1. I don’t usually criticize other physicians on this sub, especially psychiatrists when it comes to the topic of drug withdraw regimens.

  2. The inpatient psychiatric unit at my county hospital frequently uses just Gabapentin and Clonidine/Hydroxyzine for alcohol withdrawal treatment. They’ve been doing that for years. The unit has a policy of having a very high threshold for using any benzos so benzos were taken off the alcohol detox treatment protocol some time ago. It’s currently only used for acute mania with severe insomnia and for patients who cannot safely tolerate Gabapentin.

  3. Inpatient. Like. Under medical supervision, you mean?

  4. Yes. But when the unit gets full (which happens quite often) they send the lower risk patients home with Gabapentin and Clonidine/Hydroxyzine and self-monitoring instructions. Not saying I agree with this protocol, but it does work and is accepted community standard of care in some places.

  5. Can? Yes. Should? Depends on the individual case.

  6. I specialize in Reproductive Psychiatry. If it actually is PMDD (probably diagnosed), then intermittent dosing of an SSRI is a well-researched treatment. Starting a low dose of SSRI (any of them works but Prozac is the best studied) 7-10 days before the start of your period then stopping once your period starts can be very effective.

  7. We currently have no safety data for Mounjaro for breastfeeding, so best not to expose baby to it at this time. Breastfeeding itself is an efficient way to lose maternal weight. Breastmilk is very high in fat and that fat comes straight from mom’s body. As long as mom is maintaining a diet of healthy foods and getting some regular exercise in, there should be noticeable weight loss when breastfeeding.

  8. It’s impossible to tell this early on at this low of a Zoloft dose. Mood swings within the first few weeks of starting an SSRI like Zoloft are normal. You would likely benefit from a higher dose and giving the med more time to settle into your system.

  9. I think you should tell your doctor your recent symptoms and trust your doctor to make the right call on your meds.

  10. I specialize in Reproductive Psychiatry. Unfortunately, THC crosses easily through the placenta to the baby from mom’s bloodstream, and actually tends to concentrate in fetal tissues because THC likes to collect in fatty tissues. Studies on rhesus monkeys show that the fetus isn’t as good at metabolizing out the THC (likely due to an immature liver) so it tends to stay in the baby longer.

  11. You need to go see a doctor and be honest about what you’ve been doing.

  12. It wouldn’t be unreasonable for you to request a small number of Xanax pills, like 10 or 15, to hold onto for emergencies, and use them over the next 6-12 months. But if you start asking for them regularly the doctor will likely cut you off.

  13. You sound exactly like that doctor. Going around in circles while refusing to answer questions directly. You not saying this behavior is bizarre and probably inappropriate speaks volumes.

  14. I’m not one to make judgments on a situation after only having heard one side of the story. Your doctor could have a very different take on the situation. Regardless, it doesn’t matter what any of us think. Doesn’t affect your situation in any way.

  15. Oh, yes, I knew that one of was coming. I’m lying on an anonymous Reddit forum 😂 if it didn’t matter you wouldn’t have responded. I’m not as dumb as you think I am

  16. Apparently it was very poor judgment on my part to respond to your post. I won’t be making that mistake again.

  17. I’m a Reproductive Psychiatrist. Estrogen levels are very high and androgens are low during pregnancy and immediately postpartum, but then estrogen plummets and androgen levels increase again, and this combination of hormone shifts causes the physical systems you experienced. There is nothing that can be done to prevent this and it’s not healthy to try to prevent your body hormones transitioning back to pre-pregnancy levels.

  18. If you’ve moved to another state and your doctor isn’t licensed in your new state, it may be illegal for your doctor to see you. You need to check with your doctor ahead of time to see if your doctor is okay with that.

  19. The doctor said he won't prescribe it because im on an antipsychotic for psychosis and mania, and it'll make manic.

  20. Yes, missing one dose can trigger withdrawal symptoms. And no, do not take a double-dose.

  21. If you’re in the U.S. and need to use insurance, start by asking your insurance for a list of in-network mental health professionals and start calling. If you’re not restricted by an insurance network, you can look on PsychologyToday.com

  22. The half life of a drug is the same, no matter how it is formulated. SR, IR, XL differ in rates of absorption — not in their half-lives of elimination.

  23. True. Thanks. I really should stop getting on Reddit at 2am. Sigh…

  24. Ask your doctor to switch you to a formulation of Wellbutrin with a shorter half-life, like the SR or IR version, so it doesn’t last as long and won’t disrupt your sleep.

  25. I hope your grandmother is under the care of someone specializing in geriatric medicine. If not, it would be a good idea to find her one.

  26. It’s very risky having someone with Bipolar disorder on a stimulant without a mood stabilizer med at a therapeutic dose on board and established. Your psychiatrist is following standard of care. Once you’re stabilized on a therapeutic dose of mood stabilizer you can request to restart the stimulant.

  27. The generic should contain the same amount of active ingredient, but brand name pills usually have higher quality filler ingredients and the med itself has better bio-absorbability. This can sometimes be worked around by taking a higher dose, but if you’re having a reaction to the other ingredients then that’s unlikely to get any better. Depending on how the system works in your area, you may be able to ask your doctor whether it would be possible to switch to the brand name pills due to your side effects to the generic pills.

  28. No one can diagnose you over the internet. A full psychiatric evaluation is needed to determine a diagnosis.

  29. If you’re lucky, you destabilize and end up manic and psychotic and have to be hospitalized. If you’re unlucky, you destabilize and end up manic and psychotic and get yourself or someone else killed.

  30. At this point restarting the Cymbalta won’t help much. The withdrawal isn’t dangerous, just very uncomfortable. You can take Valium if you feel you really need it, but be careful as benzo withdrawal is even worse than Cymbalta withdrawal, and even more so both together at the same time. It should get better over the next couple of weeks.

  31. https://www.dea.gov/press-releases/2023/02/24/dea-announces-proposed-rules-permanent-telemedicine-flexibilities

  32. We’ll see what the DEA lands on after the public comments.

  33. Stepping down 5mg from 30mg is a very small decrease.

  34. What kinds of foods trigger hypomania? I can only think of caffeine because it's a stimulant. Maybe sugar too?

  35. Anything ingested with psychoactive properties can induce hypomania, including things like cannabis edibles and alcohol.

  36. That’s $400 per hour, which is very reasonable for an OON psychiatrist appointment, depending on location.

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