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Norman M.
Norman M., Principal psychotherapist in private practice. Newspaper contributor, over 2000 satisfied clients on JA
Category: Mental Health
Satisfied Customers: 2536
Experience:  ADHP(NC), DEHP(NC), ECP, UKCP Registered.
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I am diagnosed with Borderline Personality Disorder, OCD, and Major Depression and Anxiety. My current psychiatrtic medications are: 30mg Temazepam at night (insomnia) 40mg Prozac 150mg Wellbutrin Discontinued as of June 6, 2011 : Seroquel 1000mg/day clonazepam 3mg/day I am now experiencing sever mood swings, as if I have two personalities. I didn't feel like this on the medication, as my personality was dulled. I was simply a physical shell. I live in a country where mental illness is rarely treated or talked about. I did find a counselor that will only see my once every two weeks. I have lost all control. I've lost my self esteem, and have little self identity. I have no medical outside of the country which I am living. What shouldI do?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Fabio Goderecci replied 2 years ago.

Fabio Goderecci :

Hello and thank you for your question to JA. I wish I will be able to help you. I am not sure did I get from your description did you quit all the medications and which are the medications you were taking before you discontinued and which are other medications you took before that. Could you please elaborate. I would like know which combination of medicaments helped you the most before in your opinion. Thanks Dr. Fabio Goderecci
................
Disclaimer: this psychiatric/psycho-therapeutic advice is for educational purposes. It cannot substitute a medical/psycho-therapeutic evaluation/treatment having place in person at the practice of a licensed psychiatrist/psycho-therapist. This advice should always be applied under the personal supervision of a specialist at her/his practice. If your situation is an emergency you should visit an emergency unit right now.

monica055 : Excuse me Dr., but I would prefer to interact with a professional with a command of the English language.
Expert:  Norman M. replied 2 years ago.
Well Monica, you ARE in an awkward position. I lived in the Kingdom for 13 years, and therefore I am well aware of the difficulties that poses.

It would help me to help you of you could first of all clarify for me what medication you are actually taking at this moment, and give me some indication of how you get your treatment - is it through your sponsor (I'm assuming here that you are an expat), through your company or through the state system?

Quite apart from the question of medication, you are clearly aware that counselling/psychotherapy in conjunction with medication is is usually more beneficial, ind in this context I have noted that you only have access to that every two weeks.

There are other possibilities open to you, and we can discuss those after I have received your reply.
Customer: replied 2 years ago.
Oh thank you so much Dr.I definitely need your help

my current medication regime is as follows:

Prozac 40mg/day
Wellbutrin XL 150mg/day
Temazepam 30mg at night, (if I take only 15mg I am literally up all night).

I asked to stop seruquel (1600/day) and Clonazepam (3mg/day).I was addicted.

So I am on the two antidepressants and the Temazepam. I stopped taking the Seroquel and Clonazepam on July4. I am still suffering horribly.

I feel like I am two with tinted windows different people-sane,and insane. My family has told me "you are a walking disaster. you are making us all crazy.

Thank God someone knows what its like to live here. I live in a big cement hous
Expert:  Norman M. replied 2 years ago.
Thanks for the info - who provides your medical care?
Customer: replied 2 years ago.
Saudi Aramco Medical services.
My whole body is pins and needles, and I have difficulty walking,, as if each legs is solid concrete, I am dropping things and falling, but was told it must be stress related.







Customer: replied 2 years ago.
i don't know if I am having a nervous breakdown. My psychiatrist has been gone for six weess. Am i going crazy, do I need hospitalizatiom?
Customer: replied 2 years ago.
I am an American lady living here for 27 years. Yes, I have BPD, OCD, Major Depression, but I am simply surviving. My husband makes all decisions for me, I do not have a penny to my name,and no medical insurance. What I need to go on with my lap is some treatment that will stabilize me so that I can function again and get through a day without being told to eat,sleep, go to bed.Please advise me ASAP
Expert:  Norman M. replied 2 years ago.

