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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5110
Experience:  Dr. Mark is a PhD in psychology in private practice
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I feel as if I am on a roller coaster. i have been diagnosed

Customer Question

I feel as if I am on a roller coaster. i have been diagnosed with depression and prescribed 75 mg of Zoloft. However, I have a hard time getting motivated. I really just want to sleep. I'm not really worried. Just down. What do I do?
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Mark replied 1 year ago.

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. How long have you felt this way?

Was there a definite trigger event? Meaning, did something happen that started you off feeling down?

We have to make sure there are no biomedical problems going on. Have you had any testing done for thyroid function, nutritional deficiencies, allergies, etc.? All these can cause tiredness. Have you been tested for mono?

Now let's move on to psychological areas: was there trauma or abuse in your childhood? What about alcohol or dysfunction in your family when you were growing up?

You write you are in counseling; what type? How is it going?

Any extra information that will help, feel free to share.


Dr. Mark

Customer: replied 1 year ago.


I don't know if I necessarily had anything trigger it. I work full time as a bill collector for a major credit card company, and I go to school online full time as well. I often look at my work load and just want to give up. I have no motivation to complete it. I've dealt with lack of motivation for as long as I can remember. There has been verbal and physical abuse in my household as a child. I was in counseling with a clinical social worker it was going okay but I only went to about 5-7 sessions. It often felt like conversation and did not delve into pain as much as I would have like it to. (Pain meaning childhood) Now that I think of it, my oldest sister whom I am closest too is moving to Germany for 3 years along with my only niece and nephew. I have recently moved out of my parents home and am now living on my own with a roomate.

Expert:  Dr. Mark replied 1 year ago.

Thank you for the replies to the questions and the added information. It helps a lot in understanding what the situation is. I believe I can now be of help with this issue.

I can imagine how frustrating and overwhelming this situation must be for you. You started out describing depressive symptoms that seemed to have no life-events causes; this then showed itself to be stemming most likely from childhood in a dysfunctional and abusive environment. Your experience with therapy, even, where you wanted intuitively more to delve into your childhood seems to confirm this.

I still, though, want to make sure we are thorough here. Because you are a young lady and so we need to make sure that there are no physiological problems accounting for these symptoms, okay? That means you need to go to your doctor and to report the symptoms of being down and sleepy and tired. And ask for the testing for thyroid function, nutritional deficiencies, mono, etc. The doctor will know what needs to be tested for.

Let's proceed as if there are no physiological problems. Because that's how you started out: with your physical symptoms. But then you began to open up the interior person of who you are: and all of a sudden the depression became reactions to your to your childhood and outward expressions of very important hurtful and meaningful inner realities. And the more your wrote, the more it seemed as though you want very, very much to focus on those inner realities, to understand them more, to let them flourish.

This is in contradistinction to the more CBT approach you briefly had with the social worker, which you have not had success with. And you seem ready to explore that inner world of insight, gaining insight into yourself. So let's start with some broad areas of insight. But I also want you to know that I'm going to include a technique for you to use when there is depression and some anxiety. I know you said that worry is not a problem. But it sounds as though this is because you have repressed a lot of feelings from your childhood. The more you open yourself to your inner feelings, the more you may experience anxiety as well as depression. So I'll put it at the end of my answer. It's not a cure, it's a simple technique you can use throughout the day.

You are clearly a competent and capable woman and this is a wonderful thing. But you are also an Adult Victim of Child Abuse. You say it was physical and also emotional abuse that was part of a dysfunctional family, and so the trauma is there. And that trauma has led to a lifelong set of feelings and thoughts about yourself that have kept you from being able to be fully alive and fully loved in your own eyes.

So, there is one thing that seems more certain: the childhood trauma and drama of the dysfunction and abuse. I want to discuss with you something that you can take to therapy with you:

The first thing is something called Adult Victim of Child Abuse (AVOCA). One thing that AVOCA adults have in common:

They do not have a sense of normal. They fluctuate between feelings that are difficult for them at best. And another thing they have in common: deep within they feel totally unworthy, tremendous shame, undeserving. They fear bringing things out to the open very much. And much of these feelings are below the surface for them. They just feel rage alternating with shame most of the time. This can lead to anxiety as well as depression, easy to anger, self blame, etc.

