Hi all,

I’ve been seeing my psychiatrist for 4 months now and am wondering how I can approach her for more information regarding a diagnosis she may be working towards?
I’ve been on lamotrigine my entire duration of treatment and I understand the starting dose is too low to properly assess effectiveness. But outside of “unspecified mood disorder” she has refused to elaborate any further regarding my condition. I am up to 75mg now and feel pretty left in the dark and unsure if I should continue treatment with her or request a referral.

Is this standard practice? I understand diagnoses don’t have a timeline for discovery, however after this long I was hoping to at least have a bit more understanding of *why* we are moving forward with this treatment especially after I’ve expressed sx not improving with some worsening in fact.

I have a lot of issues. ADHD, depression, anxiety, complex ptsd related to childhood neglect and emotional abuse. I struggle to hang onto any kijd of self-worth. So why, when people I love and trust are nice to me, and give me a present, write me a card, or even a nice note, do I not embrace these gifts? I have probably 50 examples where some kind of affection or affirmation has been given to me, like at the end of a class where we all write and exchange our favorite memories of each other, or birthday or holiday cards, that i wait months or even years to open. I have a Christmas gift from my favorite sister-in-law that I haven't opened for two years. It is still wrapped.

Today, I got praise in texts, both feom colleagues and (my) students, and it left me feeling physically unwell, almost like vertigo. Why?

The thing my colleagues praised me for was mildly clever. The class went great, and the students were amazing. I would so love to wrap myself in their kind words and feel good, but I somehow cannot. What is wrong with me?

I have been on 150MG of Lamictal & 15MG of Buspirone for about a year. Recently, my manic episodes & intense rage/irritability, dissociation, and overall depression had gotten to the point where I could barely function and it was tough to even get through the day. I am a stay-at-home mom to a toddler and the overstimulation was drowning me. I have tried countless SSRI’s- Wellbutrin, Zoloft, and Effexor. All of them caused me severe sexual dysfunction and other issues that I couldn’t really deal with.

My psychiatric nurse practitioner started me on 50MG of Seroquel two weeks ago. My first impressions were holy sh\*t, 15 minutes after my dose and I am literally dead to the world. It has improved my sleep quality, but I cannot struggle to wake up that much. I have to be “ready to go” every day at 5:30am with my daughter. There is no time for a slow going wake-up routine. Here is the interesting part…

The first week of Seroquel I was a completely different person. Things no longer bothered me, I was completely unbothered, pleasant, and patient. I was amazed. My husband noticed a vast difference. I thought, finally. After the first week passed, I had a day where I just completely snapped. I basically had a mental breakdown. S\*icidal ideations, extreme rage… you get the picture. My husband had to come home from work because I was losing it. It was like a full factory-reset out of nowhere. My psychiatric provider told me I needed to go to a partial-hospitalization program for what I was experiencing, which isn’t an option, unfortunately. Since that day I have been extremely lethargic, irritable, and just insufferable. I could sleep all day, everyday if it were an option.

What the hell is going on? I am so tired of feeling this way. I long to be stable, normal, and happy. Especially for my family, whom I love dearly, and they need me.

Thoughts? Thank you, everyone.

Just confused about the concepts.

QUESTION: Are fake memories the same as fragmented memories?

What I mean by fragmented memories is like bits and pieces, they don't specifically confirm anything, but they can be befores and afters, or in-between, contain feeling or thoughs, just bits and pieces. Might be recall in a fragmented manner.

Is that the same as a fake memory? What do you people mean when they say fake memories? Like elaborate stories where you are remembering the elaborate stuff and not what you figured out or feel or implictly recall supported by fragmented memories.

are fragmented memories real?

i understand memories are reconstructions, but then how come some memories are considered fake and others are considered real. when wouldnt all memories just be fake then, none of them are the original, all of them are edited, and you can never know for sure can you? you cannot go back in time and be fully certain for breakfast you had cereal or a bagel. someone said something harsh to you or someone complimented you. unless you have some corroborating evidence, how do you if anythng is real.

anyways, not the question. got carried away.