I would have thought that AMS in Dhahran would have more than one psychiatrist available to you - forgive the assumption that you live in the Eastern Province. I do not think that you are going crazy, but I do think from all of what you tell me that you need a thorough re-evaluation, and more support in addition to the medication you are on.

I do not know what the position is now, but previously counselling support was limited to person centred therapy, which is ok as far as it goes, but I feel that you need something that is more solution-based rather than mainly supportive.

My suggestion would be t that you would benefit from some Cognitive Behavioral Therapy.

CBT is based on the fact that what we think in any given situation generates beliefs about, and reactions to that situation, and also causes the behaviour and feelings which flow from those beliefs and reactions.


These ‘automatic thoughts’ are so fast that generally, we are unaware that we have even had them. We call them ANTS (automatic negative thoughts) for short.

If the pattern of thinking we use, or our beliefs about our situation are even slightly distorted, the resulting emotions and actions that flow from them can be extremely negative and unhelpful. The object of CBT is to identify these ‘automatic thoughts’ then to re-adjust our thoughts and beliefs so that they are entirely realistic and correspond to the realities of our lives, and that therefore, the resulting emotions, feelings and actions we have will be more useful and helpful.


Cognitive therapists do not usually interpret or seek for unconscious motivations but bring cognitions and beliefs into the current focus of attention and through guided discovery encourage clients to gently re-evaluate their thinking.


Therapy is not seen as something “done to” the client. CBT is not about trying to prove a client wrong and the therapist right, or getting into unhelpful debates. Through collaboration, questioning and re-evaluating their views, clients come to see for themselves that there are alternatives and that they can change.


Clients try things out in between therapy sessions, putting what has been learned into practice, learning how therapy translates into real life improvement.

Please visit this website for much more detailed information on CBT:

http://www.rcpsych.ac.uk/mentalhealthinfoforall/treatments/cbt.aspx


Also, there are good free CBT based self-help resources here:

http://www.getselfhelp.co.uk/cbtstep1.htm


Also, there is a book called ”Feeling good - the new mood therapy” by Dr. David Burns. It has a hand book which gives you practical exercises to work through and further instructions on how to better use CBT. I really do recommend it.


Cognitive Behavioural Therapy Workbook for Dummies By Rhena Branch, Rob Willson is also pretty good.


In addition, CBT is readily available online, and that can be a very, very effective approach.


If you like, I’ll see if I can source some reliable services for you – let me know.


I think too that you would really benefit from being able just to talk – now I understand that it may not be your ‘thing’, but I have known that some ladies feel that they get a lot of support from their local community Aramco Womens’ Group – it has got to be worth a try.


Just as an aside, I worked for Aramco Medical Services myself during my time in Kingdom – long before it was Saudi Aramco !


In the immediate term, I suggest you ask your local Health Centre to get you an urgent referral to Psych Services so that you can get the re-evaluation you so urgently need. It is clear that your medication regime is ineffective, and that HAS to be resolved as a first step.

Finally, on the page here you will find a listing of therapists in KSA who have a formal training in CBT - it would be well worth talking to a couple of them.


Also, go on to Google and search for ‘Bipolar Forum’. There are several to choose from, and I’m sure that one of them will be to your taste, where you can interact (albeit at a distance) with people who know what you are talking about.


If there is anything else I can do to help, please let me know.


Best wishes,

NormanM

Norman M., Principal psychotherapist in private practice. Newspaper contributor, over 2000 satisfied clients on JA
Category: Mental Health
Satisfied Customers: 2536
Experience: ADHP(NC), DEHP(NC), ECP, UKCP Registered.
Norman M. and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
Do you know of a private therapist that is an expert on DBT? I liive in the Eastern province but the doctors here I believe are somewhat biased as they habefore seeing memo
for twenty years. To quote them "they are not here to provide counseling , they only manage medications.

Maybe there is someone o
On camp that practices out of her home..

How would I find out?
Expert:  Norman M. replied 2 years ago.
Monica - click on the word 'here' in blue type in my last answer - that should take you a list of suitable therapists. If you are ever there, give my regards XXXXX XXXXX Tanura!

Let me know if the link works, please.

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