How to come out of my ego problem at office?

Hi,

Welcome to icliniq.com.

After reading the history I can say that your main current issue is difficulty in continuing a job for long. You perform well in interviews and get selected for jobs but not able to continue the job. I want to know what kind of difficulties you face during the job? What is the main reason that compels you to leave the job? First of all find the main reason which results in change of job. Try to find the possible solutions for the problem. Once the solution is found then try to apply this for a job and you will be able to continue the job. You were not able to complete the degree during college time, because of differences in opinion with your father. There is liking for loneliness and withdrawal from society. This occurred probably because of the problems during college time. The medicines you are taking include mood stabilizer and antidepressant drugs. Oxetol (Oxcarbazepine) helps to stabilize mood and result in reducing anger, irritability, etc. Nexito (Escitalopram) helps with depressive symptoms. In my opinion as loneliness, restlessness, difficulty to stay in job, withdrawal from society, etc., are present, so you should continue to take these medicines regularly. With time the symptoms will start reducing and you will be able to lead a normal life. Avoid confrontations with anyone and this will help you a lot.

Hello,

Welcome back to icliniq.com.

1. You have mentioned that you have problems related to ego. A lot of individuals have such issues during a job, but try to accept that doing a job in an organization is part of the system.
2. The organization can bear the loss of individual, but an individual might lose big in losing a job.
3. So, even if you are not satisfied with the opinion of others still keep one thing in mind, that your main aim should be to continue the job and to do the work. Pointing others mistake or feeling that you have high knowledge should be limited to your mind only.
4. Try to channelize the energy towards positive things. Confrontations in job result in your loss only.
5. Accept this thing and you will be able to continue the job for long. Just keep one thing in mind that you have to work for your well being.
6. Continue to take medicines and remain relaxed, everything will improve.

Hello,

Welcome back to icliniq.com.

Aripiprazole is good medicine, and this can help to control bipolar disorder symptoms and also will not cause weight gain. He is on a 5 mg dose which is a very low dose. The medicines, as we discussed, are safe and if we do a risk-benefit analysis for bipolar patients, then giving medicines is beneficial rather than skipping the medicines. So please talk with his doctor and ask for an increase in doses. If he is not on any other medicines, then a dose of 10 to 20 mg should be given in order to control the symptoms. Just have faith in your doctor and avoid changing the doctors. This will help in early recovery. Thanks and Take care.

Hello,

Welcome back to icliniq.com.

He is on Aripiprazole 5 mg, and I do not think the drug is a cause of weight gain in his case. The drug is a safe drug, and we even prefer to use this drug in patients who are apprehensive about weight gain. Also, he is on a 5 mg dose which is a low dose. At this dose, such rapid weight gain is not seen. If he has gained significant weight, then that is probably due to persisting mood disturbance or some associated metabolic disturbance. If he has not been evaluated for diabetes, then please get his blood sugar levels done. Also, get his thyroid function tests done. Both these are known to result in weight gain in mood disorder patients. He is also on Escitalopram which is also not a cause of significant weight gain. But still, you can think of reducing the dose to 5 mg again if needed. For his significant weight gain, you can think of starting Topiramate. As discussed earlier too, Topiramate is a mood stabilizer too and will also result in weight loss. The drug is safe to use and has no serious side effects. He suddenly stopped going to his job, and that is most likely part of his mood disturbance. Though proper evaluation is needed, he might be suffering from bipolar depression at the present time. Try to motivate him again and ask him not to resign. Bargain with him for this, suggest to him that he can take a break for a couple of days and if he thinks that he should not leave the job then he can join back. Try to remain balanced and gentle. He should agree with you. Thanks, and take care

Hello,

Welcome back to icliniq.com.