TLDR; Are fake memories the same as fragmented memories? Where fragmented memories are bits and pieces of events/moments/memories that may not be recalled properly, with full detail, and might be missing parts. And fake memories would be fake? Are fake memories elaborate stories, but if someone has fragmented memories and a story is that fake memories because they have a narrative?

18M, 170cm, 56kg, Iraqi. Diagnosed with moderate-to-severe depression by an online therapist (credentials verified); I stopped contact, and I'm not on medication now. No smoking or drinking; problematic pornography use.

On Oct 12 I argued with my father. Minor in content, but he's a long-standing trigger for me and my tension got out of proportion. In the bathroom I ran hot water over my leg until it burned. Then I withdrew and sat in a corner for about 10 minutes, blank, no clear account of why. While he was talking I heard my name called from inside me and felt that this was the real me, while the one sitting there listening was a lifeless doll — as if my self had separated but stayed inside my body. Then an almost involuntary pull to hit my thigh, the spot I usually hit. I stopped just before contact and cried, for the first time in a long time — shocked and sad for myself, not relieved. Later I was empty, my mind replaying regrets, with strong suicidal thoughts.

Brief history: two suicide attempts in June; months of numbness and disconnection since; strong self-hitting urges in August and a few episodes in September; childhood physical punishment, and crying met with criticism. Earlier, hitting was often how I forced myself to do something, and it escalated each time.

What explains this sequence — freezing, self-injury to break the freeze, depersonalization, then tears instead of the hit? And what evaluation should this pattern get?

I am currently diagnosed with depression, anxiety, possible bipolar and ocd. Also suffering from severe suicidal thoughts and ideation

I am 19 years old, female, 52 kgs 165cm,

I am on 600mg of lithium, 60mg of fluoxetine, 20mg of propranolol, 100mg of modafinil. I have been on medication for nearly 3 years, diagnosed for 5.

I went through 4 sessions of ECT and ketamine IV a week ago.

I also have untreated sleep apnea with an AHI of around 51

I occasionally (once/twice a month) take these cannabis gummies. But I have not disclosed this to my psychiatrist or my Psychologist. I have never had actual weed/Marijuana (the stuff that gets you high) as it's not legal where I live. Should i tell my psychiatrist about it? I am extremely scared to disclose as I am afraid that my stuff would be confiscated and I wouldn't be able to have it anymore. The "high" lasts for a couple hours, it's the only time of the week where I'm not spiraling with suicidal ideation and misery.

Here's a brief description of the gummies:-

Active Ingredients: Each gummy contains ~8 mg of major cannabinoids in a 3:1 ratio (approx. 2 mg CBD and 6 mg THC), combined with 50 mg of L-Theanine, Ashwagandha, and Apple Cider Vinegar

Any response would be helpful, I have an appointment in a few hours and I'm extremely anxious

Hello medical professionals! I am a late-30s mom who is suffering from recurrent panic attacks after a car accident in August. Currently breastfeeding my 15 week old (former preemie of 4 weeks, so age adjusted is 11 weeks) and so prescription options are limited to meds with known safety in breastmilk since my husband is uber anxious and moderately controlling (separate issues affecting my mental health). I’ve also been diagnosed with depression since I was 17 and failed multiple SSRIs before getting on Wellbutrin which I tolerated off/on for 6+ years. Recently stopped it (~3-4 weeks ago) since my psych NP said it could be contributing to my anxiety.

I come here today to ask if Zoloft 50mg (titrating as follows: 12.5mg x4days, 25mg x7days, then 50mg x7days) will give me serotonin syndrome (or something else I don’t know about) with my 10mg BID Buspar prescription (total 20mg/day).Medication instructions seems to imply I’ll die if I combine them, but I assume my psychiatrist wouldn’t add the SSRI if that were really the case? I’ve read it’s most likely at high doses? Not really trying to add another issue to my laundry list over here. Also, is weight gain likely on this one? Trying to lose baby weight, not find it…

Also, can anyone explain this footnote from my Genesight results? “Genotype may impact drug mechanism of action and result in reduced efficacy” (for the Zoloft). I go to the genotypes page and it says “CYP2D6 Intermediate Metabolizer

