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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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I have been feeling depressed and have been thinking about

Resolved Question:

I have been feeling depressed and have been thinking about my options as far as help goes. What are my options.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr John B replied 2 years ago.

Hi,

Sorry to hear of the situation.

The main treatment approaches for Depression are anti-depressant medication, Cognitive Behavioral Therapy (CBT) or a combination of the two. I can recommend this excellent website here as a starting point for learning more about the treatment of
Depression.

The recommended sequence of treatments to try is:


1) Self-help using a CBT based program


2) CBT with a therapist


3) CBT & an antidepressant medication (usually a Selective Serotonin Re uptake
Inhibitor)


You can confirm that this is the correct order by checking these treatment recommendations here.


CBT is a psychotherapeutic approach that aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic
procedure. Treatment is technique driven, brief, direct and time-limited (normally 10-12 sessions). CBT is used in individual therapy as well as group settings, and the techniques are often adapted for self-help applications. I would strongly encourage you to consider CBT as I would expect you get great benefit from this approach.


Start by working through this excellent CBT based self-help program here. It should take several weeks to complete, is completely free and will teach you everything you need to know about Depression and what you can do about it. Alternatively, you could take a look at a book which will teach you some introductory techniques for dealing with Depression at home. I can recommend a well known manual titled Mind Over Mood and another book titled The Cognitive Behavioral Workbook for
Depression; A Step by Step Program
as good places to start. You can find them
both here.


If you find you aren't making the kind of progress you would like using a self-help approach I would then recommend you consult with a CBT trained therapist. CBT is usually offered by Clinical Psychologists (although not exclusively) and you can contact the American Psychology Association (APA) for assistance with locating a Psychologist; take a look at the APA locator service here. You can use this to find Psychologists in your area and there is a phone number you can contact if you want a referral arranged for you. Also, take a look at an article published by the APA here. It's an interview with a senior Psychologist and covers some of the things you should consider when you looking for a Psychologist.

If after consulting with a CBT therapist you are still having trouble with Depression
then you should consult with a Psychiatrist about commencing an anti-depressant
medication.


You mentioned that you've been having some trouble with self-harming, how long and often has that been a problem?
Customer: replied 2 years ago.
I have been self-harming for about 5 years now. It depends on what is going on in my life and the time of year for how often it happens.
Expert:  Dr John B replied 2 years ago.

Hi,

Do you mind if I ask a few more questions? The reason being that low/depressed mood sometimes occurs as part of a set of problems including self-harming. In these situations the treatment for the low mood need to be quite different to the treatments used for straight Depression.

Customer: replied 2 years ago.
Ask as many questions as you like.
Expert:  Dr John B replied 2 years ago.

Ok thanks.

How would you describe your relationship history over recent years? Romantic, platonic, family, etc?

Have you ever experienced any trauma such as an assault or serious accident?

Have you ever had difficulty with suicidal thoughts?

What is your temper like?

How would you describe yourself emotionally?

Also, have you ever been assessed by a mental health professional or received any form of treatment?

Customer: replied 2 years ago.
1) All of my relationships have been very distant. A lot of arguing within my family has resulted in me being isolated from everyone. 2) I was raped when I was 15. 3) Yes. I haven't In the last couple weeks but I have before. 4) I don't think my temper is that bad, but then again I didn't think the sky was blue for a little bit either.... 5) I would describe myself as emotionally unstable. 6) No.
Expert:  Dr John B replied 2 years ago.

Ok, thanks for the extra information.

There is a set of symptoms that we often see develop in people who are the victims of serious trauma during their teenage years. As a set it is often referred to as Borderline Personality Disorder and the information you have provided so far suggests that this may be a possibility to consider. I will post description of the disorder below and wait for you to let me know if you think it may be relevant to your own situation.


The main feature of borderline personality disorder (BPD) is a pervasive pattern of instability in interpersonal relationships, self-image and emotions. People with borderline personality disorder are also usually very impulsive. This disorder occurs in most by early adulthood. The unstable pattern of interacting with others has persisted for years and is usually closely related to the person's self-image and early social interactions. The pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner) in a person's emotions and feelings. Relationships and the person's emotion may often be characterized as being shallow.

A person with this disorder will also often exhibit impulsive behaviors and have a majority of the following symptoms:


Frantic efforts to avoid real or imagined abandonment


A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation


Identity disturbance, such as a significant and persistent unstable self-image or sense of self

Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)


Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior


Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)


Chronic feelings of emptiness


Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)


Transient, stress-related paranoid thoughts or severe dissociative symptoms


Key Features in Detail


Frantic efforts to avoid real or imagined abandonment


The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, emotion, thinking and behavior. Someone with borderline personality disorder will be very sensitive to things happening around them in their environment. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic separation or when there are unavoidable changes in plans. For instance, becoming very angry with someone for being a few minutes late or having to cancel a lunch date. People with borderline personality disorder may believe that this abandonment implies that they are "bad." These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors.