For AVOCA, start with these sites and you can do lots more searches to find other sites. But remember, some are going to be commercial.

http://www.havoca.org/HAVOCA_home.htm

http://www.wearesurvivors.org/

http://www.ascasupport.org/

Next, a book: Toxic Parents: Overcoming Their Legacy and Reclaiming Your Life by Forward and Buck. It's a classic and easily available online or in libraries. I don't know the role of your parents but I thought I'd share the name of this book with you.

Here is a chart from the HAVOCA website that will give you the idea.

From Victim to Survivor to Thriver

Victim

Survivor

Thriver

Doesn’t deserve nice things or trying for the "good life."

Struggling for reasons & chance to heal

Gratitude for everything in life.

Low self esteem/shame/unworthy

Sees self as wounded & healing

Sees self as an overflowing miracle

Hyper vigilant

Using tools to learn to relax

Gratitude for new life

Alone

Seeking help

Oneness

Feels Selfish

Deserves to seek help

Proud of Healthy Self caring

Damaged

Naming what happened

Was wounded & now healing

Confusion & numbness

Learning to grieve, grieving past aggrieved trauma

Grieving at current losses

Overwhelmed by past

Naming & grieving what happened

Living in the present

Hopeless

Hopeful

Faith in self & life

Uses outer world to hide from self

Stays with emotional pain

Understands that emotional pain will pass & brings new insights

Hides their story

Not afraid to tell their story to safe people.

Beyond telling their story, but always aware they have created their own healing with HP

Believes everyone else is better, stronger, less damaged

Comes out of hiding to hear others & have compassion for them & eventually self

Lives with an open heart for self & others

Often wounded by unsafe others

Learning how to protect self by share, check, share

Protects self from unsafe others

Places own needs last

Learning healthy needs (See Healing the Child Within & Gift to Myself)

Places self first realizing that is the only way to function & eventually help others

Creates one drama after another

See patterns

Creates peace

Believes suffering is the human condition

Feeling some relief, knows they need to continue in recovery

Finds joy in peace

Serious all the time

Beginning to laugh

Seeing the humour in life

Uses inappropriate humour, including teasing

Feels associated painful feelings instead

Uses healthy humour

Uncomfortable, numb or angry around toxic people

Increasing awareness of pain & dynamics

Healthy boundaries around toxic people, incl. relatives

Lives in the past

Aware of patterns

Lives in the Now

Angry at religion

Understanding the difference between religion & personal spirituality

Enjoys personal relationship with the God of their understanding

Suspicious of therapists-- projects

Sees therapist as guide during projections

Sees reality as their projection & owns it.

Needs people & chemicals to believe they are all right

Glimpses of self-acceptance & fun without others

Feels authentic & connected, Whole

"Depression"

Movement of feelings

Aliveness


So, if this seems like you connect with it and the resources, bring it up in therapy. Make it part of your therapy to really get closer to that "self" that had to hide deep within in childhood.

I also want to recommend to you the books of John Friel, which are readily available online. Start with Adult Children: The Secrets of Dysfunctional Families.

I don't mean for my answer to be so long, but I also want you to start to focus on the positive direction you DO want to move in, not just insight into the negative past that got you here. So there are some areas I'd like to suggest for exploration:

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 depression.

Then along with exploring the spiritual part of life, I want you to get really into motivational videos and books. Here's a simple YouTube search I put together for you on "motivational speakers":

http://www.youtube.com/results?search_query=motivational+speakers&aq=f



Some like Tony Robbins are the classic big guys. Some are newer. There are great 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.

Which brings us to psychotherapy. You need to find a psychologist or psychotherapist to help you manage the anxiety. This is for the phobic/panic reaction you are having as well.

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 psychodynamic therapy in their orientations and depression as one of the areas they work with.

http://therapists.psychologytoday.com/rms/


Interview the person and make sure you are confident with them and that they are familiar with the concepts we've been discussing. 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 and panic reactions.

Okay, that should help you get working on these symptoms and get some relief. I wish you the very best!

Now, I want to give you a tool to use for when the depression or anxiety are present. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety, 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. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. 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 in anxiety states is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack 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?

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. If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, Dr. Mark


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

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:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

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. If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, Dr. Mark

Expert:  Dr. Mark replied 1 year ago.

Hi Ericka. I see you've viewed but 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

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