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Dr. L
Dr. L, Psychologist
Category: Mental Health
Satisfied Customers: 1166
Experience:  Psychologist, Marriage and Family Therapist
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I am going to try to keep this concise without leaving out

Resolved Question:

I am going to try to keep this concise without leaving out anything important

I am a 25 y/o female who has been struggling with depression and anxiety since 18. In the past I have been prescribed (by different doctors, some GP's some psychiatrists): seroquel, celexa, ativan, Zoloft, lexapro, and effexor.

The most recent combo of Effexor (150mg) and Ativan (1mg as needed - which is now about 3 x a week or so) seemed extremely effective for a while especially with the anxiety which most of the others really did nothing for.

I am concerned because lately I am extremely withdrawn. It seems to be a reaction to a failed relationship (not a long one - we dated roughly 1.5 months). I knew i was withdrawing deep down, but it wasn't until my psychiatrist asked me if I had become withdrawn that I realized the truth was yes. I no longer seek the company of anyone. When my friend cancelled on me the other night, I was EXTREMELY relieved. I don't even like sitting in the living room of my two bedroom apartment - I prefer my bedroom even though it has no tv. When my room mate, who I have lived with for 2 years now and consider family, is home I will say hi and chat a bit but its momentary I always wind up back in my room with the door shut.

When my psychiatrist asked me if i became withdrawn after the "break up" I don't know why but I answered in a misleading way - suggesting I was withdrawn a few weeks ago but am much better now. As soon as the words left my mouth I knew it wasn't really true.

My psychiatrist suggested we meet in 4 weeks to discuss things and reassess before adjusting dosages. I don't know how I feel about increasing my dosage.

Is there anything I can or should do between now and my next appointment to try to curb this urge to curl up in a ball and stay in bed 24/7? Please note this is unlike times where I was taking to the bed because I was sad and crying. I literally feel like I don't want to see anybody or do anything, so doing nothing is in a way what makes me happy. But the happiness is, understandably, interrupted by feelings of extreme loneliness. So it's like a constant tug of war almost - I take turns feeling desperately clingy and longing for solitude. I really don't want to contact my doctor before the next appointment, as this certainly isn't an emergency, but I was hoping I could get some professional feedback in the meantime (and sometimes a different perspective is also helpful IMO). Should I be concerned? Could this be the effexor (which seems odd and scary since it has been a lifesaver for me prior to this)?

Just please don't say diet and exercise I already do those.

Thank you, XXXXX XXXXX is greatly appreciated!
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. L replied 1 year ago.

Dr. L :

Hello,

Dr. L :

I would like to help you with your question. I can understand why you are confused by your behavior and wanting to get some reassurance about what is happening and also some guidance.

Dr. L :

The tug of war that you describe sounds like ambivalence..that is, you feel comfortable being alone..but then after a while the loneliness is too much for you and you want people. So you vacillate between those two states of wanting loneliness and wanting contact....with neither state feeling fulfilling for very long.

Dr. L :

Can you tell me what you are saying to yourself when you don't want to see or be with anyone? And..what do you say to yourself when you want to see and be with others?

Customer: When I don't want to be seen with anyone, I am most often thinking "you should go." Or something like that
Dr. L :

The "do nothing" you write of puts you in a position of not having to make any choices. You get to "exist"...and basically stay numb. Is this right?

Dr. L :

Tell me a little more about what "you should go" means...

Customer: Correct... When I am "doing nothing" I most often escape somehow I think. I will watch tv, sleep, daydream
Customer: "Should go" meaning that if someone was kind enough to reach out and invite me I should accept
Dr. L :

Thanks.

Customer: Because if I don't some day the offers will stop altogether
Dr. L :

so...the do nothing is a place of rest...where you can maybe recharge your batteries...

Dr. L :

where you can "be" without any pressure to act or think or talk or do anything...

