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Dr John B
Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience:  PhD in Clinical Psychology, registered clinical psychologist.
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Dear Doc, I am 31 and you could call me successful with

Resolved Question:

Dear Doc,

I am 31 and you could call me successful with a good career ive worked hard to gain as an Artist. Im from the UK and now traveling across Canada and had some great times, I know myself and my capabilities. Reached goals, built great friends, great times and family is important.

I face a weekly problem though where I attempt to function clearly and be myself but can face 1 to 3 days of mental dullness, unproductive pessimistic feelings and unability to be interested in people or hold a conversation and prefer to be alone unable to be emotional.
It is as if im viewing the world from behind my eyes and as if a chemical switch has taken place in my brain. The best analogy i can think of as if “life” is a film on these bad days im not myself and im watching life and myself in mono(i.e mono and stereo sound), I notice myself and the world is half what it should be and I cant resume normal service until something is switched.
I have experimented with sleep patterns, exercise, organization skills, activities and whilst I have found sleep and organization of my day can reduce the period and occurrence of impaired function its not solving the problem. From 10 to 15 days of the month can be accounted for these mentally dull days which sadden me as I cant fully be myself.

So is it possible to be a chemical imbalance? If so what medications would be prescribed?
Thankyou.

I realize some of the symptoms are associated with bipolar disorder so i would really like to receive the most accurate answer on medication and diagnosis from the most relevant Psychologist so I don’t mind waiting for a response if you are not online right now. Thankyou.



Foot notes:

From 2008 to 2009 I experienced a step learning curve learning a new career which required me to work 50 to 90 hours a week, nearly every day for a year apart from the christmas holiday i felt mentally tired and dull. I questioned my mental state and questioned where this was me as I knew on the days i felt well that life seemed so much easier and dynamic.
2010 I changed jobs, hours were much shorter and with power naps in the evening time and so the mentally dull days to good days are the improved percentages they are now, its a big improvement.
Ive been travelling across Canada for the last 5 months completely relaxed and enjoying myself but still learnt to accept when im not having a good day to do as best as possible, avoid long conversations, interactions and see it as fate but I cant accept it now when its interferes with my relationship, creativity, job and social life. This isnt going to go away with positive thinking or frame of mind it feels mechanical or chemical.
I can accept that whilst everyday can't be a great one that’s reality but I would prefer to have a good day, a sad day and angry days instead of having flat, emotionless void day which feels like it takes my humanity.

Look forward to hearing from you.

Kind Regards
Customer X ;)
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr John B replied 3 years ago.

Hi,

Sorry to hear of the situation.

Given that you appear to have trialled several behavioral strategies for managing the mood variation it is more than reasonable to now query whether your symptoms stem from a chemical disturbance. Your are also right in recognizing that your experience bear similarities to Bipolar Illness, in particular Bipolar 2 Disorder. BPD2 is a form of Bipolar Illness that does not include manic symptoms. It is impossible to diagnose someone via Just Answer but based on your description it would be well worthwhile consulting with a Psychiatrist for a formal assessment.

Take a look at the treatment recommendations published by the NHS for Bipolar Illness http://www.nice.org.uk/nicemedia/live/10990/30195/30195.pdf. This document provides a detailed and clear explanation of the treatment approaches for Bipolar Illness that are supported by substantial clinical evidence. While the document is published for the UK population it provides a good conservative summary of treatment for Bipolar Illness and is relevant to any person interested in this treatment area. It is important to keep in mind that effective medication regimes vary significantly from person to person and that it is standard practice follow treatment guidelines in general but vary dosage and medication combinations until therapeutic effect is achieved.

I hope this has been of some help. Please let me know if you have further questions or would like me to clarify any part of my answer.

Customer: replied 3 years ago.

Hi John,
Thanks for your reply, its times like these I wish I was still back in the UK with the NHS supporting, im in Canada for maybe another year, im originally from Leamington.

Could you elaborate on what you mean by "formal assment" in particular:-
How much time(seshions) would the Psychiatrist need to diagnose me?

Because I have no job atm since I moved to Montreal and I need to be tactical with my diagnosis, approach and money and find out about medical insurance in Canada. i have no idea how much medication will cost me if I was put on lithium.

I asked about what medications I would be prescribed.
I described mental dullness and interruption in behaviour and lack of social intuition,
Pending a thyroid test and confirmation of bipolar2

Would I just require a mood stabilizer like Lithium long term? Would that bring me to a normal state?

