Complex Mental Health Issues and Medication Concerns

Q: Complex Mental Health Issues and Medication Concerns

Dear Sir/Madam,<br>Thank you for your questions.<br>Question 1： Will my current medication regimen cause serotonin syndrome? I am taking Zoloft (Sertraline) 50 mg twice daily, Mirtazapine 50 mg twice daily, and Clonazepam 50 mg once daily. <br>I found information online suggestin

I have severe depression, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, illness anxiety disorder, and mild auditory hallucinations?

Psychiatric prescription: At bedtime: Zoloft (Sertraline) 50mg * 2 tablets, Mirtazapine 50mg * 2 tablets, Seroquel (Quetiapine) 50mg * 1 tablet, Lyrica (Pregabalin) 75mg * 2 tablets, Zolpidem 10mg * 2 tablets, Flunitrazepam 2mg * 2 tablets, Alprazolam 0.5mg * 2 tablets each evening.
ENT: Loratadine 10mg.
Metabolism: Metformin HCL 850mg.
Urology: Tamsulosin 0.2mg * 2 tablets, Baclofen 5mg once in the morning and evening, Bethanechol chloride 25mg three times a day.
Cardiology: Somil S.C.
Tab - 40mg, 60mg.
Question 1: Will taking these medications cause serotonin syndrome? Can Zoloft (Sertraline) 50mg * 2 tablets, Mirtazapine 50mg * 2 tablets, and Seroquel (Quetiapine) 50mg * 1 tablet be combined like this? I found information online stating that this combination is not advisable.
Question 2: I have severe major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, hypochondriasis, mild auditory hallucinations, palpitations, and insomnia.
Can these conditions cause widespread bone pain?
Question 3: I also experience weakness in my limbs and have difficulty remembering names of people from the past.
When I see a certain celebrity or politician on TV, I can't recall their names.
Can my severe major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, hypochondriasis, mild auditory hallucinations, palpitations, or other mental illnesses cause this memory issue?
Question 4: Despite taking these medications, I still cannot sleep.
I either have light sleep, cannot sleep at all, have vivid dreams, or experience palpitations that wake me up.
This has been ongoing for three months.
Question 5: Will taking Mirtazapine 50mg * 2 tablets cause palpitations and insomnia? I have had an ECG and echocardiogram, both of which were normal, but I still experience palpitations and insomnia.
Question 6: I have bladder weakness and poor bladder contraction.
At my next appointment, I may switch to taking Cymbalta (Duloxetine).
Will this cause urinary retention? The leaflet seems to mention this possibility.
I have six questions.
Please, doctor, help me answer each one.
Thank you.

lov157, 30~39 year old female. Ask Date: 2020/09/15

Dr. Zhang Fangrong reply Psychiatry

Dear Sir/Madam,
Thank you for your questions.
Question 1: Will my current medication regimen cause serotonin syndrome? I am taking Zoloft (Sertraline) 50 mg twice daily, Mirtazapine 50 mg twice daily, and Clonazepam 50 mg once daily.
I found information online suggesting that this combination is not advisable.
The three medications you mentioned have a low risk of causing serotonin syndrome, so there is no need for concern.
Question 2: I have severe major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, hypochondriasis, mild auditory hallucinations, palpitations, insomnia, or other mental illnesses.
Can these conditions cause widespread bone pain? Psychosomatic disorders often present with both physical and psychological symptoms, typically manifesting as dizziness, muscle aches, etc.
Widespread bone pain is less common.
It is advisable to have a face-to-face evaluation and discussion with a psychiatrist for clarity.
Question 3: I also experience weakness in my limbs and have difficulty remembering names of people from the past.
I forget the names of celebrities or politicians I see on TV.
Could my severe major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, hypochondriasis, mild auditory hallucinations, palpitations, insomnia, or other mental illnesses be causing this memory issue? Many psychosomatic disorders can be associated with memory decline, such as depression, anxiety, and insomnia.
If you experience memory issues during treatment, there is no need to panic; typically, memory will gradually improve as the condition alleviates.
Question 4: Despite taking the medications mentioned above, I still cannot sleep at all.
I either have shallow sleep, cannot sleep, have vivid dreams, or experience palpitations that wake me up.
This has been ongoing for three months.
Since you are currently on various medications, including some specifically aimed at aiding sleep, please discuss and adjust your medications with your outpatient physician to improve your sleep.
Additionally, there are many lifestyle and dietary considerations to keep in mind.
Question 5: Will Mirtazapine 50 mg twice daily cause palpitations and insomnia? I have had an ECG and echocardiogram, both of which were normal, yet I still experience palpitations and insomnia.
Mirtazapine is an antidepressant that also has some sedative effects.
A dosage of 100 mg is considered moderate and should not typically cause palpitations as a side effect.
Question 6: I have bladder weakness and poor bladder contraction.
At my next appointment, I may switch to Quetiapine.
Will this cause urinary retention? The literature seems to suggest it might.
Clinically, urinary retention is rarely reported as a side effect of Quetiapine, so you can use it with confidence.
Based on the issues and descriptions you provided, I can sense your discomfort and concerns.
Since you are consulting multiple specialties, considering your psychosomatic condition and the use of various medications, I recommend that you establish care at a single comprehensive hospital to consolidate your medical evaluations and records.
This should better support your health.
Wishing you mental and physical well-being.
Sincerely,
Dr.
Zhang Fangrong
General Psychiatry

