Ask a Psychiatrist and Get Answers to Mental Health Questions ASAP
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 ofDepression.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 uptakeInhibitor)
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, systematicprocedure. 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 forDepression; A Step by Step Program as good places to start. You can find themboth 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 Depressionthen you should consult with a Psychiatrist about commencing an anti-depressantmedication.
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.
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?
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.
Has long has your mood been alternating in that manner?
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!
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!
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.
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.
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.
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.
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!