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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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medication and weight loss my diagnosis is Axis I ptsd

Customer Question

medication and weight loss ?
my diagnosis is:
Axis I: ptsd 309.81
Dissassociative Dis 300.6
Axis 2: no
Axis 3: no
Axis 4: Occupational problems - demanding supervisor
Axis 5: GAF 50

Meds:
200 mg provigil morning to stay awake
40 mg lexapro main drug
300 mg gabapentin for restless legs
2 mg Requip for restless legs
50 mg doxepin at night to help sleep
100 mg trazodone at night to help sleep
3 mg clonazapam at night to help sleep
120 mg propranolol at night for anxiety

I had lapband surgery almost 2 years ago and cannot lose weight. Is my medications preventing weight loss or is it me? And...what does GAF50 mean?

I see a therapist 2x a week and a psychiatrist 2x a month.
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 3 years ago.
Hello. I believe I can be of help to you with this issue.

How long have you been on all of these medications?

Yes, the meds you are on can help impede your weight loss. However, following lapband surgery, your body will gradually 'adjust' its energy and fat storage mechanisms i.e., if your brain thinks your body is starving (because of the surgery), it will institute more fat storage and other energy conservation mechanisms to compensate. So your body is really very 'smart' when it comes to dealing with a perceived 'starvation' threat brought on by lapband surgery. The KEY here is a 'must'----that is consistently and dramatically increase your activity level e.g. join a health center and start in with gentle water aerobics, take low impact jazz-ercise or similar classes, start doing weight machines, play a bit of tennis or racquetball, swim, etc. Don't do this alone----get a partner to do this with you because social support is a true, 'make or break' issue in success. This increased activity will DRAMATICALLY improve your emotion regulation and mood problems.

A GAF of 50 means that on a scale ranging from 0 to 100, you are about in the middle of a rating on Global Assessment of Functioning or a rough measure of how you are functioning in all of your life roles (work, play, family life, relationships, school, etc.) There is not hard way to measure this----a therapist or psychiatrist simply assigns a numeric value and so this number can vary depending on who is making the 'judgment'. A score of 50 means you are having serious problems, that affect your functioning, but they are not so serious as to require hospitalization or a full day treatment program. You can Google: "DSM Global Assessment of Function" or DSM GAF to read more about the subjective nature of these ratings.

I hope you have a very good therapist. Your diagnoses suggest that you have experienced considerable trauma and abuse, either in your past or more recently. You are going twice per week. Is it helping you significantly?

I will await your reaction and response to what I've written so far.............
Customer: replied 3 years ago.

I started medication on the advice of my psychologist, Dr. Russell Grieger (REBT specialist), when I finally felt comfortable enough after 6 months of weekly 45 minute appointments to tell him why I was in his office to begin with (actually, I had a meltdown in his office and apparently "went into the wallpaper" my safety mechanism). When threatened, I go into the wallpaper and I can talk to whomever I am with but I have no idea of what I have said or what has happened. That was 9 years ago. I have had problems with therapy because the very things I must work on elicit extreme fear and so I avoid it at all costs. I do not sleep without enough medication to essentially knock me out. I do not drive because of the lack of sleep and I have fallen asleep once while driving to work and had a car accident where fortunately no one else was involved and I was not hurt. I do work full-time in a high power position (my perfectionism) and my husband drives me to work. I cannot say no to someone and am always overloaded. I love being overloaded because it takes away any time to think therefore I can justify to myself why I am not facing my therapy homework. I weighed 180 lbs when I started therapy and now I weigh 300 lbs with a lapband. My psychiatrist sees me either every week or every other week to monitor me. My psychologist sees me 2x a week. He has started seeing me for a double session when he can because by the time my 45 minute appt with him is up I am starting to "leave". I was sent for a sleep study and the neurologist said there was nothing they could do for me since I had a psych issue. My eating is sporadic and I am definately an emotional eater.

 

Can you help?