I presume I wouldn’t have the shying away from social interaction because my normal behaviour would be restored I wouldnt need anxiety pills like Xanax. I also only experience mild depression because of my interruption in behaviour.



So is it possible to be a chemical imbalance?

Is this due to my thyroid gland? thyroid levels.

Can a Psychiatrist test this or is it the job of a GP?

Is this a check I should get done first before buying time with a Psychiatrist?

Expert:  Dr John B replied 3 years ago.

Hi,

A Psychiatric assessment would usually take no more than two 1 hour sessions, however there are many clinicians who would be prepared to trial medication after one session. However, if a medication was prescribed then a clinician would usually wish to monitor your response during the initial phase (especially if they prescribe a mood stabilizer) and may wish to see you on a number of occasions.

The medication you would be prescribed would be dependent on the final diagnosis and also on the prescribing clinician as there tends to be quite some variation in prescribing behavior from clinician to clinician. However, if the clinician were to be adhering to NHS recommendations (and the diagnosis was Bipolar 2) then you could reasonably expect them to trial a mood stabilizer such as Lithium or Valproate or perhaps the atypical anti psychotic Olanzapine. If the diagnosis were to be a recurrent unipolar depression (or something other than a Bipolar Illness) then you could reasonably expect them to trial Selective Serotonin Re-uptake Inhibitor (antidepressant).

The specific symptoms you describe would be expected to be resolved with effective treatment. As a general statement, when people experiencing either unipolar depression or Bipolar Depression (or even anxiety for the matter) are effectively treated we usually see an improvement in cognitive function (attention, concentration and memory), a return to pre-morbid functioning (work, leisure, etc) and improved social functioning (usually from improved motivation, reduced anhedonia and reduced anxiety).

Thyroid dysfunction is more commonly associated with anxiety disorders, however if there is any suggestion you may have Thyroid problems (for example, if there was a family history) then you would need to have this assessed and at least discounted. Medical conditions 'trump' psychological illnesses so to speak and I would expect that your Psychiatrist would assess for any potential medical factors as part of diagnosis. I would leave the decision to assess Thyroid function up to the clinician performing the assessment.

I will pause here and wait for response. If I am not quite answering specific aspects of your question please let me know and I will attempt to address them directly. It can at times be quite difficult address all aspects of a detailed post.

Customer: replied 3 years ago.

You'll have to excuse my delay in response but I need sometime to think and plan my next step.
Thankyou for your help John,
Being in a foreign country doesn’t make this easier really but im going to have to do the best I can.
So what can i do my side to make the diagnosis easier adn quicker and help them distinguish whether its bipolar 2, unipolar depression or anxiety causing chemical/hormone imbalance? (the break in my behaviour and the mental dullness?)


From today I started a diary of my attitude and mood in the day and continue to monitor my sleep I think this may help them.

Can you recommend any good Psychiatrists in Quebec or preferably in Montreal or alternatively any groups that can provide free (maybe free)help, advice or support?


I have travel insurance from multitrip.com (backpackers coverage) adn im sure that only covers for accidents and illness. i'll have to find out.


Or Leave me with any advice or tips.




Thanks Matt.

Expert:  Dr John B replied 3 years ago.

Hi Matt,

 

I can appreciate your dilemma. Keeping the mood and sleep diary will certainly facilitate assessment and can I suggest you also keep behavioral and cognitive records. Keep the behavioral record by basically making a note of what you do with your time by the hour. So, use something like this http://www.free-printables.net/free-printable-weekly-planners/assets/planner-style2.gif to record what you do with your time. You only need to put a one or two word entry into each hourly block and you can include your sleep record as part of this behavioral record. You will only need to make an estimate of waking and sleeping times and perhaps a note if you have a poor night’s sleep. Try to update the record through the day as most of us actually have very poor memories for how we spend our time. You can also use this as a basis for a mood diary, just enter a short note (or code) any time you experience periods of strong emotion that last for several hours or more.

 

For the cognitive record just keep a separate small notebook and record any time you notice strong negative emotion. This can be a brief experience like a flash of sadness or anger. When you recognize strong emotion also make a note of what you are doing and (if possible) what is running through you r head right at that moment. This task really does need to be completed real time as it is almost impossible to access automatic thoughts later in time (you are then relying on memory of an experience which is a completely different thing). If you keep a record of your behavior (including sleep), emotion and cognition you will essentially be making a start on the kind of data collection that is a key component of Cognitive Behavioral Therapy (CBT), the type of psychotherapy that is recommended for Unipolar Illness, Bipolar Illness and Anxiety Disorders.

