Typed it up in a word document, meeting tomorrow at lunch time. Gonna ask him if I can try Propranolol for anxiety:
On Activities in the Fall
I registered with the disability resource center at my school and they have allowed me some accommodations this fall including a reduced course load. So I can be a part time student. I will have two classes, arabic and anthropology. Thank you for writing the letter, it really opened the door for me in receiving accommodations. The only thing I need to do now is set up a follow-up appointment with the the disability office to talk about poverty of speech and giving presentations. These are two issues I still have issues with. Which brings me to my next topic.
Improvement on Aripiprazole
I have seen some improvement in negative symptoms as a result of the medication change. The aripiprazole seems to not flatten my emotions and affect as much. While my poverty of speech and thought and perseveration may not be completely gone, I have found that I am more of my old self. Thank you for allowing me to go forward with this. I am also more alert during the day though I still struggle with amotivation and general difficulties with getting things done.
Issues where there has been less improvement
On the negative side I still have issues with intense anxiety and attacks of intrusive thought. I also have constant anxiety at most times, especially in social situations. I can tell I have anxiety because I have certain behaviors like clenching and picking at my fingers and grinding my teeth which I seem to always be doing.
Concerning psychotic symptoms
As for the psychotic symptoms (paranoia and delusion), they are weak at this higher dose of aripiprazole. When I have my anxiety attacks I feel as if my brain has shut off, making tasks which require higher level thought. I think this is a result of the heightened anxiety, my brain is shutting off to protect itself while giving way to the strong emotion of fear.
What has been working for breakthrough symptoms
Ativan has been a godsend in this, I take that during the day and it usually pulls me out of an episode within an hour. At the same time I only take it once or twice a week to avoid tolerance. Since the psychosis usually comes during the evenings on consecutive days I will often take 200mg Seroquel IR instead.
A new proposal
I am interested in a class of medications called the beta blockers, on example being Propranolol (Inderal). I notice my episodes from week to week tend to have pronounced physiological effects such as racing heart, clenching muscles and so on. I feel like propranolol might help with disrupting that feedback loop of anxiety signals between the brain and body. Among alpha and beta blockers I chose propranolol specifically because it crosses the blood brain barrier more readily and is often used off-label to treat performance anxiety. Perhaps this would work without causing dependence or cognitive dulling like a benzo. I feel like, if an experiment with this medication showed that it had some effect, this medication might be helpful at school if I have a big exam coming up or had to be in a big lecture room for the first time with 100+ people. This is my pitch to you, perhaps alpha or beta blockers would help me chill out and stop constantly worrying.
On my weight loss
I have taken a radical approach to weight loss, where I’m averaging 1000 or less calories a day. People on the online forum have told me this is unhealthy and that I have to consume 200-500 more calories, however, I have lost 15-20lbs this way so far and have not experienced serious changes in mood or functioning. I have also started running again if somewhat infrequently. At first I took your advice about exercising more and have been walking briskly several times a week. If I ever get down to my goal weight I will definitely start running again. Now I only eat about once a day with the occasional snack in the morning.
This is the unfinished version, I usually write out the med orders I need concisely, like this:
(Aripripaxole 20 mg am + Aripiprazole 10mg pm) + Ativan .5mg 2x a day as needed + Possibly Trintellix?