Years of nightmares was ended with a short term of Prazosin. Previous HCP just increased the SSRI’s. Thanks for explaining why for this worked. And some physicians wonder why we now use Dr Google or Dr UA-cam.
Wow simply wow, you should be teaching the doctors (psychiatrists) and academics. You have real talent for explaining and teaching. Some of them have no clue, other than pushing ssri and antipsychotics .
@@PsychiatrySimplified Yeah I've been trying to explain the things you've mentioned in the video for many years and I just couldn't get them to listen. I'm out of the public system now though and doing much better. And when I get stuck I simply deep dive into the specific issue I'm dealing with and use vids like yours to guide a customised solution for myself
I really appreciate this video. None of my psychiatrists have ever explained the difference between anxiety and hyperarousal. I have both, but the hyperarousal is clearly what caused and maintains my insomnia and nightmares. I have been on an SSRI for the majority of the last 27 years, and I still struggle with anxiety, depression and insomnia. Trying to come off SSRI and it's not been easy to tolerate the withdrawal effects this time, even thought I'm also on 200 mg/day lamotrigine. I have been on SSRI's so long, there is no way to know how they have affected my brain and to what extent. I wish I never started.
@@PsychiatrySimplified Wow, thank you for your quick reply! I just found your channel and I'm finding it so helpful. It's a shame that psychiatrists have little knowledge of or time to discuss these details with their patients. It's so incredibly important when you are dealing with complex neurobiological mechanisms and mental health. I feel like my whole life revolves around trying to educate myself to fix myself. Nevertheless, I am grateful that there are credible resources to take advantage of. I will continue to watch and learn. Thank you!!
Hi Dr. Rege--fantastic presentation. Would it be fair to say that people with severe, chronic anxieties can have these symptom clusters--anxiety, hyperarousal, and agitation--or does hyperarousal and agitation suggest depression, mixed depression, bipolar, and/or possibly ADHD? In other words, do these symptoms suggest specific illnesses, or are they best treated without labeling someone as having disorder A vs B vs C? Finally, how do you treat the agitation part? In my case, I've been on SSRIs for many years for anxiety, OCD, and depression. I was recently diagnosed with ADHD. I agree with you that SSRIs can indeed cause jitteriness and agitation. I feel like my days on SSRIs may be numbered, as they have caused more harm than good. It's hard determining the next steps in these complex cases. I'm grateful to have a good doctor that's sensitive to these complexities. Anyway, thanking you again.
Is it possible for agitation to calm down after psychotherapy and meditation? I usually get very anxious over some worries which leads into severe physical symptoms like butterfly in stomach that doesn't go away, loosing focus, feeling restless, feeling tense , more overthinking and worry, severe depression. SSRIs have worked in the past but work partially now meaning if I stopped it gets out of hand plus they really help the depression. Sometimes I can break the cycle but not always. I really rely on my job and keeping busy to avoid these uncomfortable feelings. I just don't really know where this fits on the three instruments you mentioned to follow up with my GP as there is a long wait to see a psychiatrist now where I am
Anxiety is controllable and addressed well by psychotherapy ( including medication) and or SSRI. Hyperarousal is the step in between where there is some control but needs much more effort ( this can make the person feel tired, exhausted etc ) - pervades sleep - vivid dreams or nightmares , frequent waking, or not waking up refreshed. Third most severe is agitation - here there is mental and physical restlessness that is very difficult to control and also has early morning awakening or significant worsening of sleep. Hope this helps with a better understanding
Hi, excellent video. I’m a M H clinician currently experiencing burnout which is presenting primarily as agitated depression and I’m screaming inside with racing thoughts and middle sleep insomnia (skin picking too I’m embarrassed to say). Really hope I can get some help. Very uncharacteristic for me as normally quite dissociated and on autopilot.
@@bs4893 thanks for the feedback. Hope you can get treatment. The skin picking is not uncommon in such a situation. Please see the video on melancholic depression but as a clinician please have a read of this article that outlines the options. psychscenehub.com/psychinsights/melancholic-and-psychotic-depression-diagnosis-and-management/
Could you just like how you mentioned SSRI AND SNRIs for anxiety and Clonidine / Guanfacine for Hyperarousal, name a few best choices for agitation as well?