 

Can I also suggest that you browse over these two excellent CBT based self-help programs for Depression and Bipolar Illness:

 

Depression: http://www.cci.health.wa.gov.au/resources/infopax.cfm?Info_ID=37

 

Bipolar Illness: http://www.cci.health.wa.gov.au/resources/infopax.cfm?Info_ID=38

 

These programs provide excellent introductions to these illness types and concise self-help treatment packages. Hold off on actually starting them until you are assessed, but should your assessment determine that your are experiencing either of these problems reviewing these will have you well placed to commence treatment (at least the CBT component).

 

As far as recommending specific clinicians that is something we almost never do through Just Answer (for a variety of reasons) but we do usually try to direct people to services that can help them access assistance. As a Psychologist I usually have a bias for suggesting consultation with a Psychologist in many cases, however whenever there is a possibility for Bipolar Illness I recommend a Psychiatrist due to the essential role medication plays in the treatment of this illness group. Consultation with a Psychologist comes later in this situation.

 

Something like the website http://www.mentalhealthcanada.com/ will be the best place to get started. The site is comprehensive and includes listing of clinicians by local region (you can specify postcodes in Montreal) and also a range of crisis services. I must admit that I'm not quite sure how you will tackle this within the context of travelling. Obviously your insurance coverage will largely dictate your options and would unfortunately agree that it's probably unlikely they cover Psychiatric Assessment outside of emergency. If this is the case then speaking with one of the information lines provide on the website will probably be your best chance for locating services that may be able to assist.

 

I hope this has been of some help. Please let me know if you have further questions or you would like me to clarify any part of my answer.

Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience: PhD in Clinical Psychology, registered clinical psychologist.
Dr John B and other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.
Smile
John you've been a great help, it was the first step.

Ive started documenting everything and have more of an idea about this area now. thankyou,

Ive posted your comments below so i can view them on different computers when I go to consultations without having to log in.

I will be sure to pay for more of your time if I need your light on the issue in the future.

Thankyou for answering in detail and putting your full effort into every answer.


Asked by you on Monday, November 28, 2011 4:20 PM EST

Dear Doc,

I am 31 and you could call me successful with a good career ive worked hard to gain as an Artist. Im from the UK and now traveling across Canada and had some great times, I know myself and my capabilities. Reached goals, built great friends, great times and family is important.

I face a weekly problem though where I attempt to function clearly and be myself but can face 1 to 3 days of mental dullness, unproductive pessimistic feelings and unability to be interested in people or hold a conversation and prefer to be alone unable to be emotional.
It is as if im viewing the world from behind my eyes and as if a chemical switch has taken place in my brain. The best analogy i can think of as if “life” is a film on these bad days im not myself and im watching life and myself in mono(i.e mono and stereo sound), I notice myself and the world is half what it should be and I cant resume normal service until something is switched.
I have experimented with sleep patterns, exercise, organization skills, activities and whilst I have found sleep and organization of my day can reduce the period and occurrence of impaired function its not solving the problem. From 10 to 15 days of the month can be accounted for these mentally dull days which sadden me as I cant fully be myself.

So is it possible to be a chemical imbalance? If so what medications would be prescribed?
Thankyou.

I realize some of the symptoms are associated with bipolar disorder so i would really like to receive the most accurate answer on medication and diagnosis from the most relevant Psychologist so I don’t mind waiting for a response if you are not online right now. Thankyou.



Foot notes:

From 2008 to 2009 I experienced a step learning curve learning a new career which required me to work 50 to 90 hours a week, nearly every day for a year apart from the christmas holiday i felt mentally tired and dull. I questioned my mental state and questioned where this was me as I knew on the days i felt well that life seemed so much easier and dynamic.
2010 I changed jobs, hours were much shorter and with power naps in the evening time and so the mentally dull days to good days are the improved percentages they are now, its a big improvement.
Ive been travelling across Canada for the last 5 months completely relaxed and enjoying myself but still learnt to accept when im not having a good day to do as best as possible, avoid long conversations, interactions and see it as fate but I cant accept it now when its interferes with my relationship, creativity, job and social life. This isnt going to go away with positive thinking or frame of mind it feels mechanical or chemical.
I can accept that whilst everyday can't be a great one that’s reality but I would prefer to have a good day, a sad day and angry days instead of having flat, emotionless void day which feels like it takes my humanity.