Unstable and intense relationships


People with borderline personality disorder may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not "there" enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will "be there" in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.

Identity disturbance


There are sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, nurturing and support. These individuals may show worse performance in unstructured work or school situations.



Customer: replied 2 years ago.
There are some of these things I can definetly see myself displaying. Others, not so much.
Expert:  Dr John B replied 2 years ago.
Ok. It is certainly possible that a person can have some Borderline traits but not suffer from the full disorder. Regardless, if you are experiencing depressed mood within this context then the standard treatments for Depression will probably not be very helpful. Can you tell me how long a depressed episode might last and how frequently they come and go?
Customer: replied 2 years ago.
They noramlly last about 2 or 3 weeks with about the same length in-between.
Expert:  Dr John B replied 2 years ago.

Has long has your mood been alternating in that manner?

Customer: replied 2 years ago.
Ever since I was raped. So almost 5 years.
Customer: replied 2 years ago.
They started about 5 years ago, but have become more severe in the past couple years.
Expert:  Dr John B replied 2 years ago.

Sorry for the slow reply, I was unexpectedly forced to leave my computer. In terms of the best approach to treatment of these episodes it will be key to determine if they are a primary or secondary symptom. If they are primary and reflect the development of a mood disorder such as Major Depression then the treatment approach I described earlier will be appropriate. If they are occurring secondary (as part of) Borderline PD or Post Traumatic Stress Disorder (PTSD) then the effective approach will be to treat the BPD/PTSD and expect the mood episodes to resolve as a consequence.

Differentiating between what kind of mood episodes these are will require a Psychiatric assessment and you can obtain one of these from either a Psychiatrist or a Clinical Psychologist. If you wish to use a Psychiatrist you can request that your own general doctor arrange a referral for you. If you wish to consult with a Clinical Psychologist you can contact the American Psychology Association (APA) for assistance with locating a Psychologist; take a look at the APA locator service here. You can use this to find Psychologists in your area and there is a phone number you can contact if you want a referral arranged for you. Also, take a look at an article published by the APA here. It's an interview with a senior Psychologist and covers some of the things you should consider when you looking for a Psychologist.

If you have further questions about anything we have discussed so far please let me know and I will happily continue this conversation. If not......I wish you the best of luck!

Customer: replied 2 years ago.
What if I were to not seek treatment and I in fact do have this disorder? What would happen?
Expert:  Dr John B replied 2 years ago.

It is impossible to predict the course of any illness for one specific individual as there is vast variation from case to case. However, I can speak generally about the three diagnoses I have mentioned so far.

If it were to be BPD related then we usually see the mood instability last into middle adulthood before it begins to stabilize (usually when the person stabilizes successful relationships and develops a better understanding of their own emotional functioning). This is of course a general statement and may not apply to any person specifically.

If it were to be PTSD related we would usually expect to see the mood instability persist for as long as the PTSD remains problematic. PTSD can remain problematic for decades, however it does seem to settle after a few years in some people.

If it were to be a mood disorder such as Major Depression then it could resolve, deteriorate or come and go over the years. Unfortunately this is the nature of Depression and it is impossible to give you a more specific prediction that.

Psychological difficulties and the course of Psychiatric Illnesses vary dramatically from person to person. One thing we do see however is that these kinds of problems seem to become more difficult when stress levels are higher. So, if a person has an underlying vulnerability (e.g. problems with low mood) then we often see it flare when there are work difficulties, relationship problems, financial difficulties, moving house, starting a new job, etc.

Let me know if you have further questions. If not.....good luck!

Customer: replied 2 years ago.
And if I do seek treatment? What would happen and would my therapist/psychologist have to tell my parents? I am terrified of them finding out. When I was 11, my half-brother tried to kill himself. Lately I have been feeling the same way but I refuse to act on it because I don't want to be compared to my half-brother.
Expert:  Dr John B replied 2 years ago.

Hi,

I can see that you have listed your age as 19 and so no your therapist couldn't tell your parents anything without your written consent. A you are older than 18 I would assume that they are no longer your legal guardians?

Many people find they are able to make great gains with the aid of proper treatment and I would certainly encourage you to seek help. As I mentioned earlier, the first step is to get an assessment.