Low dose antipsychotics and or in some cases combined with low dose clonazepam. Sublingual dexmedetomidine is an effective new option for the treatment of mild to moderate acute agitation in patients with schizophrenia or bipolar disorder. Ps not advice
If I’m interpreting you correctly then you are postulating that these “emotions” are on a continuum. Why then do you theorize that SSRI’s help with anxiety but not hyperarousal and agitation?
Anxiety, hyperarousal and agitation are phenomenological terms. The pathogenesis of each are different. So in agitation there is significant NA and DA activity in the mesolimbic areas which SSRIs will 1. Not be able to treat 2. In Irish stages add anxiety on top of this - I.e NA activation . This is one example. Same with hyperarousal. They are different phenomenon with different underlying pathophysiologies. And we are working probabilistically.
6:20 that is what’s happening to me every single morning I feel like I’m being attacked by a SWAT team and I have been on an anxiety medication for almost 24 years now and I’m on a very high dose and it still doesn’t help I found this video to be very informative the way that he described a SWAT team when you wake up is exactly how I’ve been meaning to say how I feel for a long time
Please see a doctor / that usually is more than just anxiety - it’s usually the latter two and requires an alternative approach - does not mean anxiety medication should be changed but augmentation may be needed - depending on the situation one may need 1. Reduction of dose 2. Switch 3 or augment - these are the strategies if one strategy isn’t working. Good luck. Ps not medical advice
@@PsychiatrySimplified thank you for your feedback. I believe I accidentally commented on one of your other videos when it came to anxiety. Sorry about the mistake lol
So I developed physical anxiety. Muscle twitches and vibration 24/7 with constant low level adrenaline almost feel wired. Light and noise im sensitive and my sleep was super interrupted. I have recovered 50 percent with the sleep and noise and light sensitivity but also get brain fog few days a week. Symptoms develop after a covid infection that affected my whole nervous system and cause pain to my nerves. What do you recommend in this case ? I have been prescribed GUANFACINE but haven’t tried it yet as everything over tried makes it worse.
This sounds more like agitation which is now likely come down to hyperarousal. If sleep is not addressed yet please have a look at the video on clonidine vs Guanfacine. Guanfacine does not reduce hyperarousal as effectively as clonidine does. It’s not possible to provide specific advice as it needs a full evaluation but please see the videos on MECFS and long COVID that I’ve done.
@@PsychiatrySimplified sleep has been addressed, still struggle 1 night a week but mostly get 6-7hr with 2 wake ups every few hrs. Ill take a look at the video
Hello Dr. Rege, thank you for making these videos. They're very interesting and informative. A neuropsychiatrist told me I have aggitated depression 3 years ago. I'm wondering if agitated depression can be part of major depression? Or does agitated depression mean I don't have MDD anymore? I feel like I'm diagnosed with way too many psychiatric labels. Most of which I received at age 16, like MDD. Now, at 51, I have even more labels, including agitated depression. I can only sleep 3-5 hours a day even with Ambien for the last few years, because I'm stuck in hyperarousal mode. Can you recommend any natural supplements for this, ones that aren't from animal sources? Melatonin does nothing for me except give me headaches at 10mg or higher. I'm on so many medications as it is and decided to go off of some several months ago because of side effects or lack of making a positive difference anymore. I do try to take green tea extract and turmeric curcurum (thanks for recommending in another video) I'm sorry this became such a long comment. ☹️
Thanks for the feedback. Have a look at the video here - agitated depression is part of melancholic depression and is part of the more severe end. Clinical Symptoms and Treatment of Severe Depression - Melancholic and Psychotic Depression ua-cam.com/video/_Lfj7mXxUe0/v-deo.html
@@PsychiatrySimplified This was very helpful, thank you. I've been on so many of those drugs you mentioned in the video like lithuim when I was 16. Hated that one. I could think more clearly on Rexulti and Wellbutrin XL, but developed vision problems from Rexulti so took myself off of both. Abilify made me gain weight and made me dizzy. Wellbutrin XL helped for a while but then I hit a plateau. Adderall helps me with ADHD. I wanted to be able to get better without going back on more medications, but I'm failing in the self help department. A psych. nurse I had an appointment with a few months ago told me that if I don't get back on antidepressants, I'm going to wind up in the hospital, which shocked me and made me even more paranoid that people were going to come and take me by force. I'm not even su!cid@l at all, even though I'm depressed, I wouldn't do that to my children and animals. I'm not a dangerous, violent person in the least. I never have been. So I didn't understand why she told me that. It's just that these drugs have side effects that start to take more of a toll on people as they age, at least for me and many others I know around my age they have. I gradually began to feel that numbing my emotions with antidepressants and antipsychotics could be counterproductive to processing them and moving forward, but maybe I was wrong. I wish there were a more natural way to get better. I don't want to give up all hope of ever getting better but isn't that a stupid thought because mental illness is not going anywhere in all this time, so stupid of me to wish for the possibility of 'mind over matter' being enough. Thank you, Dr. Rege, I appreciate your kindness, and for sharing that video. 😊
I have been reporting agitation (agitated depression) to my GP but they just see it as anxiety when it is completely different! How can I get them to understand? I'm a mental health clinician and still they don't hear it!
