I see you're taking a lot of meds for anxiety and MDD. Is the topiramate for epilepsy or migraines, or something else?

What is you diagnosis?

I have severe major depression with psychotic features and I take 3 antidepressants (Prozac, Wellbutrin, Remeron), plus the antipsychotic Abilify and also Ativan/lorazepam PRN. The Remeron takes away the SI, and I find it works very quickly, too, when I take it... it's like the SI evaporates.

Have you heard of gabapentin? Have you ever disucessed it with your ARNP? I've been curious about that drug for anxiety.

I would see whether you can get the appointment that is scheduled 3 months from now with your ARNP moved up soon... as you're not doing well.

As for the LISW, what therapeutic approaches are you using? Psychotherapy, CBT, DBT, ACT or something else?

The hydroxyzine you're taking is known as Atarax, no? That's an antihistamine that can be used for anxiety sometimes, no? How long have you been taking it and what are you taking it for?

So getting to the nitty-gritty, you say you need to figure out why you're SHing... and I read that you started in your 30s, did anything happen in your 30s that could be considered a triggering event? If you were to brainstorm for someone else (why they could be doing it) what reasons would you give?