Q. I am 18 years old and about to graduate from high school and I start college in the fall. I am an identical twin, although she does not suffer from any notable mental illness. My illness started as a young child and my parents took me to see a behavior specialist when I was 11. He said that my tantrums would cause me to seek out professional help when I got older and this year, at age 17, I saw my first psychiatrist. He diagnosed me with anxiety disorder and social phobia and put me on Neurontin and Effexor. However, I have since changed doctors and I am now seeing a female doctor who has taken me off of the Effexor, increased my Neurontin from 400 mg a day gradually to 2400 a day and has tried me on small doses of Risperdal. I have tremendous mood swings and episodes, as we have begun calling them. I feel like I have gotten worse in the past few weeks rather then better. I feel as if I have totally lost control over my life. My doctor doesn't seem to think I am as bad off as I do. My boyfriend and my mother also feel like I have become worse then before and we don't know what to do about it. My Neurontin increase has occurred over a three week period and we wonder if maybe that's why I am feeling "crazier" then ever. We don't know where to turn anymore and my mother is starting to doubt how I am being treated. My boyfriend says he loves me but I know that he is getting tired of my "fits." I react to the same type of situation differently, depending on my moods. For example, last night he left my house early to go off with his friends and this evening he just wanted to go home around 11 PM to go to sleep. I didn't want him to leave and we had a major fight with me getting hysterical and crying and telling him that I know that he doesn't want to be with me anymore and that's why I am behaving this way. I think I am just making this stuff up cause I don't really think he feels like that. I don't know why I make up stuff like this. I think I am making up reasons to get mad at him and then he stays with me. I am leaving for my graduation trip on June 25. I am going to Europe with my twin sister and meeting some friends for the first week. My mother is very concerned about my mental health while I am away. I'm a little worried also because if I get upset, I can't control how I feel. In addition to the bipolar diagnosis, I have also been diagnosed with a form of obsession/compulsive disorder because I like rituals and things being the same. I don't like any changes and get upset when someone changes or breaks plans with me. I don't even like changing the place were my friends are planning on having dinner. I hope you can help direct me and my family as to what to do.

  A. As a rule of thumb, I tend to change things if they are not working. You should discuss the situation with your psychiatrist, and ask why she thinks you are better, when you (and others) feel you are not. If your psychiatrist is right (you are some better), there is still a ways to go, so some changes need to be made. If you are not better (or even worse), changes need to be made. If she cannot help you, or you feel you are not getting what you need, get a second opinion. No good psychiatrist ever minds someone getting a second opinion. Always try to work it out with your current doctor first, so you can keep your options open for treatment. Its like a job. You do not quit the one you have before you have another to replace it.