Customer: True but I don't believe this is a normal amount of recharging. Especially since I have not been doing much aside from working
Dr. L :

And the "should go" is like a voice of warning that says....take the invitation because if you don't some day there will be no invitations...

Customer: Correct
Dr. L :

The amount of recharging we need is dependent on many things. It could be related to the antidepressant medication, it could be the time of year and the fact that the amount of sunshine you are getting (Vitamin D) is low, it could be related to hormones level, etc. etc. So "normal" is really hard to define. Have you been seen by a physician lately? Depression does effect energy levels.

Dr. L :

Have you ever engaged in psychotherapy?

Customer: I had seen a physician within the last year and was given a full physical. Everything was normal. He suggested if lexapro didn't ease my anxiety that I see a psychiatrist.
Customer: I have been in therapy since I was roughly 19. Started when I was in college. Though I do question the quality of my therapist as it is the learning clinic for grad students
Customer: The reason I went to the schools counseling center at the time was for help with an eating disorder. The clinic was free for students and confidential
Customer: I remained there because I worked with one therapist for about 4 years and we became very close. About a year ago she had to leave
Dr. L :

Yes...I am familiar with these counseling centers and you are correct in questioning the professionalism and skills of the therapist.

Customer: I was given another therapist and I do sometimes debate, now that I have my own medical insurance, seeking out a psychologist
Dr. L :

Are you feeling that therapy would be beneficial again?

Dr. L :

Study after study shows that the best prognosis for depression is medication and therapy.

Dr. L :

I would encourage you to get back into therapy...this time with someone with a higher skill level - a licensed psychologist.

Customer: It is ironic, because ambivalence seems to be a recurring theme! In order to seek out a licensed psychologist that means 1) terminating with my therapist at the clinic and 2) finding a new person and starting from scratch.
Customer: These are the aspects that prevent me from taking action I already know rationally would be helpful
Dr. L :

I am glad you can see the pattern! Yahoo!

Dr. L :

Sometimes starting from scratch really gives us the opportunity to take a fresh look at what is going on in our life and benefit from a new, unique perspective offered by the new therapist.

Dr. L :

I am going to make things simple for you and give you a wonderful resource from which to locate a new therapist:

Dr. L :

www.psychologytoday.com

Customer: Thank you
Dr. L :

On the home page, you will see an icon on the top bar that says: Find a Therapist.

Dr. L :

Click on the icon and you will be asked to put in the name of your city and/or zip code. You will then be provided a list of therapists. On the left hand side of the page you can chose from a number of specialties.

Dr. L :

Go through the list of therapists...read through the bios...check out their personal websites (if listed).

Dr. L :

I trust you are savvy enough to find 2-3 that look good to you. Call them...ask them about their experience with clients like you. Set up an appointment and go from there...

Customer: Okay great. Thank you. I am wondering what your thoughts are on seeing both a therapist and psychiatrist? See it was my hope that upon finding a psychiatrist I could also receive therapy but it seems very few psychiatrists do much psychotherapy
Dr. L :

You are exactly right...very few psychiatrist do psychotherapy....so the best plan is a psychiatrist to work with the medication side of the things and a psychotherapist to work with the emotional side of things.

Customer: Do you think it is beneficial if I plan on taking medication and am going to be forging a new relationship anyway, to seek a new psychiatrist that will also do psychotherapy? Or is it more beneficial to keep one existing relationship constant
Dr. L :

I suggest you stay with the psychiatrist and find a psychologist. The reality is that there is a shortage of psychiatrists in the U.S. and an even greater shorter of psychiatrists who do therapy. So...if you already have a psychiatrist you are working with...stick with him/her.

Customer: That is very sound advice. Thank you!
Dr. L :

You are very welcome!

Dr. L :

Is there any last question I can help you with?

Customer: No I think that should be all. Thank you again!
Dr. L :

You are welcome!

Dr. L :

Good night!

Dr. L, Psychologist
Category: Mental Health
Satisfied Customers: 1166
Experience: Psychologist, Marriage and Family Therapist
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