*1/*5

CYP2D6*1 allele enzyme activity: Normal

CYP2D6*5 allele enzyme activity: None

This genotype is most consistent with the intermediate metabolizer phenotype. This patient may have reduced enzyme activity as compared to individuals with the normal phenotype.” Assuming this means I’ll need more Zoloft to work? I’m asking because I was sick with nausea/vomiting/diarrhea with Lexapro (same numbered footnote) and the Trintellix never seemed to work on my depression (with the footnote “Serum level may be too high, lower doses may be required“). On the gene-drug interaction page, they both have the same gene warning as Zoloft (e.g., dark circle in the CYP2D6 column), so will this ultimately be a waste of time? Should I have just gone up on Buspar?

appreciate your thoughts since I’m fighting for my return to baseline over here

I hope I’m posting in an appropriate place, today my cannabis prescriber asked me for a letter from my quetiapine prescriber to clarify why it is prescribed. I have bipolar type 2, it helps me sleep. The cannabis prescriber warned me about increased risk of stroke, diabetes and weight gain - the latter I did know about. I googled briefly about risk of stroke but thought I’d ask here, considering my psychiatrist knows I’m on both cannabis and quetiapine but never warned me - is having a stroke while taking 300mg quetiapine and smoking about 2gms cannabis daily, really that likely???

Other meds I take are 200mg Clonidine at night and 10mg dexamfetamine twice daily.

TIA for any advice or redirection to a more appropriate subreddit.

I’m a 23M and I’ve been dealing with depression and anxiety for a while now. I’ve gotten to the point where I’m seriously considering starting an antidepressant, but honestly, I feel so overwhelmed by all the different options.

I’ve been doing some reading about SSRIs, SNRIs, Wellbutrin, etc., and it seems like every medication has its own pros, cons, and side effects. I genuinely have no idea where to even start or what to ask my doctor/pcp

For some context, I’m about to spend the next four months studying for the MCAT, so being able to focus, stay motivated, and have enough energy throughout the day is really important to me. I currently take Adderall XR 15 mg as needed for ADHD, but I’ve noticed that it sometimes makes my anxiety and racing thoughts worse.

One of my biggest concerns about starting an antidepressant is the possibility of feeling tired, sleepy, emotionally numb, or unmotivated. I’m already struggling with my mental health, and I really don’t want to start something that makes it even harder to get through the day or study effectively.At the same time, I don’t want to keep feeling depressed and anxious all the time. I just want to feel like myself again.

I’m not asking anyone to prescribe or recommend a specific medication for me over Reddit. I’m just genuinely lost on how to approach this conversation with my PCP.

How do physicians usually decide which antidepressant to start someone on, especially when fatigue, concentration, and anxiety are major concerns? Are there certain things I should specifically bring up during my appointment?k

I want to know if i should explore psychiatry and or psych

Im a sophomore in college. I have to decide on a major. Currently in a major that i just feel as though i cant bring anything to because im not interested in pursuing it.

To be honest ive wanted to explore psychiatry and or psychology for some time. I just never felt like i can be the person to do it.
I feel like the people who go down pre med route are incredibly ambitious and intellectual. I feel like i used to be a bit more intellectual until i lost focus of what really matters to me, and wanting to appear a certain way and missing out on exploring things that interest me.

Ive wanted to explore psychotherapy and the medical side of psychology.

But how do you KNOW if its something you should really look into? Is there any signs you had like something about you as a person, the type of work you gravitate to, etc?

I dont want to sound ignorant or rude so im sorry if im making it seem like its more straightforward than the ambition and drive likely reuqired for it, i really dont want to look for any gatekeepers though. Everybody starts somewhere.

hi everyone!

I'll skip the part about introducing myself and my background, I'll just say that I'm a psychologist and I'm getting my education in my country. I work as a psychologist, but lately I've been feeling more and more that I'm lacking a proper understanding of psychiatry and psychopharmacology. Not to prescribe anything myself, obviously, but to better understand my clients, to speak the same language with the psychiatrists I refer them to, and to generally navigate clinical reality more confidently. I have certain knowledge in the field of psychiatry and psychopharmacology, but I want to hear recommendations from professionals and specialists from other countries. So I'd really love to hear from psychiatrists. I'll also warn you that English isn't my native language, so sorry if there are any mistakes here.^^

If we don't go into details and if we acknowledge HOW complexly everything is structured, what would you advise a psychologist who wants to dive into psychiatry and psychopharmacology for their work, in general? As if you were going back to the very beginning of your own path: what would you recommend to that version of yourself? What do you wish you had known or read earlier?