 

I was almost hospitalized afte my psychiatrist saw me following a therapy appt and I was still "gone". My husband who does not work and takes care of me by driving me around volunteered to keep an eye on me and to call her immediately if there was a problem. I almost agreed to hospitalization because I did not feel safe and that was my doctors reasoning for admitting me...to put me in a atmosphere of safety. I do trust my therapist; but, I am very skittish when any noise comes to my attention. I have 24-hr access to him; but, I feel like I have no right to call him when I am terrified by flashbacks. Dr. Grieger told me I am the longest patient he has ever had but he has not given up on me. This is the beginning of my 10th year of therapy. I am 53 and married for 35 years. I married as soon as I turned 18 to escape and fortunately, the only person I ever officially dated turned out to be perfect for me. IF I do not take my medication, I will not sleep. I do not even get tired. The later it gets, the more awake I feel.

 

So, you believe that if I have a way of pursuing physical activity with someone that will help push me, I can lose weight? I was on 600 mg of Seroquel for several years and went off of the seroquel almost 2 years ago to eliminate the constant slurring of my speech. At that point I requested a lapband and my surgeon hesitated due to my ptsd but he went ahead with it because I promised I would try to comply.

 

I gained 130 lbs and I am seriously overweight and feel worthless and unable to help myself.

 

Expert:  Dr. Michael replied 3 years ago.
I need some time to contemplate your post and give it the consideration it deserves. I can get back to you later tonight or tomorrow with a full response. Let me know if this is not O.K., please?
Customer: replied 3 years ago.
Yes, this is OK. I have lived with this long enough to wait for an answer.
Expert:  Dr. Michael replied 3 years ago.

You have a very complicated mixture of problems and issues, to be sure. I realize that you have a trusting relationship with your current psychologist. Frankly, 10 years is a very long time to be in psychotherapy with one therapist, and still have the extreme problems you have. it is almost universally the case that after a few years with one therapist, a patient sort of 'hits the wall' in terms of further progress. Only you can assess whether you feel, over the past 1-2 years or so, you've made some significant, additional progress, compared to the prior 8 years or so, in therapy. I am not suggesting you change therapists, but I would be irresponsible of me to not raise the issue with you, given your current problems and your long duration in therapy with one person.

 

The other thing that concerns me is that you actually have quite remarkable insight into your own behaviors, insight into how you escape/avoid stress situations, the fact that you eat to regulate your emotions......I could go on and on regarding the high quality of your insight. Yet, you seem quite 'stuck' and with regard to your body weight, are in fact getting worse. When I see such a pattern---high insight, bright, intelligent person, but no behavior change, I again think, "well something is wrong with this picture; something needs to change if this woman is to change". Sometimes the change is a somewhat more aggressive--but--supportive approach to helping push you to confront the memories and reality of the physical or sexual abuse I presume you experienced earlier in your life; to take a really systematic, and serious look at how eating helps you regulate your emotions, and what might be done to help you cope differently. Perhaps have an eating management coach work with you in your home to help you better control your eating. Perhaps, as a therapist, one would want to hunt down a women's support or therapy group for abuse victims, to supplement individual therapy. Again, I'm not sure what should change in your therapy, but my suspicion is that something really must change in order for you to start progressing again; it might be that your therapist has 'used up' his repertoire of helping skills with you and perhaps doesn't quite know what to do for you going forward. This is what often happens after years of therapy and then, relative stagnation in therapy. I'm a clinical psychologist and professor and I realize when the students I mentor have had 'quite enough of me' and need to receive mentoring from someone else---I've shared with them what I know, my perspective on my areas of expertise, etc. They need a new, different perspective in order to move on.

 

I will pause here and get your reaction............

