Advice on talking further with psychiatrist about meds?

[Horizon]

I've already discussed some of it before with him and got an increase in my dosage for my lamotrigine (it's now 200g at night and 25g during the day) and now I take half of a buspirone during the day since last time I discussed how the meds were working which is why they increased dosage but, I don't know if it's really working and I don't know if I should suggest to him actually changing out either med or increasing dosage again. (I have a past history of cycling through a lot of antidepressants I think growing up trying to find one that makes a difference. But now my main med is a mood stabilizer.)

I have concerns about it tanking my sex drive which I don't want it to for personal reasons but I'm unsure of discussing it with him, I have only had discussions related to sexual things with my therapist so far and haven't tried talking with him about any stuff related to that yet.

But, outside of that I think it's causing me to get hypomanic episodes more often but also mixed episodes? Don't know how to explain it, my head's been a weird place these days in-between my usual emotional numbness. I feel conflicted on how im gonna bring it up, I mean part of me 'likes' being hypomanic more often to some degree because it's one of the only times I feel good, too good. (Ex; Having a very sudden shift in mindset that's unrealistic to have changed so soon. Then immediately crashing) It makes me feel awful too, but I don't know.

I feel like he may just continue to increase dosage which I don't mind, nessarliliy but I'm worried about the effects since there's still no balance and even at 200g it didn't exactly curb episodes? (I don't expect any meds to completely erase them, either, btw.)

I'm wondering if my prescribed med for insomnia is also interfering with the mood stabilizer and anxiety med I take at night, since unless it's just the place I'm trying to sleep at, I keep waking up at 1-3 am even if I go to sleep sooner. And I'm unable to sleep when I wake up till I take my morning scheduled meds and crash out during a random time in the day. But there's also been nights where I'd take it, get more exhausted but not stay exhausted and end up staying awake the whole night. (This happened for 2 nights in a roll.) I deal with fatigue alot, the lack of sleep does end up boosting my energy for a moment but I think I just was dealing with hypomania during those times since it can be a trigger for that and has.

I don't know how to approach him since I'm unsure of what he'll do and I'm kind of just, nervous about it. The meds do work, I know that since I'm worse mentally without taking them whenever I have to go without them (during refills). I'm aware there may be no choice but to maybe have med changes at some point but I can't really ignore the fact I'm also tired of shifting through meds with psychiatrists looking for "the one" but I also think maybe I'm just having too high of expectations for my medication.

I just feel like shit because I still don't feel stable like I "should be", in my head despite being medicated. I feel like the med also makes me even more numbed out but I have a hate/love for it/being numb in general. I find it convenient and inconvenient based on emotions and how I'm feeling at the time/or NOT feeling.

He's gonna be out of office (don't know for how long or anything else about that) so the appointment is rescheduled to be sooner and I think it's something I need to talk about regardless but I'm drawing a blank mentally when I think about how to go about it. Any advice? (Since I didn't explicitly mention it, I have bipolar 2, and GAD. Which is the main thing in kind of focusing on, not nessarliliy my insomnia and what this is about, for any clarification purposes)

 

[PamelaS]

I've already discussed some of it before with him and got an increase in my dosage for my lamotrigine (it's now 200g at night and 25g during the day) and now I take half of a buspirone during the day since last time I discussed how the meds were working which is why they increased dosage but, I don't know if it's really working and I don't know if I should suggest to him actually changing out either med or increasing dosage again. (I have a past history of cycling through a lot of antidepressants I think growing up trying to find one that makes a difference. But now my main med is a mood stabilizer.) I have concerns about it tanking my sex drive which I don't want it to for personal reasons but I'm unsure of discussing it with him, I have only had discussions related to sexual things with my therapist so far and haven't tried talking with him about any stuff related to that yet. But, outside of that I think it's causing me to get hypomanic episodes more often but also mixed episodes? Don't know how to explain it, my head's been a weird place these days in-between my usual emotional numbness. I feel conflicted on how im gonna bring it up, I mean part of me 'likes' being hypomanic more often to some degree because it's one of the only times I feel good, too good. (Ex; Having a very sudden shift in mindset that's unrealistic to have changed so soon. Then immediately crashing) It makes me feel awful too, but I don't know. I feel like he may just continue to increase dosage which I don't mind, nessarliliy but I'm worried about the effects since there's still no balance and even at 200g it didn't exactly curb episodes? (I don't expect any meds to completely erase them, either, btw.) I'm wondering if my prescribed med for insomnia is also interfering with the mood stabilizer and anxiety med I take at night, since unless it's just the place I'm trying to sleep at, I keep waking up at 1-3 am even if I go to sleep sooner. And I'm unable to sleep when I wake up till I take my morning scheduled meds and crash out during a random time in the day. But there's also been nights where I'd take it, get more exhausted but not stay exhausted and end up staying awake the whole night. (This happened for 2 nights in a roll.) I deal with fatigue alot, the lack of sleep does end up boosting my energy for a moment but I think I just was dealing with hypomania during those times since it can be a trigger for that and has. I don't know how to approach him since I'm unsure of what he'll do and I'm kind of just, nervous about it. The meds do work, I know that since I'm worse mentally without taking them whenever I have to go without them (during refills). I'm aware there may be no choice but to maybe have med changes at some point but I can't really ignore the fact I'm also tired of shifting through meds with psychiatrists looking for "the one" but I also think maybe I'm just having too high of expectations for my medication. I just feel like shit because I still don't feel stable like I "should be", in my head despite being medicated. I feel like the med also makes me even more numbed out but I have a hate/love for it/being numb in general. I find it convenient and inconvenient based on emotions and how I'm feeling at the time/or NOT feeling.

