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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5107
Experience:  Dr. Mark is a PhD in psychology in private practice
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I took the CES-D test and had a result of 51. Ive been taking Celexa (20mg) every mo

Customer Question

I took the CES-D test and had a result of 51. I've been taking Celexa (20mg) every morning for 6 weeks. While my anxiety attacks have lowered to about twice a week, my job burnt me out and I had to leave on medical leave. I have had nightmares for months. I feel like I am constantly shaking and in pain. I know I need more help, but I feel like giving up. I feel paralyzed. I feel like a burden.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 2 years ago.

Hi! I believe I can be of help with this issue.

First, let me say I can imagine how distressing and worrisome this situation with your depression and anxiety is for you. I also want you to know that at the end of the posting I'll paste in for you a technique you can use to help you when you are feeling low and in that dark hole of depression and anxiety. This is something you can use to help yourself with some relief and you can use it over and over.

You have tried to deal with the problem through medications alone and it has not brought a solution. You are now starting to open yourself to other ways of dealing with your situation and that is so vital and so positive. We need to go even further with this. So I want to start by having you reorient your focus from the medications being your main "work" on your anxiety and depression to your exploring your emotional reactions of feeling so anxious and being in such a depressed dark place as being your MAIN work and the meds as being the boost you need to help you not be so panicked and anxious and in a dark hole so that you CAN work on what's going on inside. Do you see this reorientation? The idea is that YOU ARE A HUMAN BEING and human beings don't just have emotions because they hit 40,000 miles like a car or like tires! We have emotions because they are part of how we grow and learn and become more fulfilled. But if we keep running from them and trying to get them just to go away without ever exploring what's going on, we NEVER get that chance to get anything from them. They just make us feel terrible year after year. And they leak out in unhealthy ways, like anxiety and nightmares.


So let's focus on three things: diet, exercise, psychotherapy.

 

Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. Also, you need to take Omega 3 fatty acids. Either in fish oil or capsules. You need because you have depression a clinical dose, about 3,000 mg a day. Discuss this with your doctor. The research is conclusive on this. So that's diet. Oh, and lean meats only. No fast food restaurants, no fatty foods.


Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Pretty amazing isn't it? I told you it would require work, but what you put in to it you will get out of it. Your doctor will verify the research results showing the benefit.

Psychotherapy: this requires to have you reorient your thinking about yourself and depression and meds like we discussed above. Medications and remedies only treat the symptoms of depression and that it is important to treat your depression as a HUMAN symptom.

You need to find a psychologist or psychotherapist to help you with the underlying CAUSES of these symptoms, who can help with the depression itself and the anxiety and nightmares it's leading to. You need to feel comfortable with the psychologist or psychotherapist and I don't want you to accept just anyone. You have the right to interview them until you find one who you feel comfortable with and that you feel will understand your experience!

If your doctor isn't able to refer to anyone, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list CBT therapy in their orientations and depression as one of the areas they work with.

http://therapists.psychologytoday.com/rms/

If you want someone who isn't as structured as a pure CBT therapist, consider seeing if the therapist also lists humanistic and/or psychodynamic therapy in their orientation. The idea here isn't that these types of therapy are magic. It's that you may want to find a therapist who will form a strong therapeutic alliance with you and will help you look at the sources of your emotions.

I wish you the very best!

Now for the technique: here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.


I want to stress the importance of breathing as well. Part of the physiology of what is happening to you when the anxiety of depression is present is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety and depression, which strengthens the emotion and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5107
Experience: Dr. Mark is a PhD in psychology in private practice
Dr. Mark and 3 other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
thank you for your response. It is appreciated to see I am on the right track. I simply struggle maintaining a consistency on any exertion. I have cut sugar and caffeine and alcohol completely from my diet and I have a caring spouse, but I seem to have a block at remaining consistent with forgiving myself and moving on. I knew I needed help when I contemplated 'ending everything' a few months ago, and that was a startling thought for me to have, hence why I reached out for help. I am trying to use a mantra every morning, but I feel I awaken and within seconds my head is racing with thoughts out of control. (I do have tinnitus - over 10 years- that complicates things pretty bad sometimes, too) I have learned to shut up about the panic because all I heard from work was, "You don't deal with stress well." and "We sell the dream and you service the nightmare" and "be lucky you have a job. You're just not looking at it right." Now I question the viability of my skills and trying to get another job as my confidence has been beaten to a vegetative state, and I know that I should't and I need to move on and let go of the resentment. I guess I get upset at seeing the solution and knowing it but being frozen on acting on it. I don't expect an answer back, as I understand this is a service, and I am financially challenged right now, but this gave me the opportunity to verbalize (write) out and see part of what I am coping with and hopefully give me some relief. Again, thank you for your advice. I have already printed your exercise and will use that before bed this evening.

-Dave
Expert:  Dr. Mark replied 2 years ago.
Dave, You need to take charge of your internal sadness and negativity. YOU need to rule over them, like a parent over an unruly child. They are not you; they are representatives of undeveloped parts of you that need to be worked on in psychotherapy. Perhaps psychodynamic therapy focusing on your development in your childhood, youth, adulthood. But as you do this work, you need to take the attitude of being the parent disciplining your emotions, the negative emotions that get triggered so easily.


Coach yourself. Be your own life coach! I want you to get really into motivational videos and books. In other words, accept your past fears, accept your past worries and hurts and traumas. Accept them and focus on becoming who you WANT to be now. Here's a simple YouTube search I put together on "motivational speakers":


http://www.youtube.com/results?search_query=motivational+speakers&aq=f

Some like Tony Robbins are the classic big guys. Some are newer. Watch them all. Get inspired. Buy a book or two. Here are some possibilities, but they are only suggestions as there are so many good ones.

The first book is the father of all these type of books. How to Win Friends and Influence People by Dale Carnegie. There are classes in these books now! It was written in the 1930s and still has something to say to us today that is very worthwhile.

I think very highly of the second book on my list, which is a real classic: The Seven Habits of Highly Effective People by Stephen Covey. It is the book that has helped more people than probably any other.

The third book is by Anthony Robbins. He's one of those speakers who fills up huge auditoriums. For a reason. He's a terrific speaker and writer. The particular book (if you like it, try his others): Awaken the Giant Within.

All the best, XXXXX XXXXX


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