Customer: replied 2 years ago.
I don't know if I could handle that. I don't want them to leave me or cut me off completely. They have always been very overprotective and sheltering and honestly, I would die if they found out I was seeking treatment for anything.
Expert:  Dr John B replied 2 years ago.
If you choose to consult with a Psychiatrist or Clinical Psychologist they will be bound by strict confidentiality laws. You could discuss the exact nature of their confidentiality restrictions prior to actually holding any session with them. It is common practice for people to seek reassurances about confidentiality prior to commencing any sessions.
Customer: replied 2 years ago.
What if what I am going through is not BPD or ptsd or a major depressive disorder? What if it is something more serious?
Expert:  Dr John B replied 2 years ago.
It's impossible to diagnose someone via Just Answer but based on what your have written so far they would be my suspicions. Repetitive low mod can occur as part of some medical conditions but the appropriate process of investigation would be to have a Psychiatric assessment first (given that your description fits well with psychiatric difficulty). BPD, PTSD & Major Depression can all be serious illnesses and any clinician will treat your situation and symptoms seriously.
Customer: replied 2 years ago.
Do you mind if I ask a couple of more questions? If not, here they are.

1) What would drugs and alcohol do to my "symptoms"?

2) What if therapy doesn't help? What do I do when I get desperate?

3) What do I do when therapy isn't enough? What do I do when drugs aren't cutting it anymore or when actual cutting isn't working like it used to, to help me cope and keep on going?

4) Only a couple of friends know of what happened to me and what my brother tried to do. My parents won't talk about him, and lately I feel like they are under the false belief that I AM him.
Expert:  Dr John B replied 2 years ago.

Hi,

I'll answer each individually.

1) Likely to make them much worse over time.

2) Therapy would be very much focused on learning new skills that you can use when you do feel desperate. The therapies that have been established for Depression, BPD & PTSD can very effective if delivered well. There is always the possibility for using medications at times of emergency however this is usually used as a last resort with a strong emphasis placed on therapy (for BPD & PTSD, medication plays a more central role in the treatment of Depression).

3) As I mentioned above therapy is very much focused on learning skills to cope

4) You'll have to clarify your question here. I understand that you are saying but I'm not sure what the question is.

Customer: replied 2 years ago.
Do you think if it would be a good idea for me to not tell my family about the issues I have been having and about my past? I am going to school to ha a music therapist/social worker and I just don't know if I want them to know about what happened because I think they will judge me and disown me basically
Expert:  Dr John B replied 2 years ago.

Disclosing this kind of information can be a difficult decision to make. My suggestion would be that perhaps you first start working with a professional so that they can assist you with this very difficult aspect of your situation.

You really shouldn't have to manage all of this on your own and I really do implore you to consult with a professional who can help you through all of this.

Customer: replied 2 years ago.
Would talking to a counselor at my current college help? Like if I talked to them at least once a week?
Expert:  Dr John B replied 2 years ago.

Yes I think that would be a good start. I really think you need some help with all of this, even if it is to get some help deciding whether to consult with a Psychiatrist or Psychologist.

You deserve to have someone on your side so you can begin to work through the situation. I hope you make an appointment with the counselor.

Customer: replied 2 years ago.
I just don't know that it will be tomorrow or even this week. I am just still very uneasy about this whole situation. I just don't get why this happened to me. I have been through so much in my life and now this? It makes me wonder whats next, what else is going to get throw in my face.
Expert:  Dr John B replied 2 years ago.
It certainly is unfair when people experience these things...especially when so young. Try to remember that there are people out there who specialize in helping people in your exact situation and you just need to get there help. Starting by making an appointment with your school counselor is the first step and I hope you make the phone call as soon as possible.
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 2 years ago.
I just don't know what to do right now. I don't like pills and I don't like doctors either (no offense). I just don't know what to do. I don't want my parents to find out because they will look down on me. They don't like people to know about family or personal matters outside of the family. They have always been this way since my brother tried to kill himself. Do you have any advice for this situation?
Expert:  Dr John B replied 2 years ago.

That's Ok.....I don't much like most doctors either!

The thing is....you need help! This is too much for you to manage on your own. It doesn't sound like telling your parents is an option right now so don't. Unless it is a mood disorder (which I doubt) pills won't help much anyway.

That only leaves getting some help. Take it slow and find someone who you do like (or can tolerate). Your school counselor is unlikely to be a doctor anyway so start with them. You may be surprised to find that they are really helpful!

Customer: replied 2 years ago.
And what if I don't think that the counselors and psychiatrists are doing any good? What then?
Expert:  Dr John B replied 2 years ago.
You keep trying with new ones until you find one that does help. You have to approach this situation with hope. Many, many people are able to have low mood (regardless of whether it is Depression, BPD, or PTSD) treated successfully and there is no reason why you won't be able to. Stay hopeful and stay determined.
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
Expert:  Dr John B replied 1 year ago.
Hi DeAnn,

I hope you've been able to get an appointment with the counselor. If I can be of further help, or if you ever have other questions in the future, please don't hesitate to contact me directly. You can do this by simply putting "For Dr John B" at the start of any question you post.

Regards,

John

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