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Are my psychotic nightmares a medication side-effect?
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Are my psychotic nightmares a medication side-effect?

This is my first time asking for help online, as I would usually take any concerns straight to my psychiatrist. But I'm a little hesitant to speak to anyone about this face-to-face until I get an opinion anonymously.

I have been diagnosed with a schizoaffective disorder (with Bipolar II as the mood disorder) and have been very compliant with all psychotherapy and medication requirements over the last 10 years.
My medication is still altered quite regularly, but my doctor & psychiatrist have helped me to stop taking anti-psychotics (6 years on them, currently >1 year off) and I've managed quite well without them. I do have occasional psychotic episodes, but the duration and severity has decreased drastically, to a point where I feel I'm able to manage them in everyday life. I have never been a danger to myself or others during episodes, except on one occasion a few years ago when I lost control of a vehicle, and I haven't driven since.
I have also been allowed to stop taking mood stabilizers for the last few months, and have replaced them with Omega-3 fish oil (750mg krill oil / day.)
So the only medication I am currently taking is anti-depressants, which is where my question begins… (Sorry for the lengthy intro!)

I have been taking venlafaxine for over a year and the dosage has steadily been increased, but my psychiatrist recently wanted to try adding an additional anti-depressant instead of increasing the dose further.
For 3 months, I was taking 300mg venlafaxine + 300mg bupropion. This seemed like the perfect combination and I was feeling really positive about the changes I was seeing.
However, I was taking the bupropion as a quit-smoking aid, and the medication cost would not be subsidized after the 3-month period.
So my psychiatrist said to try a different anti-depressant – 15mg mirtazapine (still continuing with 300mg venlafaxine in the morning.)
I have been taking the mirtazapine at night and have been able to fall asleep instantly (which is a very nice change) and I haven't experienced any side effects during the day.
However, since I began taking it, I have had frequent nightmares which have been extremely graphic and disturbing.
I've had my share of nightmares at other times, but these ones don't seem like regular nightmares. They are absolutely terrifying and literally seem to last for an eternity. It actually feels more like psychosis than a dream. During the nightmares, I am completely lucid and try desperately to wake myself up, but nothing works. I even have "false awakenings" where I believe I've woken up, but within a few minutes I realize I'm still trapped in that awful nightmare. I eventually wake up, drenched in sweat and finding it difficult to breathe. Some nightmares have been so horrific that I've burst out crying upon waking.
I told my psychiatrist about this after 4 weeks of taking the medication, but he said it sounds like a normal part of my condition and I should keep taking the medication.
So I have continued, and so have the nightmares. It's now been 2 months, and the nightmares are beginning to affect my waking life. Some of them seem so real that it's difficult to ignore them. I'm not a religious person, but the nightmares often involve demons who tell me I am trapped halfway between waking-life and hell. In this place, I am tortured, beaten, burned, raped, forced to inhale solids and liquids, and made to torture other prisoners. The demons taunt me and tell me they can keep me there eternally, because I cannot die and time does not exist where they are. Sometimes they let me escape, just so they can chase me and capture me again. I have tried to take control of the dreams, but there's nothing I do can change them. They are so real and intense that I'm beginning to actually believe that I've entered another plane of existence. It's only when my mind literally cannot cope with the torture anymore – when I feel myself separating from the abuse and escaping to a place in my head – that I can finally wake myself up and come back to reality. It feels so real, and some of the torture is so unimaginable that I can't believe it's coming from my own head.
I know that sounds crazy. And I know it probably is.

I want to be completely open with my psychiatrist, but I'm afraid I'll be put back on anti-psychotics if I tell him. It's not that I have an issue with taking medication, but I feel SO much more alive and healthy without the massive sedation that comes with taking anti-psychotics.
I trust in my psychiatrist's opinion and knowledge, and I have continued to take the mirtazapine despite the nightmares, but it is really getting unbearable.
My mood has also dropped since I came off the bupropion, so I don't think the mirtazapine is working as a replacement. And I feel like it's sending me backwards in terms of my schizophrenia.

