asleep. Added to this I have begun to experience what is possibly hypnagogia which has quite bizarre content – the confusion being that it works its way into my waking life and I believe what has happened throughout times to come. Apolgies for not being very succinct; my question is whether, in this sort of case, struggling to distinguish dreams, or indeed, delusions from reality is normal in psychosis or whether it’s likely to be something else?

A. There is no need to apologize. The thoughts and ideas presented in your letter seem indicative of psychosis. Please keep in mind that I cannot know that with certainty because I am basing my opinion on a short letter with limited details.

You asked whether or not your specific symptoms (i.e. difficulty distinguishing dreams from reality) is a “normal” aspect of psychosis. Yes, the very definition of psychosis is having a break with reality. Many people describe their psychotic experiences as their having difficulty knowing what is real and what is not. That, however, does not rule out the possibility of another problem. Alternative explanations for your symptoms may include an undiagnosed medical condition or a sleep disorder.

You did not mention whether or not you are taking psychiatric medication. If not, you may want to consider it as an option. Antipsychotic medications can reduce or eliminate psychotic symptoms. Understandably, some individuals are reluctant to take psychiatric drugs but a low dose might considerably improve your symptoms.

I would recommend being evaluated by your treating clinician and/or a medical doctor. You may also want to inquire about a sleep study. Your symptoms require treatment and they should not be ignored. An evaluation can uncover what might be wrong. Please take care.

Dr. Kristina Randle