Customer: replied 3 years ago.
yes, stagnation has been an issue. i requested a double appt time to 1.5 hours from 45 minutes so he could see how i left his office. It takes me a longer time to open up. He just changed tactics and he wrote out what my irrational thoughts were and new rational thoughts to replace them. That way I don't dissociate when trying to figure out why my IB are irrational....which essentially ends my participation in therapy. The 2x we have met for an one and a half have both involved dissociation on my part and his attempting to bring me back to reality. He now sees why I have so much trouble writing out my IB's on my own and I have enough data to justify what makes no sense to anyone else...it's my fault, I am no good, etc. I have another double appointment with him this week and I hope it is fruitful. I do not do good with support groups, he tried that a while back. I do not feel safe enough to tell anyone else what my problem is. He also was not aware that the person responsible for my situation is still in contact with me which has also precluded forward movement on my part. I am terrified of this person. I tried to get a restraining order but the court told me that without an actual crime taking place at the current moment, I could not get one. He has been to prison 2x for raping children before the registry went into effect and he is not on any list. I am not strong enough to prosecute my mother's favorite brother. My mother thinks I am a whore and as called me such since I was a small child. I remember no other reality outside of him from my earliest memories and to this day I will do whatever he or any other man tells me to do. I just "go away". My husband installed a security system in our house a month ago and that helps me know what doors are open; but, I still cannot go to sleep. Most of the events happened while I was asleep in my bed. My uncle called me at work 2 days ago out of the blue and that has thrown me off completely. He did apologize to me for the first time and gave me some excuse about kiddie porn. I was on the phone with him for 2 hours but I do not remember what we spoke about outside of what I just said.
Customer: replied 3 years ago.
i have been thinking about a ptsd camp. what do you think.
Expert:  Dr. Michael replied 3 years ago.

I continue to be somewhat amazed at your insight and ability to 'connect the dots' in your life, regarding the cause and effects (i.e., of your abuse history on your current life).

 

I'm also surprised to hear that your uncle called and apologized. You probably fell into a sort of semi-dissociative mode during that phone call--your coping strategy for having to deal with him. This would certainly explain why you wouldn't likely remember much of what was said across 2 hours. I think you will know you are really getting better when you can accept such a call and can stay in the moment with it---perhaps actually keep notes on what he says to you. His B.S. about the kiddy porn is really quite "classic" is it not? I'm sorry, but I had to chuckle when I read that excuse.

 

You know, a PTSD camp might help you. It could be stressful and difficult, but it certainly won't kill you nor likely make you worse. It might be quite liberating as well. Also, you are clearly in very good control of what you want to divulge or keep to yourself, so you can control the situation if you wish. As I noted, something radically different needs to happen to move you out of the therapeutic stagnation you are in. The camp idea could be part of the remedy to this.

 

I hope this information has been helpful to you. I would be curious to see how this turns out for you, because you certainly have faced a terrifically bad history with your family, and had a rather pathetic, unsupportive and ineffective woman as a mother. So please accept my well wishes and let me know if I have overlooked any aspect of your original question. Please hit the green Accept button if you would, at the bottom of the screen. Thanks.

Customer: replied 3 years ago.

Thank you for your help and advice. Are there any ptsd camps you would recommend? Especially on the east coast as I am in Virginia.

 

I will let you know what happens to me in the future.

Expert:  Dr. Michael replied 3 years ago.
Unfortunately, I'm out west here. The only retreats/camps for PTSD I'm aware of out here are designed for returning soldiers/veterans. You may have some luck by accessing PTSD support groups on the web and asking this question of the participants, bloggers, etc. My very best to you, Vicky.
Expert:  Dr. Michael replied 3 years ago.
My customer roster shows that this question has been 'timed out'. If you would like to provide a response to my last post, please feel free to do so. Alternatively, please hit the green Accept button at the bottom of this screen so I may receive credit for answering this question. Thanks.
Expert:  Dr. Michael replied 3 years ago.
My customer roster shows that this question has been 'timed out'. If you would like to provide a response to my last post, please feel free to do so. Alternatively, please hit the green Accept button at the bottom of this screen so I may receive credit for answering this question. Thanks.
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience: Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
Dr. Michael and other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.
Thank you so much for your response. I apologize for not accepting the answer. I fully accept your responses and I will try to keep you informed. Thank you..
Expert:  Dr. Michael replied 3 years ago.
My very best wishes to you.

Thanks...........

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