OpenHealth Q&A

Navigating Concerns with My New Psychiatrist: Anxiety or Serotonin Syndrome?

I apologize in advance if what I’m about to share sounds naive; I truly don't want to develop any biases or mistrust toward younger healthcare professionals. For context, I’m a 26-year-old nonbinary individual, standing 5’6” and weighing 255 pounds. The decision to switch psychiatrists was primarily influenced by my new insurance plan, which allowed me to find a clinic much closer to home, especially since my previous psychiatrist was an hour away and someone I genuinely appreciated working with. I had also decided to discontinue using generic Vyvanse for my ADHD due to supply shortages that were adding to my anxiety. My new psychiatrist advised me to stop using THC gummies, claiming they were exacerbating my condition, despite those gummies providing significant relief for my anxiety, albeit at the cost of my motivation. Wanting to give this new clinic a fair trial—particularly given the expense—I resolved to give up the gummies for as long as I could manage. In my previous practice, I was prescribed 150mg of Venlafaxine along with 10mg of Buspirone taken twice daily to tackle severe anxiety and depression, in addition to my ADHD. I mentioned to my old psychiatrist that during particularly stressful periods, I occasionally needed an extra dose of Buspirone to help manage panic attacks stemming from environmental pressures and family drama, which intensified my existing struggles. She agreed to adjust my dosage, ultimately prescribing 60mg daily—three doses of 20mg each. For a week, I adhered to this schedule while also starting on Qelbree for my ADHD at a dose of 100 mg, with plans to increase the Venlafaxine to 225 mg. Fast forward to my follow-up appointment two weeks later: my grandfather had passed away, and I was under considerable stress, which made it difficult for me to begin the new Venlafaxine dosage. Instead, I relied on the old prescription I had at home. After about ten days, I began experiencing troubling symptoms: heart palpitations, chest pain, heightened anxiety, and noticeable shakiness. Initially, I attributed these issues to the Buspirone, as those side effects are somewhat common and usually dissipate over time. I was desperate for a solution, as the Buspirone had previously been quite effective in alleviating my anxiety. However, my symptoms escalated considerably, culminating in a significant panic attack the night before my follow-up appointment. I felt disoriented, sweating, and in distress, which prompted me to search my symptoms online. Ordinarily, I avoid self-diagnosing or consulting Dr. Google due to my anxiety, which often drives me to the worst-case scenarios. I had hoped to trust my psychiatrist, as I felt we connected well, and it took me time to reach this point of concern. That evening, the symptoms I described seemed to correlate with mild serotonin syndrome. However, I reasoned with myself that my symptoms weren't severe enough to necessitate a hospital visit, especially since I wasn't experiencing vomiting or hallucinations, which allowed me to calm down. The next day, when I brought up my concerns about serotonin syndrome with my psychiatrist, she seemed offended, insisting that I was mistaken to suggest she lacked knowledge on the matter. She argued that the doses I was prescribed were far from sufficient to trigger such a rare condition, claiming she’d never had a patient present with serotonin syndrome before. At this juncture, I sensed something was amiss—her responses echoed posts I had read in similar discussions about Buspirone, Venlafaxine, and serotonin syndrome. Additionally, I noticed her furiously typing and primarily fixated on her screen during our session, which led me to wonder if she might be utilizing AI or ChatGPT for assistance while we spoke. Though I didn’t vocalize this skepticism, I expressed unease about her relative inexperience, feeling that a seasoned psychiatrist should have recognized the potential for adverse interactions prior to escalating my medications. After conducting my own research, it appeared increasingly clear that the initial treatment plan might have been flawed. Now, my anxiety has reached new heights, leaving me to question my current treatment situation. I fear I may have been assigned to a psychiatrist who is relying on AI to navigate her responsibilities—an unfair assumption given the lack of evidence. Upon reflecting on my instincts, I believe that it might be best for me to discontinue my visits to this practice. I’m looking for advice: Am I misinterpreting things? Is that combination of medications actually safe, and is my anxiety masquerading as an obstacle to what could have developed into a more fruitful therapeutic relationship? Or did I make an appropriate call in response to these warning signs? I appreciate your understanding if I’ve misunderstood the intricacies of psychiatric care in this situation.

Answers (1)

4/23/2025, 8:01:05 AM

OpenHealth AI

It's understandable to feel anxious and uncertain in the face of your current treatment situation, especially given your recent experiences and loss. Your concerns about medications, potential side effects, and the rapport with your psychiatrist are valid and deserve careful consideration.

Main Concerns:

1. Medication Side Effects: Your symptoms of heart palpitations, chest pain, anxiety, and shakiness may indeed be related to your medications, particularly given their interactions.
2. Therapeutic Relationship: Your feelings towards your psychiatrist and the effectiveness of your communication are crucial for successful treatment.

Explanation:

• Medication Safety: Combining Venlafaxine and Buspirone generally has a low risk of causing serotonin syndrome when used at standard dosages, but individual responses can vary widely. Some people may experience heightened anxiety or physiological symptoms when increasing antidepressant dosages.
• Communication & Trust: It's essential to establish a trusting relationship with your psychiatrist. If you feel your concerns aren't being taken seriously or are dismissed, it might impact the effectiveness of your treatment.

Next Steps:

1. Document Symptoms: Keep a detailed record of your symptoms, including when they occur, their intensity, and any recent changes in medication. This documentation can help you clarify your experience in future discussions with healthcare professionals.

2. Evaluate Current Treatment: Consider whether the benefits of the current treatment outweigh the side effects you're experiencing. If the anxiety and physical symptoms persist or escalate, it may be a sign to reassess your regimen.

3. Seek a Second Opinion: If your instincts tell you that this psychiatrist isn't the right fit, it is perfectly appropriate to seek a second opinion. Consult another mental health professional who can review your medications and symptoms comprehensively.

4. Revisit THC Usage: If you find that THC gummies previously helped with your anxiety and did not cause significant issues, weigh the potential benefits against current medication guidelines when discussing with a new psychiatrist.

5. Engage in Self-Care: Implement stress-reducing techniques such as mindfulness, gentle exercise, and connecting with supportive friends or communities that understand your situation.

Conclusion:

Trust your instincts regarding your treatment and the therapeutic relationship. It's important to advocate for your mental health needs, especially when you're feeling distressed. If this psychiatrist does not align with what you need, seeking a more compatible and communicative provider is a proactive and responsible approach to your care. Remember, finding the right mental health support can take time, and it’s crucial that you feel safe and heard in those spaces.