Ask a Psychiatrist and Get Answers to Mental Health Questions ASAP
Hi! You know, to give you the best answer, I think I should ask you a few questions first that will help define the problem and the situation.
Your question is very evocative that there is so much behind the simple few words you write. Have you always felt this way?
Was there trauma or abuse in your childhood? What about alcohol or dysfunction in your family when you were growing up?
Are you interested in medications to help? Or self help techniques? Or psychotherapy?
Are you getting any treatment right now? If so, what type? How is it going?
If not, when was the last treatment? What type of treatment was it? Was it helpful?
Any extra information that will help, feel free to share.
Please go ahead and post your response. I'm going to be going into therapy sessions in my office soon, so if I can't answer before that, would later today be okay for me to respond?
You are looking for some sort of direction. That's good. I am very much in favor of medications. They can be a boost when you're depressed. But I'm also concerned that doctors just dispense them as if they are solutions; and rarely is that the real situation. The person still feels unhappy and stuck, but not so depressed. But that is an advantage if you see it as just 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, 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. I believe they have a strong presence in the UK.
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. They are mostly Americans, but so what? 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!
The NHS is not very comprehensive or quick with therapy, so you might want to contact a psychotherapist on your own and see if they will work on a sliding scale if private service is difficult. If your doctor isn't able to refer to anyone, here is the web address for the UK association of humanistic psychotherapists. Ask them there if they do CBT work as well as humanistic therapy or if they can refer you to someone. Here's the web site; they have a search for therapists there. http://www.ahpp.org/
Here is the British Psychology Society's directory. I don't know how receptive anyone there would be to a reduced fee but you can still ask. Don't be embarrassed:
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?
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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:
Hi, Claire. I see you haven't responded yet to my answer. I would be very interested in hearing back from you on whether you thought my response was on target or if we need to continue with further clarification. My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons.
Let me know, Dr. Mark
Hi. This thread with your question and my answer will soon time out. Before it closes, though, I would be very grateful if you could go back and give my efforts a positive rating. If you would like to continue the discussion, that would be very welcome. But if you feel that you don’t need to, then please consider giving a positive rating.
My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons.
Thank you, Dr. Mark