Look forward to hearing from you.

Kind Regards
Customer X ;)

 

Optional Information:
Gender: Male
Age: 31

Already Tried:
Creating a Diary of sleep patterns. Achieve 8.5 hours of sleep every night. exercise and get out once a day go traveling for a year, have power naps when to prevent it power nap when feeling flat - sometimes works. be proactive


Edit Price
Picture

Expert

You have received an Answer!

Monday, November 28, 2011 4:58 PM EST

Hi,

Sorry to hear of the situation.

Given that you appear to have trialled several behavioral strategies for managing the mood variation it is more than reasonable to now query whether your symptoms stem from a chemical disturbance. Your are also right in recognizing that your experience bear similarities to Bipolar Illness, in particular Bipolar 2 Disorder. BPD2 is a form of Bipolar Illness that does not include manic symptoms. It is impossible to diagnose someone via Just Answer but based on your description it would be well worthwhile consulting with a Psychiatrist for a formal assessment.

Take a look at the treatment recommendations published by the NHS for Bipolar Illness http://www.nice.org.uk/nicemedia/live/10990/30195/30195.pdf. This document provides a detailed and clear explanation of the treatment approaches for Bipolar Illness that are supported by substantial clinical evidence. While the document is published for the UK population it provides a good conservative summary of treatment for Bipolar Illness and is relevant to any person interested in this treatment area. It is important to keep in mind that effective medication regimes vary significantly from person to person and that it is standard practice follow treatment guidelines in general but vary dosage and medication combinations until therapeutic effect is achieved.

I hope this has been of some help. Please let me know if you have further questions or would like me to clarify any part of my answer.

You replied

Monday, November 28, 2011 6:28 PM EST

Hi John,
Thanks for your reply, its times like these I wish I was still back in the UK with the NHS supporting, im in Canada for maybe another year, im originally from Leamington.

Could you elaborate on what you mean by "formal assment" in particular:-
How much time(seshions) would the Psychiatrist need to diagnose me?

Because I have no job atm since I moved to Montreal and I need to be tactical with my diagnosis, approach and money and find out about medical insurance in Canada. i have no idea how much medication will cost me if I was put on lithium.

I asked about what medications I would be prescribed.
I described mental dullness and interruption in behaviour and lack of social intuition,
Pending a thyroid test and confirmation of bipolar2

Would I just require a mood stabilizer like Lithium long term? Would that bring me to a normal state?

I presume I wouldn’t have the shying away from social interaction because my normal behaviour would be restored I wouldnt need anxiety pills like Xanax. I also only experience mild depression because of my interruption in behaviour.

So is it possible to be a chemical imbalance?

Is this due to my thyroid gland? thyroid levels.

Can a Psychiatrist test this or is it the job of a GP?

Is this a check I should get done first before buying time with a Psychiatrist?

Picture

Expert

You have received an Answer!

Monday, November 28, 2011 7:04 PM EST

Hi,

A Psychiatric assessment would usually take no more than two 1 hour sessions, however there are many clinicians who would be prepared to trial medication after one session. However, if a medication was prescribed then a clinician would usually wish to monitor your response during the initial phase (especially if they prescribe a mood stabilizer) and may wish to see you on a number of occasions.

The medication you would be prescribed would be dependent on the final diagnosis and also on the prescribing clinician as there tends to be quite some variation in prescribing behavior from clinician to clinician. However, if the clinician were to be adhering to NHS recommendations (and the diagnosis was Bipolar 2) then you could reasonably expect them to trial a mood stabilizer such as Lithium or Valproate or perhaps the atypical anti psychotic Olanzapine. If the diagnosis were to be a recurrent unipolar depression (or something other than a Bipolar Illness) then you could reasonably expect them to trial Selective Serotonin Re-uptake Inhibitor (antidepressant).

The specific symptoms you describe would be expected to be resolved with effective treatment. As a general statement, when people experiencing either unipolar depression or Bipolar Depression (or even anxiety for the matter) are effectively treated we usually see an improvement in cognitive function (attention, concentration and memory), a return to pre-morbid functioning (work, leisure, etc) and improved social functioning (usually from improved motivation, reduced anhedonia and reduced anxiety).

Thyroid dysfunction is more commonly associated with anxiety disorders, however if there is any suggestion you may have Thyroid problems (for example, if there was a family history) then you would need to have this assessed and at least discounted. Medical conditions 'trump' psychological illnesses so to speak and I would expect that your Psychiatrist would assess for any potential medical factors as part of diagnosis. I would leave the decision to assess Thyroid function up to the clinician performing the assessment.

