u/Impossible_Pace7773

I have been taking bup for 8 weeks now, 150 XR for 4 weeks and then 300 XR. I have been in a depressive episode (bipolar) for a good year now, and have tried many meds including; lithium (loved, but fucked up my kidneys), lamotrigine, amisulpride (i became psychotic because of lamotrigine it turned out), abilify, ritalin (such good sleep on that!) escitalopram (made me manic), seroquel (gave me hallucinations). I am very sensitive to medications and have a pharmacogenetic passport. I am IM for CYP2B6 which metabolizes bupropion, so the 300 was likely necessary to get to a dose high enough to notice. Still, it has been a tough time. At first bupropion didn't seem to do anything, and after 6 weeks my psychiatrist suggested we switch to lurasidon. Because it took 2 weeks for it to come in, I have continued taking bupropion.

What I notice; I feel capable to do stuff in my house again. I can cook, and then finish the dishes. But, it feels like there is an external motor strapped to my back forcing me to do stuff constantly, while my body and mind are done. When I sit, I feel like I need to do something. I feel wired but also so immensely tired. It (almost) feels as if I am hypomanic, but then with a lot of dysphoric and anxious feelings. I am not actively suicidal anymore (which I have been for longgg). SH thoughts have however been more present. I seem to have a lot of intrusions, including ones about harming myself or others. I feel more anxious, have racing thoughts, and can lie in bed with heart palpitations and problems breathing. I have been more paranoid, and definitely snappy towards others. Emotions are not there, or are very intense and then I am sad and teary, while I normally can't really embody the sadness. It is hard for me to focus and follow conversations, which my therapist noticed and she was confused because I normally am good at following. I also have physical side effects including needing to pee all the time, headaches, and problems with vision where I have more auras and see spots.

I do not know what to think. Being able to do more stuff and feeling a bit more positive are great. Yet the wired and dysphoric feeling I have is not. I do not know what to expect as this is the first med that has even touched my depression. Do I continue? Do I switch? Did anybody experience the increased anxiety get better with time?

Tldr; I am scared of my psych and feel hurt. She has helped me but now hurts me.

I have been with my psychiatrist for approx. a year now. I was referred to her from crisis services when I was severely depressed, and unfortunately discovered I am bipolar due to the antidepressants I was taking. Her focus is on giftedness in combination with psychiatric problems. At first, I really liked her and felt understood. But because of the severity of my illness and the fact I didn’t stabilize, I had to lean on her and her practice a lot. At some point I was seeing mental health professionals 5 days a week (I had quit studying and could barely take care of myself). I had a drama therapist, who is amazing and who I still see, an art therapist, a psychiatric nurse provider, and my psychiatrist. At the beginning of the year I was referred to the hospital because it was getting too complex and constant crisis. I was psychotic and depressed and still not stable after almost a year. The psych ward / new meds helped and I am feeling a bit better for the first time in a year. The hospital psych is taking care of my mess because my own psychiatrist has made clear it is too complex. He is great, but does not provide therapy, and is also in the province of my parents, while I live 3 hours away.

I have been getting more hurt by conversations me and her have had, where I leave feeling terrible and getting into crisis after speaking with her. She will often go over time, which is nice sometimes but also confusing because there is no clear boundary. She has called me and then charged me for the time, even though I didn't reach out. On several occasions, she said she can no longer take care of me because I am simply too complicated/it is too much. This is a deep wound I have carried from childhood with my parents as well. Before she stated she would support me and be there for me. On the other hand, she has supported me through a lot of tough times and been there even outside of office hours in crisis. I just feel as if I can no longer be myself, because it will be too much. I am scared to be judged and will withhold information even though she does help me. I think she might be triggering the pattern I have with my mother, who is also very judgemental at times but does usually come from a place of care. Because I haven’t been stable at all, I haven't been diving into these patterns enough in therapy yet.

My relationship with my drama therapist is very different, where I always feel save to share and have the idea I am ok and not doing something wrong if I share my thoughts or experiences. I am wondering, do I confront my psychiatrist about me feeling judged/scared of her? How do I do this? Am I just too sensitive? I don’t see myself able to switch because other providers in the region are not attuned to my neurodivergency and likely wouldn’t care about the relation between chronic illnesses, neurodivergence, and psychiatric problems. I am, indeed, not the easiest case, but these are the cards I’ve been dealt. Help.