[22F] Experiencing auditory hallucinations and mood disturbances

Patient Description

A 22-year-old female is experiencing auditory hallucinations and delusions, alongside anxiety. These symptoms began gradually, with the voices starting about five days ago. The patient reports feeling very low and depressed for approximately two weeks, with worsening symptoms at night and in public. Additionally, she feels twitchy, wired, and tired. The patient has a history of major depression, generalized anxiety disorder (GAD), ADHD, and hypomania, diagnosed over five years ago. She experienced a seizure on Wellbutrin 450. Current medications include Prozac 60 mg, propranolol 20 mg, Concerta 27 mg, and ZzzQuil (one extra strength tablet nightly), all taken daily. There have been recent changes in medication with the introduction of propranolol and Adderall. No family history of psychiatric illnesses or known allergies reported.

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Arora's Assessment

What might be happening

Your symptoms could be related to several factors:

  1. Medication Side Effects:

    • ZzzQuil: Contains diphenhydramine, which can cause hallucinations, especially if taken in higher doses.
    • Adderall and Concerta: Both are stimulants that can cause anxiety, restlessness, and insomnia, potentially contributing to feeling "wired" and tired.
  2. Mental Health Conditions:

    • Major Depression and GAD: These conditions can cause low mood, anxiety, and even auditory hallucinations in some cases.
    • Hypomania: Can cause increased energy and restlessness, which might explain feeling "wired."
  3. Recent Medication Changes:

    • Starting propranolol and Adderall around the time your symptoms began could be contributing to these changes.

What you can do

Medication Management:

  • Consult Your Doctor: It's important to discuss these symptoms with your healthcare provider. They may need to adjust your medication or explore alternatives.
  • Avoid Self-Medication: Do not change or stop your medications without professional guidance.

Managing Anxiety and Depression:

  • Relaxation Techniques: Practice deep breathing, meditation, or yoga to help manage anxiety.
  • Routine: Maintain a regular sleep schedule and daily routine to help stabilize mood.

Tracking Symptoms:

  • Use MDandMe: Journal your symptoms, track progress, and share insights with your provider. This can help in adjusting your treatment plan effectively.

What you should look out for

  • Worsening Symptoms: If you experience increased hallucinations, severe mood swings, or thoughts of self-harm, seek immediate medical attention.
  • Seizure Precautions: Given your history, be cautious of any signs that might precede a seizure, such as unusual sensations or confusion.

Remember, it's crucial to work closely with your healthcare provider to address these symptoms. They can provide a formal diagnosis and appropriate treatment.

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People Also Ask


Can medications like ZzzQuil cause hallucinations?

Yes, ZzzQuil contains diphenhydramine, which can cause hallucinations, especially if taken in higher doses. It's important to discuss any unusual side effects with your doctor.


How can stimulants like Adderall and Concerta affect mental health symptoms?

Stimulants like Adderall and Concerta can increase anxiety, restlessness, and insomnia, which may exacerbate symptoms of feeling 'wired' and tired. They can also contribute to mood swings and other mental health symptoms.


What should I do if I experience worsening symptoms like increased hallucinations or severe mood swings?

If you experience worsening symptoms such as increased hallucinations, severe mood swings, or thoughts of self-harm, it's crucial to seek immediate medical attention. Contact your healthcare provider or go to the nearest emergency room.


How can I manage anxiety and depression alongside medication?

Managing anxiety and depression can involve a combination of medication and lifestyle changes. Techniques such as deep breathing, meditation, yoga, maintaining a regular sleep schedule, and following a daily routine can help stabilize mood. It's also important to work closely with your healthcare provider to adjust your treatment plan as needed.


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