Have you considered a referral to a psychiatrist? And if insomnia is present which is often present as part of agitation then consider addressing that by stating the insomnia - which Gp’s may be more comfortable treating until one can see a psychiatrist. Often way is to consider the diagnosis of agitated depression or mixed states which as labels may be more understandable? Ps not advice . But hope you get some relief.
Thank you for your reply. I have worked in all the planned and urgent care services so have concerns re anonymity. I know the 2 local community treatment team psychiatrists very well. have reached out to practitioner health to see what they say (for practitioners who have concerns about accessing confidential care in their locality).
Another great video. Haven't seen this before re these distinctions. Based on this id say I've got hyper arousal...sleep has been all over the place. Decided to try Agomelatine cf SSRIs. Have had SSRIs in past but the side effects and withdrawal effects not great so not keen to go back on. Weirdly when i do manage to sleep i get a crazy amount of REM but not much deep sleep. REM over represented. This will be night 3 on the Agomelatine.... first two nights i got to sleep ok but still woke a few hours later and restless sleep. Wonder if this will improve
It’s too early to tell but if it worsens or sleep continues to be an issue then options can include 1. Adding short term ( or longer term) depending on severity agents that treat hyperarousal ( please see video on clonidine 2. Changing Agomelatine to alternative agent depending on diagnostic clarification I.e if mixed state is present ( see video) . Ps not advice
@@PsychiatrySimplified I have tried that and it always takes away my motivation for life and sometimes gives me suicidal thoughts. Plus when I come off I feel way worse for a few weeks. I have tried olanzapine and also lamotrigine as mood stabilizers. I am supposed to try vrylar next but I am terrified
Depending on the condition - once agitation goes away - people usually will have a slowing - that’s when one can target the motivation to improve it . It really depends on the condition being treated. Sometimes we need a multipronged approach based on the symptom profile of the patient
Wouldn't a benzo be appropriate at the agitation/beating drum level? Also, the use of clonidine is a brilliant suggestion. I usually think of clonidine for ADHD, which would make sense why it would work in a hyperarousal state.
Yes benzodiazepine can short term - Clonazepam much better for agitation but issue is with agitation with other benzos including clonaz breakthrough can occur which necessitates ‘stronger ‘ agents as stand alone or augmentation.
@@PsychiatrySimplified I'm a relatively new psychiatry provider and I've noticed that regarding anxiety it seems that in many of my clinical observations, I've had slightly better outcomes with SNRIs (probably not significant). I've also noticed some gender differences concerning multiple different psychotropics (SSRIs, SNRIs, and bupropion), such as one drug working better in male pt versus females as an example. Have you seen any of these scenarios in your clinical experience?
