Severe Mental Health Disorders and Medication Concerns

Q: Severe Mental Health Disorders and Medication Concerns

Hello： Here are the answers to your six questions：<br>Question 1： Will this diet cause serotonin syndrome? <br>Answer： This dosage is still within a reasonable range and is unlikely to cause serotonin syndrome.<br>Question 2： The physician diagnosed me with severe major depressi

Severe Major Depressive Disorder, Severe Generalized Anxiety Disorder, Severe Obsessive-Compulsive Disorder, Severe Panic Disorder, Severe Hypochondriasis, Delusional Disorder, Post-Traumatic Stress Disorder, Mild Auditory Hallucinations, Palpitations, Insomnia, and possibly other psychiatric symptoms?

Psychiatric prescription: At bedtime: Zoloft (sertraline) 50mg * 2 tablets, Mirtazapine 50mg * 2 tablets, Clonazepam 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.

Physician's diagnosis: Major depressive disorder, severe anxiety disorder, severe obsessive-compulsive disorder, severe panic disorder, severe hypochondriasis, delusional disorder, post-traumatic stress disorder, mild hallucinations, palpitations, insomnia, and possibly other psychiatric symptoms.
Question 1: Will taking these medications cause serotonin syndrome? Can Zoloft 50mg * 2 tablets, Mirtazapine 50mg * 2 tablets, and Clonazepam 50mg * 1 tablet be combined? I found information online suggesting that this combination is not safe.
Question 2: The physician diagnosed me with major depressive disorder, severe anxiety disorder, severe obsessive-compulsive disorder, severe panic disorder, severe hypochondriasis, mild hallucinations, palpitations, insomnia, or other psychiatric disorders.
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.
Could my severe depression, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, hypochondriasis, mild hallucinations, palpitations, insomnia, or other psychiatric disorders be causing this memory issue?
Question 4: Despite taking all these medications, I still cannot sleep at all.
I either have light sleep, cannot sleep at all, have vivid dreams, or experience palpitations that wake me up.
This has been going on for three months with no sleep.
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.
Next time I visit the doctor, I might switch to taking Duloxetine.
Will this cause urinary retention? The leaflet seems to mention this possibility.
I have six questions.
Please, doctor, help me answer each one.
I am really struggling and feel like I'm going crazy.
Thank you.

lov157, 30~39 year old female. Ask Date: 2020/09/16

Dr. Liang Sunyuan reply Psychiatry

Hello: Here are the answers to your six questions:
Question 1: Will this diet cause serotonin syndrome?
Answer: This dosage is still within a reasonable range and is unlikely to cause serotonin syndrome.
Question 2: The physician diagnosed me with severe major depressive disorder, severe generalized anxiety disorder, severe obsessive-compulsive disorder, severe panic disorder, severe hypochondriasis, hallucinations, palpitations, insomnia, or certain mental illnesses.
Can these conditions cause widespread bone pain?
Answer: Some mental disorders can cause somatic sensations, which may lead to internal pain.
Appropriate treatment can improve this condition.
Question 3: I also have weakness in my limbs and cannot remember names of people from the past.
When I see a celebrity or politician on TV, I cannot recall their names.
I have severe major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, hypochondriasis, hallucinations, palpitations, insomnia, or certain mental illnesses.
Could these conditions be causing my memory issues?
Answer: Depression, anxiety, and mental disorders can indeed lead to memory impairment.
Question 4: I have taken the medications mentioned above but still cannot sleep at all.
It’s either light sleep, I can’t fall asleep, or I have vivid dreams, or I wake up due to palpitations.
I have been unable to sleep for three months.

Answer: It is recommended to discuss this with your physician during your next visit.
Question 5: Will taking 50 mg of Mirtazapine (Mei Shu Yu) twice cause palpitations and insomnia? I have had an ECG and echocardiogram, both of which were normal, but I still experience palpitations and insomnia.