How do I talk to my psychiatrist about my concerns without him just thinking I need anti-psychotics?
If it makes any difference, I'm 22 years old. I've spent almost half my life medicated for my mental health, and 99% of the time, I have done exactly as I've been told by doctors.
But I feel like I've finally been given a break to actually live my life and have enough energy to experience the world as a real, normal person. I don't want to withhold information from my psychiatrist, but I don't want to be drugged into a lifeless stupor either.
Any help will be greatly appreciated. Thanks for reading my essay!
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585414_tn?1288944902
  Yes you do need to discuss this with your psychiatrist so they can be aware of what is happening and how to follow up. Some psychiatric medications can cause sleep disruption and a change in dreams but regardless of cause they need to address this. For example, if they can't find a specific cause, a sleep study might show what's going on. I had one and its an easy procedure that's not at all uncomfortable.
   Also for a person with bipolar or the bipolar aspect of schizoaffective disorder an anti-depressent by itself can often worsen mania and a full mood stabilizer is what's needed. Fish oil is of some help as an adjunct mood stabilizer but not a full one. The FDA approved medication Lovaza that is derived from fish oil has shown to be of help as a mood stabilizer and I am prescribed that. Some psychiatrists would use that. It would depend of what options they'd consider
  As regards antipsychotics in general a person with schizoaffective disorder needs them.  I always have as have other people I know with this diagnosis or I would have break through episodes of psychosis. Regardless of any choice of medication its important if you ever have any thoughts that might be psychotic to discuss them with your psychiatirst. Also be aware (I am taking one treatment in this class of medications in Phase 2 FDA study under psychiatric supervision and have had a favorable response) that there are a new class of antipsychotics in clinical study the NMDA receptor modulates that are showing to have a safer long term side effect profile and an easier to tolerate short term side effect profile (google "A New Class of Antipsychotics, Psychiatric Times"). Keep yourself updated of medications as they are approved and in the meantime ask your psychiatrist about available options so they can appropriately adjust and/or change your medication as needed. This has websites that can be of help for informational purposes that you could discuss with your psychiatrist:
http://www.medhelp.org/tags/health_page/34/Mental-Health/Useful-Bipolar--Depression-Webisites?hp_id=523
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585414_tn?1288944902
  Yes you do need to discuss this with your psychiatrist so they can be aware of what is happening and how to follow up. Some psychiatric medications can cause sleep disruption and a change in dreams but regardless of cause they need to address this. For example, if they can't find a specific cause, a sleep study might show what's going on. I had one and its an easy procedure that's not at all uncomfortable.
   Also for a person with bipolar or the bipolar aspect of schizoaffective disorder an anti-depressent by itself can often worsen mania and a full mood stabilizer is what's needed. Fish oil is of some help as an adjunct mood stabilizer but not a full one. The FDA approved medication Lovaza that is derived from fish oil has shown to be of help as a mood stabilizer and I am prescribed that. Some psychiatrists would use that. It would depend of what options they'd consider
  As regards antipsychotics in general a person with schizoaffective disorder needs them.  I always have as have other people I know with this diagnosis or I would have break through episodes of psychosis. Regardless of any choice of medication its important if you ever have any thoughts that might be psychotic to discuss them with your psychiatirst. Also be aware (I am taking one treatment in this class of medications in Phase 2 FDA study under psychiatric supervision and have had a favorable response) that there are a new class of antipsychotics in clinical study the NMDA receptor modulates that are showing to have a safer long term side effect profile and an easier to tolerate short term side effect profile (google "A New Class of Antipsychotics, Psychiatric Times"). Keep yourself updated of medications as they are approved and in the meantime ask your psychiatrist about available options so they can appropriately adjust and/or change your medication as needed. This has websites that can be of help for informational purposes that you could discuss with your psychiatrist:
http://www.medhelp.org/tags/health_page/34/Mental-Health/Useful-Bipolar--Depression-Webisites?hp_id=523
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520191_tn?1355639002
If the mirtazapine is giving you unbearable side effects such as the night terrors then i would defiantly tell your psychiatrist this and maybe ask to try something else. If you are not experiencing any psychosis or hypo-mania and your doctor is happy with you not been on a mood stabilizer or anti psychotic than that's great as long as you don't need it.

Hope  that helps
Freddie
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2110259_tn?1335111572
Thanks so much for your replies!
I was totally honest with my psychiatrist and he has taken me off the mirtazapine. I'll be starting a different drug in a couple of weeks, but for now, I've just had to take an increased dose of the venlafaxine.
The nightmares have stopped completely, so I guess it was just an unlucky side effect for me.
And so continues the trial and error routine...
Hopefully I'll find the right combo one day! :)
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675718_tn?1321008971
i take prazosin for nightmares good stuff for PTSD
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Avatar_m_tn
i had a very terrible one right now it scared me so badly that i came look for answers on the internet and stumbled on this site,
i cant for the life of me explain what happend,
it whas so scary that i almost begun to hyperventilate in my sleep,
my eyes wur open and my sight whas awake i saw my room, but i could hear terrible angry sounds like my dog who's one floor down, just running up the stairs barking verry agressively, which cant be, because he sleeps in a kennel, and some other strangly sounds, and my body is in shock t starts to shiver very violently, when all of these thngs happen, i try to snap out of it, i am slighly awake, with alot of strength i can tild my head slighltly up, and when i am lucky i become fully awake,
my first reaction whas to look at the side effects of the medication i am taking because i had noticed by some medication you really do get auwfull nightmares, but on the flyer it does not show nightmares as a side effect,
so i am very confused right now.
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Avatar_m_tn
i had a very terrible one right now it scared me so badly that i came look for answers on the internet and stumbled on this site,
i cant for the life of me explain what happend,
it whas so scary that i almost begun to hyperventilate in my sleep,
my eyes wur open and my sight whas awake i saw my room, but i could hear terrible angry sounds like my dog who's one floor down, just running up the stairs barking verry agressively, which cant be, because he sleeps in a kennel, and some other strangly sounds, and my body is in shock t starts to shiver very violently, when all of these thngs happen, i try to snap out of it, i am slighly awake, with alot of strength i can tild my head slighltly up, and when i am lucky i become fully awake,
my first reaction whas to look at the side effects of the medication i am taking because i had noticed by some medication you really do get auwfull nightmares, but on the flyer it does not show nightmares as a side effect,
so i am very confused right now.
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675718_tn?1321008971
what do you take?
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Avatar_m_tn
ibuprofen, i stoped the threatment a month ago,

i dont really think that it has something to do with those auwfull dreams,
but i am no doctor..


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