Good observations - here is a gender related article i wrote. Yes related to anxiety SNRIs can be effective. There are nuances as you mention - psychscenehub.com/psychinsights/female-specific-psychiatry/
Can you say or point me to more terms for more related experiences to Hyperarousal, Agitation, and akathisia? I need as many terms as possible, because i haven't seen terms that make a difference in communication from me to others or maybe others to me
That's good question. A helpful way of thinking about it is - ability to control vs loss of control. Anxiety is usually controllable. Agitation - very difficult to control - often loss of control which is where the distress is significant. Agitation is usually present at all times - day and night. Hyperarousal is middle ground between anxiety and agitation.
Thank you. Are these 4 words the only for experiences like this? And Is there a way to connect to understanding people?, because i see anxiety used as one of the main psychological overused words, and akathisia used for rich patients
We don’t usually only look at a symptom in isolation. We take patient descriptors and then look at where it lies in the whole picture. For example someone might say I’m worried and anxious , But if they are waking up at 3 am every night and wired after that - that’s not anxiety ; that’s likely agitation. Agitation? Anxiety and hyperarousal are clinical words
Ah, thanks. Is there a way for me to connect to people understanding this? I know me asking people in general would result in being told yes or not connecting to help for things like this. I saw this channel was Australia based, but on all google, this was the seeming most clear place i saw. Im by ny, if it's ok to ask
@@JohnEpto-ng6mlmost will be able to recognise that the word agitation so if one states that it’s not just anxiety but I actually feel agitated that communicates the higher level of acuity. All clinicians should be able to recognise this.
The only time i dont wake up exhausted after a night full of horrific dreams and night sweats is when i smoke kush before bed. I am daignosed autistic but im pretty sure i have ptsd from childhood abuse.
What is it being prescribed for? What are the symptoms that are being targeted with clonidine and what are the overall symptoms that one wants to target. It all depends on the aim. As the medication mechanism and response is matched to the illness / diagnosis domains.
@@PsychiatrySimplified well i have Depression, Anxiety and Agitation, nothing of those anti depressant Medication worked, many of them made my condition worse, also i have a high Blood preassure
@@PsychiatrySimplified all my life i am deppresed, nothing did help, do you think i can use at Night Clonidine , and maybe to try for my Resistant Depression /Anxiety, Cariprazine?? The only anti depressant which i could tolerate was Trazodone, bur it didnt lift the Depression, you know, it did help, burt not complete, so i think, should i try againe Trazodone and ad 1.5mg Cariprazine, or Cariprazine ans Clonidine??
Very interesting explanation. But, what do you call the stage after Agitation? The mushroom cloud, smash stuff, fists through walls and even dissociation stage? Sure wish I was in Australia so I could get help from you. Unfortunately, Canada would rather just let you eventually go nuclear and die. It's cheaper and avoids actually having to help people that are really desperate.
@@PsychiatrySimplified Olanzapine 2.5mg, did work, overnight!! Yes hard to belive, next Day i was Free of Depression, Anxiety, first time in my life i felt to enjoy Life, and feel pleassure, but i was afraid about weight Gain, which happend to me earlyer with mirtazapine, so i stoped Olanzapine, years later, a Doctor gave me againe Olanzapine but 5mg, they dont have in Croatia 2.5mg, and i took it and this time nothing
Years of nightmares was ended with a short term of Prazosin. Previous HCP just increased the SSRI’s.
Thanks for explaining why for this worked. And some physicians wonder why we now use Dr Google or Dr UA-cam.
Glad it worked!
Wow simply wow, you should be teaching the doctors (psychiatrists) and academics. You have real talent for explaining and teaching.
Some of them have no clue, other than pushing ssri and antipsychotics .
Thank you for your feedback. Im teaching through academy.psychscene.com and psychscenehub.com
V interesting and helpful. Thanks as always.
The best explination of what i go through I have ever heard.
Glad you found it useful.
You are the first psychiatrist that hasn't left me feeling in a fit of rage.
Guess that’s good feedback 😊
@@PsychiatrySimplified Yeah I've been trying to explain the things you've mentioned in the video for many years and I just couldn't get them to listen. I'm out of the public system now though and doing much better. And when I get stuck I simply deep dive into the specific issue I'm dealing with and use vids like yours to guide a customised solution for myself
@@PsychiatrySimplified😂
It probably explains why prozac works so good. Were more angry and aggitated than sad.