Answer: Taking two tablets of Mirtazapine is unlikely to cause palpitations and insomnia; it may be due to underlying anxiety or panic symptoms.
Question 6: I have bladder weakness and poor bladder contraction.
During my next visit, I might switch to taking Duloxetine (Qian You Jie).
Will this cause urinary retention? The leaflet seems to mention this possibility.

Answer: The likelihood is low, but it is advisable to discuss this with your physician during your next appointment.
Wishing you a speedy recovery.

Reply Date: 2020/09/16

More Info

Understanding severe mental health disorders and the complexities of medication management is crucial for individuals navigating these challenges. The case presented involves a patient diagnosed with severe depression, anxiety, obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder (PTSD), among other symptoms. The patient is on a complex medication regimen that includes multiple psychotropic medications, which raises several concerns regarding potential side effects, interactions, and overall management of their mental health.

1. Serotonin Syndrome Risk
The first concern is whether the current medication regimen could lead to serotonin syndrome, a potentially life-threatening condition caused by excessive serotonergic activity in the nervous system. The patient is taking Zoloft (sertraline), a selective serotonin reuptake inhibitor (SSRI), along with other medications that may also affect serotonin levels. While the combination of Zoloft with other SSRIs or serotonergic agents (like certain antidepressants) can increase the risk of serotonin syndrome, the specific combination mentioned (Zoloft, Mirtazapine, and Fluoxetine) should be carefully monitored by a healthcare provider. It is essential to communicate any symptoms such as confusion, rapid heart rate, or unusual muscle rigidity to a doctor immediately.

2. Physical Symptoms and Mental Health
The second question addresses whether the diagnosed mental health conditions can cause physical symptoms such as widespread bone pain. It is well-documented that severe anxiety and depression can manifest as physical symptoms, including pain and fatigue. This phenomenon is often referred to as somatic symptom disorder, where psychological distress is expressed as physical pain. The patient should discuss these symptoms with their healthcare provider to explore potential underlying causes and appropriate treatments.

3. Cognitive Impairment
The third concern involves cognitive symptoms, such as difficulty recalling names or recognizing familiar faces. Cognitive impairment can be a symptom of severe depression and anxiety, as well as a side effect of certain medications. It is crucial for the patient to discuss these cognitive changes with their doctor, as they may need adjustments to their treatment plan or further evaluation to rule out other causes.

4. Sleep Disturbances
The fourth question pertains to persistent sleep issues despite the use of multiple medications intended to aid sleep. Insomnia is a common symptom of anxiety and depression, and while medications like Zolpidem and Flunitrazepam are prescribed for sleep, they may not always be effective for every individual. The patient should consider discussing their sleep patterns with their doctor, who may recommend a sleep study or alternative therapies, such as cognitive-behavioral therapy for insomnia (CBT-I).

5. Side Effects of Mirtazapine
The fifth question inquires about the potential side effects of Mirtazapine, specifically regarding heart palpitations and insomnia. Mirtazapine can cause sedation, but it can also lead to increased anxiety in some individuals, which may exacerbate insomnia or cause palpitations. The patient should monitor these symptoms and communicate them to their healthcare provider for possible medication adjustments.

6. Urinary Retention Concerns
Lastly, the patient expresses concerns about urinary retention with the potential addition of a new medication. It is essential to understand that certain medications, particularly those with anticholinergic properties, can lead to urinary retention. The patient should discuss their urinary symptoms with their doctor, who can provide guidance on managing these side effects and consider alternative treatments if necessary.

Conclusion
Navigating severe mental health disorders and their treatment can be overwhelming, especially with the complexities of medication management. It is vital for patients to maintain open communication with their healthcare providers, report any side effects or new symptoms, and actively participate in their treatment plans. Regular follow-ups and adjustments to medication regimens can significantly improve outcomes and quality of life. Seeking support from mental health professionals, support groups, or therapy can also provide additional coping strategies and emotional support.

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