I'm feeling stuck with regards to my current specialist, and trying to find a new specialist or help convey better patterns to my doctor. He's more resourceful than most, but I am complicated. I have a combination of attention, anxiety and mood issues. Not sure what that means for treatment. If these symptoms all just a manifestation of attention issues, or if I have several different more independent conditions that would be treated more like those associated disorders. For example, the emotion dysregulation with ADHD gets treated with stimulants or sometimes intuniv. But bipolar type issues are better treated with mood stabilizers.
I have significant attention problems. I excessively need structure. Without structure, I fall apart and it takes me the entire day to do the dishes. So I have so much variability depending on how much I have to deal with during the week. Since I focus on one thing at a time, it's hard to keep perspective. Additionally, this also crops up as a poor processing of information and poor emotional memory. I seem to just focus on snippets and not be able to efficiently and consistently keep a view of the entire situation and its details.
The mood swings are frustrating because I can't anticipate that I will flip from neutral or naively relieved that I don't have work and actually hopeful that I am on track, to devastation and dysphoria when I make mistakes. They're partly intertwined with the frustration when I can't monitor how off I am. But are exaggerated. Moment by moment I can't anticipate if I will focus. If I can't I interpolate that I'll be doomed to dysfunctionality. And have suicidal thoughts. But if I'm not judged or have time off, I just don't confront this as much and so I can live between very different extremes.
I've done lifestyle/therapy (CBT/DBT/ACBT/MCBT) and continue to do so. But it's hard to fully leverage the benefit. I end up stuck in the same poor follow through and frustration despite effort.
I was on a combo of stratterapristiq/memantine/aetonolol (for the heart rate increased by strattera). At my psychitrist's suggestion, I switched to imipramine. I also worked in supplements after a few weeks, because the imipramine experience was more stressful than I was told. My psychiatrist's doesn't really buy into supplements, and not all of them have known drug interactions. Whenever I would dose with Carpylic Acid, which helps my attention, my mood seemed much worse. But it could also just have been the events of that day, since when things reach a certain low threshold of stress, my mood swings.
I'm not sure what else to try. My psychiatrist will not use MAOis. He is suggesting Lamitcal or a transition to low dose (2.5-10 mg) of Ability as a bridge to Lamitcal, since that's a long upwards taper. I have PCOS and a 5ht2c mutation, and am worried about the side effecs of Abilify. Also, technically, I shouldn't be on both imipramine and abilify together for a long period since both elongate QTC.
I know I can't get better focus until I deal with my mood issues. I'm not sure what approach to take. I don't know if there's any value in trying out TMS or neuforeedback to reduce my need for an excessive number of medications. At the moment, COVId19 and my job are pretty stressful and I need to be able to deal with those.
I have a really bad emotional memory. Not sure if this is just an attention issue/the result of growing up in a family that struggles with attention issues.