He is on Aripiprazole 5 mg and I do not think the drug is a cause of weight gain in his case. The drug is a safe drug and we even prefer to use this drug in patients who are apprehensive about weight gain. Also he is on 5 mg dose which is a low dose. At this dose such rapid weight gain is not seen. If he has gained significant weight then that is probably due to persisting mood disturbance or some associated metabolic disturbance. If he has not been evaluated for diabetes then please get his blood sugar levels done. Also get his thyroid function tests done. Both these are known to result weight gain in mood disorder patients. He is also on Escitalopram which is also not a cause of significant weight gain. But still you can think of reducing the dose to 5 mg again if needed. For his significant weight gain you can think of starting Topiramate. As discussed earlier too, Topiramate is a mood stabilised too and will also result in weight loss. The drug is safe to use and has no serious side effects. He suddenly stopped going to job and that is most likely part of his mood disturbance. Though proper evaluation is needed but he might be suffering from bipolar depression at present time. Try to motivate him again and ask him to not resign. Bargain with him for this, suggest him that he can take a break for a couple of days and if he thinks that he should not leave the job then he can join back. Try to remain balanced and gentle. He should be agree with you. Thanks and take care

Hello,

Welcome back to icliniq,com.

All three attachments (attachments removed to protect the patient's identity) are same only. This prescription also shows some drugs which are mood stabilizers. If he got a response from these drugs, I suggest these can be restarted. No need to worry. If you need more clarifications on these prescriptions, please elaborate in detail. Thanks.

Hello,

Welcome back to icliniq.com.

The symptoms he is showing are bipolar depression, most probably. I suggest this should be treated with the addition of at least a mood stabilizer. I understand your concern, but if he gets proper treatment in good doses, he should come out of his depression. Aripiprazole can help, but 5 mg is a very low dose. This will not help in controlling all symptoms. I suggest you give him the tablet Revital (multivitamins), which should help him. No need to get worried. Consult a specialist doctor, discuss with them and take medications with their consent. Thank you.

Hello,

Welcome back to icliniq.com.

We discussed him in the past, too, and his symptoms are not due to unipolar depression alone. He does not have a job because of depression symptoms and his mood swings, and the reverse is not true. His depression persists, and the illness itself is more responsible for that than having no job. Since he got angry again and his symptoms persisted, he should be started with some mood stabilizer again. Please try to understand that his illness is the cause that his behavior is bad with you. This cannot be overlooked or justified by any means. You should accept this. If he is not ready to take medicines, he can be given by mixing them with food. Thank you.

Hello,

Welcome back to icliniq.com.

This is happening because of his illness only. Suspiciousness or ideas that someone is against me are part of bipolar disorder and also psychosis. He is more or less stable on his medicines, so there is no acute need to change medicines or alter the doses. First of all, you should try to increase his motivation level. Try to make him understand that the training period will be over in some time and once he is regular in job then there shall be no issues. These things will be there for some time only and are not permanent. He should focus on his job and the thing that are beneficial to him. Try to tell him these points. Ask him if he should not quit his job by making any abrupt decision. Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your problem. But you have to accept that his illness is not mild. He has a history of repetitive shifts of jobs, loss of jobs, and social and occupational dysfunction. But the medicines he is taking are not in the proper dose. We discussed this in the past too. The dose of Aripiprazole should be increased since his mood is again unstable. Rest prescription should be the same. Talk with him about his depression symptoms and explain that he should seek re-evaluation by a psychiatrist. Once he is ready, visit his psychiatrist. Talk about the dose adjustments and any need for Lamotrigine which is very helpful in bipolar depression. Than you.

Hello,

Welcome back to icliniq.com.

I can understand your concern. He is socially doing good, but you have to accept that he has bipolar disorder and he is not performing well on the job. He is shifting jobs and not finishing tasks. These, too, are psychiatric symptoms. Please do not think of stopping his treatment. I know you have consulted many doctors, but the doses of medicines he was given were not adequate. The doses should be increased to get the best results. Once he becomes stable, he will perform well in the job. He should take the opinion of a psychiatrist again for best results.

Hello,

Welcome back to icliniq.com.

If he is taking medicines regularly, then that is very good. Aripiprazole 20 mg will help to reduce his symptoms. His loneliness and fear of not finishing or completing work are most likely due to mild depression symptoms. Bipolar depression can be the reason. In that case, I suggest increasing the dose of Desvenlafaxine to 100 mg. This will help to reduce the depression symptoms, and he will regain the lost confidence. Also, if his weight is normal, then get his lipid profile done. If lipids come in the normal range, then I suggest the tablet Lipicard can be stopped. Please visit a doctor for a proper prescription and only give him the medicines in prescribed doses. Always motivate him to continue to take medicines. Thanks.