I'm also very concerned about the question of literature: textbooks, manuals, guides, anything useful. Could you recommend must-reads at a basic level, something on various aspects, some SSS+-tier books?

Thank you so much! You'll be helping me incredibly, good luck

Hi everyone,

I’m looking for people who have experience with ECT (electroconvulsive therapy), especially those who were suffering from severe anhedonia and emotional numbness.

My main symptoms are:

• Severe anhedonia — feeling little or no pleasure from activities.
• Emotional numbness and feeling disconnected from life.
• Difficulty enjoying things I used to enjoy.
• Feeling mentally empty and struggling to feel motivated.

I’m interested in hearing from people who have actually undergone ECT, particularly those whose depression involved severe anhedonia rather than mainly sadness.

My questions are:

1. Did ECT improve your anhedonia and ability to feel pleasure, or did it mainly improve sadness and other depressive symptoms?
2. Did you regain interest, motivation, emotions, and enjoyment in everyday activities?
3. How long did it take before you noticed improvements?
4. If your anhedonia was medication-induced or began after taking psychiatric medication, did ECT help?
5. Did the benefits last after completing treatment?
6. Did you experience memory problems, cognitive difficulties, or emotional blunting from ECT?
7. If ECT didn't help, what happened?

I would especially appreciate hearing from people who had severe, persistent anhedonia and eventually recovered or experienced significant improvement.

Thank you for sharing your experiences.

I have been on Lithium 600 mg once a day for a little over a year.

My levels have ranged from 0.55-0.85.

My eGFRcr just came back as 61.

It was 85mL/min/1.73m2 in March, then 67 in July but I was dehydrated.

Now 61, and I'm pretty sure I wasn't dehydrated.

- is this a concerning decrease?

- Can a decrease like this be caused by Lithium that was always in a healthy range and haven't been on it a long time?

I see my doc next Wednesday, but I sort of want the lay of the land now.

I was prescribed quetiapine (Seroquel) to help me sleep because chronic pain was keeping me awake. I took it every night for almost three years. I don’t remember every dose change, but I was on around 200–400 mg a night for much of 2024 and 2025. I tapered down gradually. Before stopping, I spent two months on 12.5 mg, then a couple of weeks on 6 mg.

Soon after stopping, I started getting intense burning and pain similar to sunburn in my genitals and along my inner thighs near the groin. It’s bad enough to make falling asleep difficult, and it’s been going on for a while now.

I’m honestly scared this might be permanent. I don’t know whether it’s related to stopping quetiapine or whether something else is going on.

Has anyone experienced anything like this after coming off it?
What did it feel like for you?
Did it improve or go away, and how long did that take?
Was there anything that actually helped?

I'm looking for advice from psychiatrists familiar with treating premature ejaculation (PE).

I've struggled with PE for a long time. My ejaculation latency is extremely short, often only a few seconds, and the problem has persisted despite trying several medications.

I've tried multiple SSRIs under psychiatric supervision, but haven't experienced meaningful improvement:

- Fluoxetine: Approximately 9 days.

- Escitalopram: Started at 10 mg, then increased to 20 mg for several weeks, without meaningful improvement.

- Paroxetine: Increased from 20 mg to 30 mg and then 40 mg daily over several weeks. I noticed only a slight improvement.

- Sertraline: Tried at different doses, including in combination with paroxetine, without meaningful improvement.

I've recently consulted another psychiatrist, who changed my treatment to paroxetine CR 25 mg nightly, sertraline 50 mg daily for 14 days followed by discontinuation as directed, and mirtazapine 15 mg nightly. Olanzapine was discontinued as instructed.

I've now been on this new regimen for more than a week, but I've noticed only a slight improvement so far.

My questions are:

1. After inadequate responses to several SSRIs, what evidence-based treatment strategies would a psychiatrist typically consider next?

