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i'm in a quandry because i don't know which direction to go in.
Hi! I believe I can be of help with this issue.
I can imagine how frustrating this situation must be for you. You are having no energy but you're unable to fall and stay asleep. Let's address the medications issues.
When you say THC I am assuming from your first posting that you mean the THC in smoking or ingesting marijuana, not that you're taking some concentrated form, okay? The normal THC content in cannabis is not known to have interaction effects with these medications. There's no research and no reported cases showing interaction effects.
The next issue, though, is that you're taking quite a cocktail of medications this past week from what you wrote. If it is only one week, you may find that some of the reduction in energy will even out. But there is an important discussion to have with your psychiatrist about consolidating the medications regime. These medications do interact and heighten each others' effects. The dosages were probably calculated by your doctor with this in mind. However, you should discuss this as you're showing some possible symptoms of overmedication.
Finally, you may want to do the counterintuitive but more effective thing with the marijuana: you're smoking more and getting less benefits. Of course, that means you've built up tolerance to the drug. So the self medicating is becoming counterproductive as it increases your anxiety each day it doesn't do what you want it to do. You might, therefore, consider using marijuana only occasionally and/or strategically. For example, only 1-2 days a week to heighten its medicating properties and only in the evenings when you're preparing for rest states.
You might also consider adding a behavioral component to your treatment for your depression and anxiety and/or Bipolar Disorder. While behavioral treatment requires more effort from the patient than medications and is not as quick acting, it doesn't have the side effects nor withdrawal symptoms of the medications. If you would like to introduce a behavioral treatment, feel free to ask me another question about it. Just write “For Dr. Mark” at the beginning and everyone will know it’s for me.
Okay, I wish you the very best!
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You are looking for some sort of direction. That's good. I am not judgmental about self medicating; it's an attempt as a person to somehow feel better when the medical system isn't succeeding. Okay. There is the problem of overmedicating and we dealt with that. But again, you're also a human being and the problem as an expression of human problems needs to be considered as well. We want to come up with a coherent program that will include medications and behavioral treatment. The six components of a total natural care program are: herbal remedies or meds, diet, exercise, motivation, spiritual life, and psychotherapy.
Meds and herbal remedies: You're on meds now and you're not going off them at least for a while. So this part is for the future in the sense of giving you hope and implanting the idea that you are allowed to work toward not needing medications your whole life. When you be done with medications, St. John's Wort is the only herbal remedy that has any clinical evidence supporting its effectiveness for depression. Other "products" claim to, but in the psychological literature, this is the only remedy accepted as having significant evidence. IMPORTANT: do not take St. John's Wort with any antidepressants. This is important, because SJW is a medication so to speak and needs to be treated as such. And with other meds, talk to your doctor to make sure it's okay. At one point if you are able to reduce your meds to a large extent, you might already start with SJW under doctor's supervision. You may at one point want to find a psychiatrist who is more "holistic" and not very rigid about the medical model.
Any other herbal remedies are going to be a matter of whether you want to try it for the cost. Remember: no "natural" remedy is going to have the quick and powerful effect you will see from the medications--but not the side effects or withdrawal effects either.
For anxiety, I'm going to make two herbal recommendations. This is because I know there is SOME research evidence for these two herbs. However, it is not that conclusive or even impressive. But it is some and they have the following going for them: in the cultures they come from, they are traditionally used for anxiety. That's encouraging. The first is Black Cohosh, the root of which was used by Indians in our country. The second is Kava, sometimes called Kava Kava, which is from the Pacific Islands. Again, these herbal recommendations are secondary to the medication treatment unless medications show they are not working.
Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. And lean meats only. No fast food restaurants, no fatty foods. Weight Watchers is a good option, especially for the support of meetings but also the tools on the website, if you need to lose weight.
Vitamins can be useful for moods. A good quality daily vitamin, for example. One of the most important supplements is Omega 3 fatty acids, either in fish oil or capsules or in flax seed oil. Buy good quality. The clinical dosage is 1,600 mg to 3,000 mg daily. Try the higher end of the range if you can afford it. Omega 3 is the main supplement. The research on it and depression is conclusive. All these things you should get at the biggest and most frequented health food store and ask them for the best brands they trust in terms of quality.
Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Your doctor will verify the research results showing the benefit. Making the time for this will in itself help you deal with all the embarrassments and strain of what's happening.
Motivation: I recommend you apply the principles in the following videos and books. So that you can be yourself with more confidence and share it with others. 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":
Some like Tony Robbins are the classic big guys. Some are newer. There are now wonderful women speakers as well. 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.
Spiritual life: the medical literature is now rather overwhelming about the benefits to so many different areas of physical health of regular religious and spiritual practice. Going to church, meditation, etc. are all shown to produce benefits to the physical body. What about our mental health? Well, you will see that meditation is now a regular part of psychotherapy interventions. I don't know if you're a religious person or not. But if not, this may be a good time in your life to tune up your spiritual life. If you do not believe in G-d, that's not a barrier to your own spiritual life. Just thinking about the meaning of your life, of life in general, and studying spiritual texts and practices will help with the anxiety and depression.
Psychotherapy: this requires to have you orient your thinking about depression and meds and remedies as treating the symptoms of your anxiety and depression and that it is important to treat your situation as a HUMAN problem. This would mean making your focus of your "work" be on exploring your emotional reactions, your history and behavior patterns you've learned from your history, and your negative thinking you've adopted from your history. We have emotions because they are part of how we grow and learn and become more fulfilled. But if we keep trying to get them just to go away without ever exploring what's going on, we NEVER get that chance to get anything important from them.
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. You need to feel comfortable with the therapist 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 along with psychodynamic therapy in their orientations and depression and anxiety disorders as one of the areas they work with. http://therapists.psychologytoday.com/rms/
In your situation, you are seeking someone who isn't as structured as a pure CBT therapist, and that's why the psychodynamic therapy is important to be in their orientation, which is a more insight based therapy. In psychodynamic therapy you are looking at the causes of your behavior, your history, and its effect on you. 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?
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:
Dr, Mark, thank you for all them positive reinforcements, and the idea of being holestic would be a miracle, but I do hope to one day see that day!
Thank you again for your professional info.