I really appreciate this video. None of my psychiatrists have ever explained the difference between anxiety and hyperarousal. I have both, but the hyperarousal is clearly what caused and maintains my insomnia and nightmares. I have been on an SSRI for the majority of the last 27 years, and I still struggle with anxiety, depression and insomnia. Trying to come off SSRI and it's not been easy to tolerate the withdrawal effects this time, even thought I'm also on 200 mg/day lamotrigine. I have been on SSRI's so long, there is no way to know how they have affected my brain and to what extent. I wish I never started.
Please have a look at the latest video about SSRI withdrawal. There are agents for hyperarousal - they are usually noradrenergic reducing agents
@@PsychiatrySimplified Wow, thank you for your quick reply! I just found your channel and I'm finding it so helpful. It's a shame that psychiatrists have little knowledge of or time to discuss these details with their patients. It's so incredibly important when you are dealing with complex neurobiological mechanisms and mental health. I feel like my whole life revolves around trying to educate myself to fix myself. Nevertheless, I am grateful that there are credible resources to take advantage of. I will continue to watch and learn. Thank you!!
Thanks for your feedback. Wish you well
Hi Dr. Rege--fantastic presentation. Would it be fair to say that people with severe, chronic anxieties can have these symptom clusters--anxiety, hyperarousal, and agitation--or does hyperarousal and agitation suggest depression, mixed depression, bipolar, and/or possibly ADHD? In other words, do these symptoms suggest specific illnesses, or are they best treated without labeling someone as having disorder A vs B vs C? Finally, how do you treat the agitation part? In my case, I've been on SSRIs for many years for anxiety, OCD, and depression. I was recently diagnosed with ADHD. I agree with you that SSRIs can indeed cause jitteriness and agitation. I feel like my days on SSRIs may be numbered, as they have caused more harm than good. It's hard determining the next steps in these complex cases. I'm grateful to have a good doctor that's sensitive to these complexities. Anyway, thanking you again.
Can I ask what would be your thoughts re possible medication for agitated depression if no other meds currently prescribed?
Good question. Please see this video ua-cam.com/video/_Lfj7mXxUe0/v-deo.htmlsi=axa7KIexEuaQdD2m
Is it possible for agitation to calm down after psychotherapy and meditation? I usually get very anxious over some worries which leads into severe physical symptoms like butterfly in stomach that doesn't go away, loosing focus, feeling restless, feeling tense , more overthinking and worry, severe depression. SSRIs have worked in the past but work partially now meaning if I stopped it gets out of hand plus they really help the depression. Sometimes I can break the cycle but not always. I really rely on my job and keeping busy to avoid these uncomfortable feelings. I just don't really know where this fits on the three instruments you mentioned to follow up with my GP as there is a long wait to see a psychiatrist now where I am
Anxiety is controllable and addressed well by psychotherapy ( including medication) and or SSRI. Hyperarousal is the step in between where there is some control but needs much more effort ( this can make the person feel tired, exhausted etc ) - pervades sleep - vivid dreams or nightmares , frequent waking, or not waking up refreshed. Third most severe is agitation - here there is mental and physical restlessness that is very difficult to control and also has early morning awakening or significant worsening of sleep. Hope this helps with a better understanding
@@PsychiatrySimplifiedit does thank you
Hi, excellent video. I’m a M H clinician currently experiencing burnout which is presenting primarily as agitated depression and I’m screaming inside with racing thoughts and middle sleep insomnia (skin picking too I’m embarrassed to say). Really hope I can get some help. Very uncharacteristic for me as normally quite dissociated and on autopilot.
@@bs4893 thanks for the feedback. Hope you can get treatment. The skin picking is not uncommon in such a situation. Please see the video on melancholic depression but as a clinician please have a read of this article that outlines the options. psychscenehub.com/psychinsights/melancholic-and-psychotic-depression-diagnosis-and-management/
Could you just like how you mentioned SSRI AND SNRIs for anxiety and Clonidine / Guanfacine for Hyperarousal, name a few best choices for agitation as well?
