Dr. Jose Apud, MD, PHD

Hi youngster: I can see that you are in a difficult situation but, with time and a correct treatment it can be improved. You are at an age in which some young people develop this problem. To address the issue, there are two issues that need to be addressed. I usually do not give advice without evaluating the patient but you have described very well your conflict and I can provide some basic advise.
1) I see that you have been diagnosed with anxiety and OCD. It is likely that these conditions are increasing the feelings you have and if treated properly, you would have some relief. The dose of Zoloft you are taking may treat the anxiety but is not treating the OCD part. In general the treatment of OCD is done with higher doses of the SSRI. Also, Prozac or clomipramine are first line treatments for OCD, so adjusting the dose of medication and/or changing the medication for a first line medication for OCD and reaching the right dose may help significantly.
2) The second point and as important as point # 1 is doing intensive psychotherapy with a therapist that understands gender issues and can help you along the way together with the medication. Choosing the right therapist is paramount in cases like yours. I am positive that if you do the right treatments, you will get the relief you deserve. My recommendation is that you do these treatments before you decide about any surgery. Many times, without the treatment you may still face the same problem even after any surgery. I hope tis is helpful for you. Best

Thank you very much for your consultation with FindaTopDoc. Our role is to help people with difficulties and we hope to be useful for everyone. Even though as a standard rule we do not diagnose or treat people without seeing them personally or through virtual means (Zoom, etc), the description of your condition is so detailed and thorough to the point that.
I can provide some help at this time.
- Based on your account, you seem to be suffering from a condition called Obsessive-Compulsive Disorder (OCD). OCD is a condition that features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). Its manifestations often lead to severe impairment and to conflict in the family and others.
- OCD affects 2.5 million adults or *1.2%* of the U.S. general population but in young people can get up to 3%.
- Experts aren't sure of the exact cause of OCD. *Genetics, brain abnormalities, and the environment* are thought to play a role.
- Researchers know that OCD is triggered by communication *problems between the brain's deeper structures and the front part of th brain.* These parts of the brain primarily use serotonin to communicate. Therefore increasing the levels of serotonin in the brain can help to alleviate OCD symptoms.
- *Symptoms related to Obsessions can be the following:*
- Fear of contamination or dirt
- Doubting and having difficulty tolerating uncertainty
- Needing things orderly and symmetrical
- Aggressive or horrific thoughts about losing control and harming
yourself or others
- Unwanted thoughts, including aggression, or sexual or religious
subjects
- *Symptoms related to Compulsions can be the following:*
- Washing and cleaning
- Checking
- Counting
- Orderliness
- Following a strict routine
- Demanding reassurance
-
- *Treatments*
- 1) *Medications: *Antidepressants that work on serotonin, the
so-called selective serotonin reuptake inhibitors (SSRIs) and clomipramine,
are the pharmacologic first-line treatment of OCD. You usually start the
treatment with medium to large doses of SSRIs for initial acute treatment
for at least 3 months to assess efficacy. Afterwards, your physician or
psychiatrist will determine the right dose to take it long term. At times
and in some cases, you may need to augment the effect of SSRIs with other
medications.
- 2) *Psychotherapy: *
- a) Exposure Therapy.
b) Imaginal Exposure. ...
c) Habit Reversal Training. ...
d) Cognitive-behavioral Therapy.
- 3) *New treatments*: Transcranial magnetic stimulation (TMS) is a
non-invasive brain stimulation technique that has shown promise as an
adjunct treatment for the symptoms of Obsessive-Compulsive Disorder (OCD)
- The success of the treatment depends on your compliance with both
medications and psychotherapy and a good therapeutic rapport with your
psychiatrist and therapist.
- Hope this is helpful for you and, if you need additional information,
do not hesitate to contact me again.

Best, Jose Apud MD, PhD

Hi: Using citalopram or sertraline together with risperidone can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. An option is to use Fluoxetine (Prozac) with risperidone. However, Prozac may
increase the blood levels and effects of risperidone. You may need a dose adjustment of risperidone or more frequent monitoring by your doctor to safely use both medications. Hope this is helpful.