2. Does the limited response to multiple SSRIs suggest that further SSRI trials are less likely to help?

3. Are there other medications worth discussing after several unsuccessful trials?

4. What factors should be assessed to understand why my PE has persisted despite treatment?

5. At what point would it be reasonable to consider the condition insufficiently responsive to medication and reassess the treatment strategy?

I'm not planning to change medications without medical supervision. I'd like to understand the available options so I can have a more informed discussion with my psychiatrist.

I'd particularly appreciate input from psychiatrists familiar with persistent PE despite multiple medication trials.

Both my Dad and Mom are incompatible. They shouldn't have gotten married in the first place. Instead they got married and is not ready for divorce. Both of them have some kind of mental issue, which is the extreme in case of ny Dad. He smashes everything at my home these days and physically abuses and cusses at my Mom everyday. If I get involved in the fight, I will also get thuds from my Dad. His rage is extreme these days. My mom is incapable of handling my Dad, I want him to get hospitalized and it will be expensive but my Mom is not listening to me. I dont know what is she waiting for. Does she think that he will get better if he go on like this ? What a funny thing ?. I dont know what to do. The only relief is that I don't stay in the same home as my parents. Has any of your parent's shown these kind of symptoms ? How have you handled it ?

I’m trying to confirm which provider types are eligible to bill for psychological testing under Medicare. My research indicates that Medicare reimburses Clinical Psychologists (CP), Nurse Practitioners (NP), and Clinical Nurse Specialists (CNS) for these services.

Are psychiatrists (MDs/DOs) also eligible to bill for psychological testing? If so, could someone provide an official reference or citation? and can they supervise an LPC and bill it incident to?

This student refuses to go to school because the academic stress made them cut off their friends, get rid of their hobbies, and study non stop at every waking hour. They see their teachers as demons, even if they didn’t do anything wrong, because they feel that school work will cause them to die. They then take a several months long break where they actually rested and now refuse to go to school because they see it as a place of hell where their life ends. They refuse to go, even if you offer to transfer them to an easier school. They can’t breathe and develop nausea when doing anything school-related, even simple emails and registration matters.

The student is in college.

If a psych eval is needed, how will it help in this context? What does a psych eval do?

26F, USA, childfree, pet free, single, straight. Live at home.

I have been applying for one year of and one month. I have only been able to get retail jobs, and internships. I graduated in May 2025.

My job coach said be more confident and that there is no magic potion. I have to work on it. Which is true. I had an interview for a sales job. It didn’t go well. These are the jobs that get back to me the fastest with the horrible job market.

My confidence has gone down since applying. Bullshit keeps happening. I’m not as nervous for retail jobs interviews.

I have been able to get a seasonal job at kohls and I start on Thursday.

I wish recruiters could have empathy. I hope one day they find themselves in the same situation or maybe there kids. Then they will let people who make mistakes during interviews have leeway.

My dog died in July of a heat stroke. I feel bad for not bringing her in. She was a chihuahua who was 13.

January I tried to unalive myself stepped out on the road. Police were called and EMS.

February forced inpatient; tricked by a counselor who told me it’s a place. Where better therapy is at. I had an emergency detention order placed on me. And couldn’t leave the facility until 3 days.

It wasn’t a good facility.

Nov 2025 SA and strangled by a guy I met on tinder. We have been talking for a couple of months. It sucks bc he’s was my first kiss and other stuff.

I ended up passing out. He stole my phone too. I underestimated how naturally strong men were. I sort of wish I died that day. But I sort of don’t.

On Monday me and a possibly homeless person got into a shouting match. She didn’t like the fact I gave her no money.

Bc I said no to giving her money but also asked why she needed it. Then she cussed me out.

I got kicked off my parent’s insurance earlier this year. But was able to get put back on.

With proof of disability. I learned this month I have low iron and low vitamin d. With a blood test.

I’m tired I wish I went into teaching disabled kids. Since I have Autism and struggle w socialization with people. I would have an easier time getting a job.

Does anyone else also get an extreme feeling of wanting to die. Before an interview. I do. I have to work on this I would rather be stabbed or shot than do an interview. It’s only this way for non retail jobs.

I know it’s due to my depression.

I’m still fucking trying even with this bullshit.

Anyone else can relate? I am in therapy.

But still. I’m grateful I have parents that let me stay with them. And. I have a car and can drive now.