Reply Date: 2020/09/15

More Info

Understanding complex mental health issues and medication concerns is crucial for effective treatment and management. Based on the information provided, it appears that you are dealing with a range of mental health conditions, including severe depression, generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, hypochondriasis, mild hallucinations, palpitations, and insomnia. You are also taking multiple medications, which raises several important questions regarding their interactions and side effects.

Question 1: Serotonin Syndrome Risk
Taking Zoloft (sertraline), along with other SSRIs like fluoxetine (美舒鬱) and escitalopram (思樂康), can indeed increase the risk of serotonin syndrome, a potentially life-threatening condition caused by excessive serotonin in the brain. Symptoms can include confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, and in severe cases, seizures or loss of consciousness. It is essential to consult your healthcare provider about the combination of these medications. They may need to adjust dosages or switch to alternative treatments to mitigate this risk.

Question 2: Pain and Mental Health Conditions
Your question about whether severe mental health conditions can cause widespread bone pain is valid. While mental health disorders primarily affect emotional and cognitive functioning, they can also manifest physically. Chronic stress and anxiety can lead to muscle tension, which may be perceived as pain in various parts of the body, including bones. Additionally, depression can lead to fatigue and a lack of motivation to engage in physical activity, which can exacerbate feelings of discomfort. It is important to discuss these symptoms with your doctor, as they may need to evaluate other potential causes of your pain.

Question 3: Memory Issues
The cognitive symptoms you describe, such as difficulty recalling names or recognizing familiar faces, can be associated with severe anxiety and depression. These conditions can impair concentration and memory, leading to what is often referred to as "brain fog." It's crucial to address these cognitive concerns with your healthcare provider, as they may be related to your mental health conditions or the medications you are taking.

Question 4: Sleep Disturbances
Persistent sleep issues, such as difficulty falling asleep, staying asleep, or experiencing vivid dreams, are common in individuals with anxiety and depression. The medications you are taking, particularly those affecting serotonin levels, can also contribute to sleep disturbances. If you have been experiencing these issues for three months, it is essential to discuss them with your doctor. They may consider adjusting your medication regimen or recommending behavioral therapies to improve your sleep quality.

Question 5: Side Effects of Medications
Regarding whether 美舒鬱 (fluoxetine) can cause palpitations and insomnia, it is known that SSRIs can have various side effects, including sleep disturbances and increased anxiety in some individuals. If you are experiencing these symptoms, it is important to communicate this to your healthcare provider, who may consider switching medications or adjusting dosages.

Question 6: Urinary Retention Concerns
If you have been diagnosed with bladder weakness and are considering switching to another medication, such as 千憂解 (duloxetine), it is important to be aware that some medications can indeed cause urinary retention. Duloxetine, an SNRI, can affect bladder function in some individuals. Discussing your urinary symptoms with your doctor is essential to ensure that any new medication will not exacerbate this issue.

Conclusion
Managing complex mental health issues requires a comprehensive approach that includes medication management, therapy, and lifestyle changes. It is crucial to maintain open communication with your healthcare provider about any side effects or concerns you may have regarding your treatment. They can help tailor a plan that addresses your specific needs and improves your overall well-being. Additionally, consider seeking support from mental health professionals, support groups, or counseling services to help you navigate these challenges. Remember, you are not alone in this journey, and there are resources available to assist you.

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