Hello,

Welcome back to icliniq.com.

First, you have to accept that something is wrong, resulting in repetitive loss of jobs and shift of jobs. Pressure at jobs could result in reduced interest, but if this results in loss of jobs or resigning from jobs, this is due to poor interest in work. On the other hand, this might be because of depression. Depression results in progressive loss of motivation, lack of desire, poor focus in work, poor concentration, lack of interest in anything, etc., symptoms. This is the probable reason you see such setbacks in life. Considering your history, you have bipolar depression and should take medicines regularly. You were advised Aripiprazole, a good drug with no serious side effects. In the past, you have been advised medicines, but these were not in sufficient doses, and this could be why you suffered symptoms like loss of any emotional feelings, etc. So please take your medicines regularly and avoid missing the doses. I hope you will follow my advice. Take care.

Hello,

Welcome back to icliniq.com.

The tablet Fluoxetine was advised in replacement of Deveniz. He is on the right medicines. One thing that should be done is to reduce the dosage of Deveniz to 50 mg or one more week and then stop it completely. So, I suggest he take the tablet Aripiprazole 20 mg (preferably in 10 mg dose twice daily), Deveniz 50 for one more week, and then stop it completely. Thanks.

Hello,

Welcome back to icliniq.com.

First, I would like to tell you that no doctor deliberately makes a wrong diagnosis. The diagnosis in psychiatry is based on clinical symptoms, history, and the effect of clinical symptoms on social, personal, and occupational life. Family history, too, plays a role. Now coming to the symptoms of your son. You mentioned frequent job changes, a sense of superiority, and frequent anger outbursts during the start of the illness. He used to be argumentative, and these are symptoms of bipolar disorder. He is drowsy, tired, and sleepy, and has other depressive symptoms. So he might be in bipolar depression. But the clinical diagnosis might vary between two clinicians. Since the beginning, I have stressed that he should be given drugs in proper doses and that regular psychiatrist consultations are needed. Thanks.

Hello,

Welcome back to icliniq.com.

If he was doing better, but on the job shift, his performance has reduced, and he lost confidence, then that could be pointing towards a relapse of his depression. He has resigned from the job he is capable of managing, which cannot be ignored. How is his mood now? Is he following his day-to-day routine? Any change in diet or daily routine? Medicines should be started again, and this will help him to come out of this depressive episode. I think this is the time he should consult a psychiatrist again. Preferably the older one. Thank you.

Hello,

Welcome back to icliniq.com.

Since the tablet Venlafaxine worked in the past, I suggest him to take it again. This can be started with a lower dose, like 37.5 mg twice a day, and gradually the dose can be increased. Thank you.

Hello,

Welcome back to icliniq.com.

It is an older antidepressant known to cause some weight gain but not so significant. But since he is stable in the mood now, I do not think this is a good idea to change the drug. Instead, I suggest you improve his lifestyle by increasing protein and decreasing the refined carbohydrates in the diet. You should motivate him in exercise, and his weight shall come down.

Hello,

Welcome back to icliniq.com.

I think if he is ready, please consult a local psychiatrist. A full evaluation by a new psychiatrist will help in revising the diagnosis. He has resigned from his job, which means that depression is relapsing. We cannot just ignore this.

Hello,

Welcome back to icliniq.com.

It seems his depressive symptoms are persisting. Bipolar depression results in such kind of symptoms. I suggest instead of Escitalopram, other drugs like Fluoxetine should be added. The doses should be gradually titrated up. Along with this, there is a need to add drugs like Olanzapine which will boost other antidepressants and will also aid in helping bipolar symptoms. Consult a specialist doctor, discuss with them, and take medications with their consent.

Hello,

Welcome back to icliniq.com.

The drowsiness could be due to an increase in the dose of Clonazepam. If his sleep is good at night, you can think of reducing the dose to 0.5 mg again. This should reduce his daytime drowsiness.

Thank you.