Low dose antipsychotics and or in some cases combined with low dose clonazepam. Sublingual dexmedetomidine is an effective new option for the treatment of mild to moderate acute agitation in patients with schizophrenia or bipolar disorder. Ps not advice
If I’m interpreting you correctly then you are postulating that these “emotions” are on a continuum. Why then do you theorize that SSRI’s help with anxiety but not hyperarousal and agitation?
Anxiety, hyperarousal and agitation are phenomenological terms. The pathogenesis of each are different. So in agitation there is significant NA and DA activity in the mesolimbic areas which SSRIs will 1. Not be able to treat 2. In Irish stages add anxiety on top of this - I.e NA activation . This is one example. Same with hyperarousal. They are different phenomenon with different underlying pathophysiologies. And we are working probabilistically.
Would abilify be a good choice for agitated depression ?
Im currently having agitation anxiety and what would you recommend me to speak to my psychiatrist about managing it and overcoming
Please provide your symptoms - rhe psychiatrist is trained to elicit the diagnostic elements to develop a management plan
6:20 that is what’s happening to me every single morning I feel like I’m being attacked by a SWAT team and I have been on an anxiety medication for almost 24 years now and I’m on a very high dose and it still doesn’t help I found this video to be very informative the way that he described a SWAT team when you wake up is exactly how I’ve been meaning to say how I feel for a long time
Please see a doctor / that usually is more than just anxiety - it’s usually the latter two and requires an alternative approach - does not mean anxiety medication should be changed but augmentation may be needed - depending on the situation one may need 1. Reduction of dose 2. Switch 3 or augment - these are the strategies if one strategy isn’t working. Good luck. Ps not medical advice
@@PsychiatrySimplified thank you for your feedback. I believe I accidentally commented on one of your other videos when it came to anxiety. Sorry about the mistake lol
No probs 👍🏼
So I developed physical anxiety. Muscle twitches and vibration 24/7 with constant low level adrenaline almost feel wired. Light and noise im sensitive and my sleep was super interrupted. I have recovered 50 percent with the sleep and noise and light sensitivity but also get brain fog few days a week. Symptoms develop after a covid infection that affected my whole nervous system and cause pain to my nerves. What do you recommend in this case ? I have been prescribed GUANFACINE but haven’t tried it yet as everything over tried makes it worse.
This sounds more like agitation which is now likely come down to hyperarousal. If sleep is not addressed yet please have a look at the video on clonidine vs Guanfacine. Guanfacine does not reduce hyperarousal as effectively as clonidine does. It’s not possible to provide specific advice as it needs a full evaluation but please see the videos on MECFS and long COVID that I’ve done.
@@PsychiatrySimplified sleep has been addressed, still struggle 1 night a week but mostly get 6-7hr with 2 wake ups every few hrs. Ill take a look at the video
Hello Dr. Rege, thank you for making these videos. They're very interesting and informative. A neuropsychiatrist told me I have aggitated depression 3 years ago. I'm wondering if agitated depression can be part of major depression? Or does agitated depression mean I don't have MDD anymore? I feel like I'm diagnosed with way too many psychiatric labels. Most of which I received at age 16, like MDD. Now, at 51, I have even more labels, including agitated depression. I can only sleep 3-5 hours a day even with Ambien for the last few years, because I'm stuck in hyperarousal mode. Can you recommend any natural supplements for this, ones that aren't from animal sources? Melatonin does nothing for me except give me headaches at 10mg or higher. I'm on so many medications as it is and decided to go off of some several months ago because of side effects or lack of making a positive difference anymore. I do try to take green tea extract and turmeric curcurum (thanks for recommending in another video) I'm sorry this became such a long comment. ☹️
Thanks for the feedback. Have a look at the video here - agitated depression is part of melancholic depression and is part of the more severe end. Clinical Symptoms and Treatment of Severe Depression - Melancholic and Psychotic Depression
ua-cam.com/video/_Lfj7mXxUe0/v-deo.html
@@PsychiatrySimplified This was very helpful, thank you. I've been on so many of those drugs you mentioned in the video like lithuim when I was 16. Hated that one. I could think more clearly on Rexulti and Wellbutrin XL, but developed vision problems from Rexulti so took myself off of both. Abilify made me gain weight and made me dizzy. Wellbutrin XL helped for a while but then I hit a plateau. Adderall helps me with ADHD. I wanted to be able to get better without going back on more medications, but I'm failing in the self help department. A psych. nurse I had an appointment with a few months ago told me that if I don't get back on antidepressants, I'm going to wind up in the hospital, which shocked me and made me even more paranoid that people were going to come and take me by force. I'm not even su!cid@l at all, even though I'm depressed, I wouldn't do that to my children and animals. I'm not a dangerous, violent person in the least. I never have been. So I didn't understand why she told me that. It's just that these drugs have side effects that start to take more of a toll on people as they age, at least for me and many others I know around my age they have. I gradually began to feel that numbing my emotions with antidepressants and antipsychotics could be counterproductive to processing them and moving forward, but maybe I was wrong. I wish there were a more natural way to get better. I don't want to give up all hope of ever getting better but isn't that a stupid thought because mental illness is not going anywhere in all this time, so stupid of me to wish for the possibility of 'mind over matter' being enough. Thank you, Dr. Rege, I appreciate your kindness, and for sharing that video. 😊
This could be an entire masterclass in itself. If your not a member of the academy, then your missing out.