He's gonna be out of office (don't know for how long or anything else about that) so the appointment is rescheduled to be sooner and I think it's something I need to talk about regardless but I'm drawing a blank mentally when I think about how to go about it. Any advice? (Since I didn't explicitly mention it, I have bipolar 2, and GAD. Which is the main thing in kind of focusing on, not nessarliliy my insomnia and what this is about, for any clarification purposes)

I feel for you. With my last psychiatrist it took 2 years to find a combination of meds that would stabilize me enough to function. It is a hard road to find a good psychiatrist and find the right combination that works with your body.

Each of our bodies are different. The majority have average scores on blood pressure and body temperature, etc.. but my body has never worked that way. My body is different. You are the only one who knows you the best. You know what you’ve been through and you know what your body and mind do. We might not always be able to describe it, and we might not be able to be diagnosed with something, but you know what happens in your body and in your mind.

I hope and pray that you find a way to move forward either by opening the subject of sex with your current psychiatrist or trying a different psychiatrist. But to get a good psychiatrist is not easy and there are few good ones out there.

Spend time evaluating how you have done under this psychiatrist’s care and then decide whether you feel comfortable approaching the subject with them or whether you might feel safer with someone else. Either way, telling your story, explaining what you’re going through is the only way the provider is going to know what you need. And you are the only one who knows what is going on in your body and in your mind. It’s your job to communicate to the people who are there to help you. And it’s their job to listen to you and believe you and trust you to do the best you can to take care of the body and mind you have. I wish you all the best moving forward. Thanks for asking for help. I hope this helps.

 

[Horizon]

I'm gonna attempt, but regarding the sexual stuff I'm also just worried it won't be taken seriously. (My relationship with that stuff is complicated as it is and my concerns regarding thoughts and behaviors related to it have no been taken seriously by other people, and my 1st psychiatrist wasn't able to do much in relation to it.) besides stuff regarding the actual state of my body, I guess. - I'm paranoid something is wrong but also paranoid to see confirmation of it. I just know I don't want to lose my sex drive because of meds.

I intend to talk about it or least try regarding everything it's just a lot to say in my mind and I don't know how well it'll be mentally there when time comes to speak of it. (I feel like my mind blanks out or just shuts off a part of itself so it's hard to know what I'm feeling or thinking in the moment and I tend to only answer his questions based on the current exact moment instead of the following days, least not in any specifics-? Should probably consider them moreso than just my current state when going to appointments). And thank you, this was helpful and also reassuring to read and the encouragement helps. I'll keep this in mind! Have a good day/or night wherever you are.

 

[Sideways]

I’ve tried around 30 different psychotropic medications (including mood stabilisers - tried lamotrogine & was on lithium for quite a long time) in my hunt for the right combo. It took more than 10 years to get it right.

Things I wish I’d done differently:
- getting a genetic test right at the start to determine which meds were likely to work for me, and which weren’t (this would have shaved years off that process, I only got it done towards the end of that decade of trial and error)
- getting a second opinion on diagnosis and treatment options. I only did this once, but really it’s worth repeating when things stall - asking your treating psychiatrist about someone they’d respect for input, so they can do the referral for that consult
- had trauma-specialist psychiatrist on my team earlier. They tend to have a better understanding of how much of our presentation is trauma-based, and how much is separate pathology (like Major Depression, Bipolar II etc) and can better tease out a dissociative disorder from disorders that present similarly (like personality disorders or Bipolar II).

Always, my medication is primarily been to stabilise me sufficiently to do the work to heal my trauma. It’s not going to achieve much more than that. Periodically, I have a depressive episode and need to respond to that with tweaks to my meds, but even then, the meds are supporting my ability to do the hard work of healing.

Studies are very consistent that medication on its own isn’t going achieve what medication and additional therapy can achieve, not just for the symptoms you’re experiencing now, but also for preventing relapse in the future. That’s been really helpful for me, because it guides both my priorities for treatment, and how I approach my medication.

Hope something in there is helpful. Trying to get medication right is a nightmare!

 

[Friday]

One cool trick with MedPros : Take your OP & make a bullet point list of concerns, observations, problems, what’s working fantastic (if anything), & questions. Move stuff around into groups (so all the stuff you don’t know how to talk about it is in one group, etc.).

Do include where you’re getting stuck in HOW to discuss, when that’s happening.
- concerned about it tanking my sex drive, but unsure of how to bring it up or discuss it
- concerned about hypomanic & mixed episodes, but conflicted about bringing it up
- etc.

OR

Print out your OP, bring it to your therapist and have THEM bulletpoint it, in super short speak medicalise… then go over it in session to make sure you’re on the same page. That’s one of the badass things about a therapist & psychiatrist TEAM. Your T does all of the talking-talking-talking, then 60-Second-Shakespeare’s it for your Doc.

 

[PamelaS]

One cool trick with MedPros : Take your OP & make a bullet point list of concerns, observations, problems, what’s working fantastic (if anything), & questions. Move stuff around into groups (so all the stuff you don’t know how to talk about it is in one group, etc.).

Do include where you’re getting stuck in HOW to discuss, when that’s happening.
- concerned about it tanking my sex drive, but unsure of how to bring it up or discuss it
- concerned about hypomanic & mixed episodes, but conflicted about bringing it up
- etc.

OR

Print out your OP, bring it to your therapist and have THEM bulletpoint it, in super short speak medicalise… then go over it in session to make sure you’re on the same page. That’s one of the badass things about a therapist & psychiatrist TEAM. Your T does all of the talking-talking-talking, then 60-Second-Shakespeare’s it for your Doc.

That’s perfect. My providers have not had a team approach. Thanks for the good info. Have a good day.