The existing literature shows a strong consensus: accurate identification
of depression that starts early in life and recurrent course with multiple
episodes, subthreshold hypomanic and/or mixed (irritability) symptoms, and
family history of bipolar disorder signs towards the possible conversion
from depression to bipolar disorder. The cumulative incidence of
conversion from depression to bipolar disorder was found to be 8.4% in one
study.
Hope this is helpful. Best, JA

Olimelt produces constipation and sleepiness. It does not produce insomnia.

Nearly all antidepressants have the potential side effect of causing weight gain but also depends on the person's sensitivity to gain weight. There are a few things you can do to avoid gaining weight such as:
How can I avoid gaining weight on citalopram:
1. Cut back on sweets and sugary drinks.
2. Replace high-calorie foods with tasty fruits and vegetables.
3. Give yourself smaller portions and eat more frequently throughout the day.
4. Eat slowly.
5. Take the stairs instead of the elevator.
6. Get outside and take a walk.

The best way to understand this issue is to have an evaluation with a psychiatrist that understand hormonal issues and determine the characteristics of the depression during your menstrual cycle, is it only pure depression? Is it depression with dysphoria? Is it depression with mood swings? Is there a minor sub-clinical depression during the first part of the cycle? Etc.

Are you asking whether Bipolar Disorder can persist in older seniors, or whether they can have the first episode at that old age? When Bipolar disorder starts at old age, you have to investigate thoroughly whether this is related to a medical condition first. It can persist in older seniors that carry the diagnosis since they were younger.

Alcohol intoxication has different stages and they are the following:

Stage 1: Sobriety, or Subclinical Intoxication.
Stage 2: Euphoria.
Stage 3: Excitement.
Stage 4: Confusion.
Stage 5: Stupor.
Stage 6: Coma.
Stage 7: Death.

Depending on the stage, the person may have different behaviors. Alcohol does not change your personality but changes your behavior. Sometimes it exacerbates or blunts some aspects of the personality. Stages 1, 2 and 3 may be the most common stages you see in people that drinks socially and, in stages 2-3 the person may get desinhibited and can do things he usually does not do. Stages 4 to 7 are the more severe ones and, in some cases, are life threatening.

Yes, alcohol can affect your emotions.

There are a number of good medicines for anxiety and panic attacks, mainly the so-called SSRIs (selective serotonin re-uptake inhibitors). However, medication should be combined with a type of therapy called Cognitive Behavioral Therapy (CBT).

If you consider that antidepressants could be considered mood stabilizers, then the best ones for anxiety are the SSRIs (Selective serotonin re-uptake inhibitors).
The other mood stabilizers such as Depakote, Lithium, Trileptal, etc. are not indicated for anxiety unless there is an anxiety with a comorbid mood instability.

Absolutely, those are one of the first things the physician has to investigate when there is a sleep problem.

Being manipulative is more part of a personality disorder than from a bipolar disorder.

Benzodiazepines ( Valium, Ativan, Xanax, etxc.) are well known to be addictive medications and for that reason, should not be taken for a long time. There are other non-addictive medications such as SSRIs and Buspar that can be effective to treat anxiety.

It's basically a special type of couple's therapy to work out differences and understand how is the best way to proceed with the divorce process. Most time is also very helpful to understand the source of conflict.

The best group of medicines are the SSRIs (Selective serotonin reuptake inhibitors) but should be paired with a therapy called Cognitive Behavioral Therapy (CBT). Using benzodiazepines (Valium, Ativan Xanax, etc) at the beginning help stabilize faster but they should not be used for a long time.

The best course of action is to have a medical/psychiatric evaluation to understand the source of your nervousness.

The best course of action is to consult with your psychiatrist and evaluate the present situation. If you were doing well right before your divorce and the symptoms appeared right at the time that the time that your divorce process started or after the divorce, you could ascribe the problem to divorce stress but a formal evaluation from your psychiatrist is the best way to proceed.

A breakup is always extremely difficult and some persons who may have risk factors such as anxiety, depression or any other preexisting psychological condition may be more susceptible than persons with no preexisting conditions to have a nervous breakdown.