Thank you 🙏🏼
What if my ssri used to cover the anxiety/agitation but its not anymore?
@@NilyNazemzadeh SSRI is unlikely to cover agitation - it can worsen it. It addresses anxiety but struggles to address agitation
I have been reporting agitation (agitated depression) to my GP but they just see it as anxiety when it is completely different! How can I get them to understand? I'm a mental health clinician and still they don't hear it!
Have you considered a referral to a psychiatrist? And if insomnia is present which is often present as part of agitation then consider addressing that by stating the insomnia - which Gp’s may be more comfortable treating until one can see a psychiatrist. Often way is to consider the diagnosis of agitated depression or mixed states which as labels may be more understandable? Ps not advice . But hope you get some relief.
Thank you for your reply. I have worked in all the planned and urgent care services so have concerns re anonymity. I know the 2 local community treatment team psychiatrists very well. have reached out to practitioner health to see what they say (for practitioners who have concerns about accessing confidential care in their locality).
Another great video. Haven't seen this before re these distinctions. Based on this id say I've got hyper arousal...sleep has been all over the place. Decided to try Agomelatine cf SSRIs. Have had SSRIs in past but the side effects and withdrawal effects not great so not keen to go back on. Weirdly when i do manage to sleep i get a crazy amount of REM but not much deep sleep. REM over represented. This will be night 3 on the Agomelatine.... first two nights i got to sleep ok but still woke a few hours later and restless sleep. Wonder if this will improve
It’s too early to tell but if it worsens or sleep continues to be an issue then options can include 1. Adding short term ( or longer term) depending on severity agents that treat hyperarousal ( please see video on clonidine 2. Changing Agomelatine to alternative agent depending on diagnostic clarification I.e if mixed state is present ( see video) . Ps not advice
Clonidine caused tinnitus in many people. Really bad for anxiety to get such a condition.
Does the third one basically requireds antipsychotics?
@@NilyNazemzadeh yes low dose
@@PsychiatrySimplified I have tried that and it always takes away my motivation for life and sometimes gives me suicidal thoughts. Plus when I come off I feel way worse for a few weeks. I have tried olanzapine and also lamotrigine as mood stabilizers. I am supposed to try vrylar next but I am terrified
Depending on the condition - once agitation goes away - people usually will have a slowing - that’s when one can target the motivation to improve it . It really depends on the condition being treated. Sometimes we need a multipronged approach based on the symptom profile of the patient
@@PsychiatrySimplified Is it possible to have a consultation with you?
Wouldn't a benzo be appropriate at the agitation/beating drum level? Also, the use of clonidine is a brilliant suggestion. I usually think of clonidine for ADHD, which would make sense why it would work in a hyperarousal state.
Yes benzodiazepine can short term - Clonazepam much better for agitation but issue is with agitation with other benzos including clonaz breakthrough can occur which necessitates ‘stronger ‘ agents as stand alone or augmentation.