I will pause here and wait for response. If I am not quite answering specific aspects of your question please let me know and I will attempt to address them directly. It can at times be quite difficult address all aspects of a detailed post.

You replied

Tuesday, November 29, 2011 12:08 PM EST

You'll have to excuse my delay in response but I need sometime to think and plan my next step.
Thankyou for your help John,
Being in a foreign country doesn’t make this easier really but im going to have to do the best I can.
So what can i do my side to make the diagnosis easier adn quicker and help them distinguish whether its bipolar 2, unipolar depression or anxiety causing chemical/hormone imbalance? (the break in my behaviour and the mental dullness?)

From today I started a diary of my attitude and mood in the day and continue to monitor my sleep I think this may help them.

Can you recommend any good Psychiatrists in Quebec or preferably in Montreal or alternatively any groups that can provide free (maybe free)help, advice or support?

I have travel insurance from multitrip.com (backpackers coverage) adn im sure that only covers for accidents and illness. i'll have to find out.

Or Leave me with any advice or tips.

Thanks Matt.

Picture

Expert

You have received an Answer!

Tuesday, November 29, 2011 4:04 PM EST

Hi Matt,

 

I can appreciate your dilemma. Keeping the mood and sleep diary will certainly facilitate assessment and can I suggest you also keep behavioral and cognitive records. Keep the behavioral record by basically making a note of what you do with your time by the hour. So, use something like this http://www.free-printables.net/free-printable-weekly-planners/assets/planner-style2.gif to record what you do with your time. You only need to put a one or two word entry into each hourly block and you can include your sleep record as part of this behavioral record. You will only need to make an estimate of waking and sleeping times and perhaps a note if you have a poor night’s sleep. Try to update the record through the day as most of us actually have very poor memories for how we spend our time. You can also use this as a basis for a mood diary, just enter a short note (or code) any time you experience periods of strong emotion that last for several hours or more.

 

For the cognitive record just keep a separate small notebook and record any time you notice strong negative emotion. This can be a brief experience like a flash of sadness or anger. When you recognize strong emotion also make a note of what you are doing and (if possible) what is running through you r head right at that moment. This task really does need to be completed real time as it is almost impossible to access automatic thoughts later in time (you are then relying on memory of an experience which is a completely different thing). If you keep a record of your behavior (including sleep), emotion and cognition you will essentially be making a start on the kind of data collection that is a key component of Cognitive Behavioral Therapy (CBT), the type of psychotherapy that is recommended for Unipolar Illness, Bipolar Illness and Anxiety Disorders.

 

Can I also suggest that you browse over these two excellent CBT based self-help programs for Depression and Bipolar Illness:

 

Depression: http://www.cci.health.wa.gov.au/resources/infopax.cfm?Info_ID=37

 

Bipolar Illness: http://www.cci.health.wa.gov.au/resources/infopax.cfm?Info_ID=38

 

These programs provide excellent introductions to these illness types and concise self-help treatment packages. Hold off on actually starting them until you are assessed, but should your assessment determine that your are experiencing either of these problems reviewing these will have you well placed to commence treatment (at least the CBT component).

 

As far as recommending specific clinicians that is something we almost never do through Just Answer (for a variety of reasons) but we do usually try to direct people to services that can help them access assistance. As a Psychologist I usually have a bias for suggesting consultation with a Psychologist in many cases, however whenever there is a possibility for Bipolar Illness I recommend a Psychiatrist due to the essential role medication plays in the treatment of this illness group. Consultation with a Psychologist comes later in this situation.

 

Something like the website http://www.mentalhealthcanada.com/ will be the best place to get started. The site is comprehensive and includes listing of clinicians by local region (you can specify postcodes in Montreal) and also a range of crisis services. I must admit that I'm not quite sure how you will tackle this within the context of travelling. Obviously your insurance coverage will largely dictate your options and would unfortunately agree that it's probably unlikely they cover Psychiatric Assessment outside of emergency. If this is the case then speaking with one of the information lines provide on the website will probably be your best chance for locating services that may be able to assist.

 

I hope this has been of some help. Please let me know if you have further questions or you would like me to clarify any part of my answer.



Edited by Dr John B on 11/29/2011 at 4:08 PM EST



If I have been helpful please accept my answer -
Dr John B.
Clinical Psychologist

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Dr John B
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