@@PsychiatrySimplified I'm a relatively new psychiatry provider and I've noticed that regarding anxiety it seems that in many of my clinical observations, I've had slightly better outcomes with SNRIs (probably not significant). I've also noticed some gender differences concerning multiple different psychotropics (SSRIs, SNRIs, and bupropion), such as one drug working better in male pt versus females as an example. Have you seen any of these scenarios in your clinical experience?
Good observations - here is a gender related article i wrote. Yes related to anxiety SNRIs can be effective. There are nuances as you mention - psychscenehub.com/psychinsights/female-specific-psychiatry/
@@PsychiatrySimplified Thank you!
Chronic Depression , Anxiety, and Agitation, what Medication??
Difficult to state this generically. Needs an evaluation. Sorry.
Can you say or point me to more terms for more related experiences to Hyperarousal, Agitation, and akathisia? I need as many terms as possible, because i haven't seen terms that make a difference in communication from me to others or maybe others to me
That's good question. A helpful way of thinking about it is - ability to control vs loss of control. Anxiety is usually controllable. Agitation - very difficult to control - often loss of control which is where the distress is significant. Agitation is usually present at all times - day and night. Hyperarousal is middle ground between anxiety and agitation.
Thank you. Are these 4 words the only for experiences like this?
And Is there a way to connect to understanding people?, because i see anxiety used as one of the main psychological overused words, and akathisia used for rich patients
We don’t usually only look at a symptom in isolation. We take patient descriptors and then look at where it lies in the whole picture. For example someone might say I’m worried and anxious , But if they are waking up at 3 am every night and wired after that - that’s not anxiety ; that’s likely agitation. Agitation? Anxiety and hyperarousal are clinical words
Ah, thanks. Is there a way for me to connect to people understanding this? I know me asking people in general would result in being told yes or not connecting to help for things like this. I saw this channel was Australia based, but on all google, this was the seeming most clear place i saw. Im by ny, if it's ok to ask
@@JohnEpto-ng6mlmost will be able to recognise that the word agitation so if one states that it’s not just anxiety but I actually feel agitated that communicates the higher level of acuity. All clinicians should be able to recognise this.
The only time i dont wake up exhausted after a night full of horrific dreams and night sweats is when i smoke kush before bed. I am daignosed autistic but im pretty sure i have ptsd from childhood abuse.
Clonidine makes me sedated even the next Day, even the loweest dose, do you think that will go away after time,
What is it being prescribed for?
What are the symptoms that are being targeted with clonidine and what are the overall symptoms that one wants to target.
It all depends on the aim. As the medication mechanism and response is matched to the illness / diagnosis domains.
@@PsychiatrySimplified well i have Depression, Anxiety and Agitation, nothing of those anti depressant Medication worked, many of them made my condition worse, also i have a high Blood preassure
@@PsychiatrySimplified all my life i am deppresed, nothing did help, do you think i can use at Night Clonidine , and maybe to try for my Resistant Depression /Anxiety, Cariprazine?? The only anti depressant which i could tolerate was Trazodone, bur it didnt lift the Depression, you know, it did help, burt not complete, so i think, should i try againe Trazodone and ad 1.5mg Cariprazine, or Cariprazine ans Clonidine??
Very interesting explanation. But, what do you call the stage after Agitation? The mushroom cloud, smash stuff, fists through walls and even dissociation stage?
Sure wish I was in Australia so I could get help from you. Unfortunately, Canada would rather just let you eventually go nuclear and die. It's cheaper and avoids actually having to help people that are really desperate.
Psychic agitation followed by motor agitation or psychomotor agitation.
We call that losing your shit over here in england 😂
Olanzapine 2.5mg did help, but weight Gain
Yes, it's an unfortunate side effect; however, this can be counteracted via Metformin / topiramate, etc. A risk benefit analysis. Ps not advice
@@PsychiatrySimplified Olanzapine 2.5mg, did work, overnight!! Yes hard to belive, next Day i was Free of Depression, Anxiety, first time in my life i felt to enjoy Life, and feel pleassure, but i was afraid about weight Gain, which happend to me earlyer with mirtazapine, so i stoped Olanzapine, years later, a Doctor gave me againe Olanzapine but 5mg, they dont have in Croatia 2.5mg, and i took it and this time nothing
What did it help for?