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Ask Dr. L Your Own Question

Dr. L
Dr. L, Psychologist
Category: Mental Health
Satisfied Customers: 1166
Experience:  Psychologist, Marriage and Family Therapist
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I was diagnosed with post-partum depression back in 2005.

Resolved Question:

I was diagnosed with post-partum depression back in 2005. I was on Zoloft for this condition for a couple of months. When I was pregnant again in 2007- I was placed back on Zoloft and not taken off the medication by my psych which my OB referred me to. I repeatedly told her I wanted to come off and she decreased my dose to 50mg. I was on 100mg. From there I weaned myself off back in Oct 2012. I was doing really well until April. I do not know why I went back to my scheduled appt after coming off and not cancelling. She had told me I was suffering and could not be trusted to get help when I needed it. It was after that appt that all hell broke loose. I began to doubt myself and all the questions she asked to diagnose me came true! I began not being able to concentrate at work, had racing thoughts, started crying, etc. Then I was unable to sleep. I crashed and started to get these adrenaline rushes- which I know now are panic attacks. These progressively got worse and I was unable to sleep for days. I went in to my primary care MD instead because I believe the psych triggered this episode and my self doubt. She has placed me back on Zoloft, and put me on Seroquel for sleep. Stated that 50mg has worked to help the insomnia in certain people and gave me lorazepam for anxiety. My question is this:are the panic attacks the bodies way of compensating for the depressive episode? Are they related? How long will it take to get back on track? And now that Seroquel has been added will I have to be on that for life too? She has stated that her plan is to increase the Seroquel so I can sleep without the lorazepam and then wean me off the Seroquel. I am skeptical due to the fact of what has happened to me in the past. I have read the side effects of this drug and weaning sounds very difficult and am not sure I want to increase to dose at all. (I have been on this for about a month now.) I would like to totally come off it before it is too late. Once your body gets used to these meds can you ever come off?
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.

Dr. L :

I am sorry that you are experiencing depression, insomnia and anxiety. I do understand how challenging it is to depend on medication to stabilize your mood. Let me address the questions you asked:

Customer:

thank you

Dr. L :

First, you asked about the panic attacks compensating for the depressive episode. Panic attacks are about fear. When I read what your experience, it would seem that what might have happened is that you became very fearful about life because of the self-doubt that crept into your thinking based on what the psych told you. I must say that I am very sorry that you were told that you were suffering and could not be trusted to get help. That seems not only hurtful, but unfair. You had already been treated for post-partum which would have indicated that you knew how to seek help.

Customer:

So this was the trigger

Dr. L :

It certainly sounds like it to me.

Dr. L :

After your first episode of post-partum and medication you did fine. Correct?

Dr. L :

But it was the 2nd experience and the psych telling you basically that you couldn't trust yourself that the trouble began.

Customer:

Yes. They put me back on after my 4th pregnancy

Dr. L :

Often times we take the word of a professional over our own. It's like we give away our power to them.

Dr. L :

It seems to me that you said to yourself, "This psych knows me better than I know me. They think I can't be trusted. And then you developed these fears about yourself...couldn't sleep...etc. etc.

Dr. L :

I hear you when you say that you do not want to be depend on medication for life.

Dr. L :

Have you had any individual therapy? Was that suggested?

Dr. L :

The best approach to depression and anxiety is a combination of medication and individual therapy. The medication to address what is biologically happening in the body, the therapy to address your emotional life.

Customer:

What do I do about this? I wake up with panic attacks and basically have 3 a day which lasts very long. The morning heart rate finally slows down around 2:00 pm. I have had individual therapy in the past and was also screwed over by the same people.

Dr. L :

Thanks for your response...

Dr. L :

To address the anxiety you need to understand and face the fears. So...when you wake up with anxiety what are you saying to yourself? What are the words and thoughts you are having?

Dr. L :

Let's see if we can't make a little progress here this morning...

Customer:

I basically think here we go again. Will this ever stop

Dr. L :

While you are typing I'm going to answer your other question: can you ever come off these drugs. That answer is yes. One can always be weaned.

Dr. L :

And the here we go again is what...I've woken up anxious again and I don't know if there will be a day when I wake up without those feelings?

Dr. L :

Is that right?

Customer:

yes

Dr. L :

Okay. So what I hear is that you are stuck in this pattern of anxiety and what you know believe right now is that there is no escape from this horror. Is that right?

Customer:

This has been going on for over 2 months now. I feel fatigued and yet I can not sleep because I can not relax

Dr. L :

And that every day will be the same...anxiety...anxiety...anxiety...calm around 2 pm.

Customer:

and then stress before bed

Dr. L :

Yes...the sleep issue is related to the anxiety and negative thoughts. Sometimes we try to stay awake so that the "nightmare" doesn't start all over again in the morning...because we know and believe it will just start all over again.

Dr. L :

What is the stress before bed?

Dr. L :

Tell me more about this please.

Customer:

That I will not be able to sleep and this will start all over again

Dr. L :

Do you see the cycle you are in?

Customer:

Yes. I do not know how to break it

Dr. L :

Understood.

Dr. L :

To sleep you need to be able to relax and you are just not able to do that at this point in time.

Dr. L :

You are too keyed up and unable to let go of the fear.

Dr. L :

Let me ask you this....do you feel physically and emotionally safe? Please think about that carefully...physically safe meaning that you feel protected and away from any physical harm. Emotionally safe meaning that you feel safe to share your emotions with your partner and others.

Dr. L :

Emotionally safe also means that you feel understood and cared about.

Customer:

My husband has been really supportive but he know thinks that I am mentally ill and need my medication to get better. I also sometimes feel my family is sick of me talking about my issues

Dr. L :

Thanks. When you used the word mentally ill in the above statement...tell me what that means to you.

Customer:

labeled and judged

Dr. L :

And yes...for now you need medication in order to stabilize and deal with the emotional upheaval in your life.

Dr. L :

Yes...I thought that's what you meant. And those are very negative words...words that likely leave you feeling inadequate, damaged, and maybe even "bad"...

Dr. L :

Is that right?

Customer:

yes

Dr. L :

It is important for you to know that many, many women suffer post-partum after giving birth.

Dr. L :

It is nothing you did to make this happen. It is a biological function because of the changes in hormone levels that occur after birthing.

Dr. L :

You are NOT a bad person for having post-partum. You are merely a woman whose body took some time to re-adjust hormones. The percentage of women who have post-partum is extremely high. Some get help...others struggle alone and try to manage on their own...You chose the healthy path...get medical attention to relieve the symptoms and give your body the opportunity to re-adjust.

Dr. L :

There is no shame in post-partum. It is a natural phenomenon.

Dr. L :

And...you are not mentally ill in the way you are thinking.

Customer:

why did she wait 5 years to take me off the Zoloft and I finally had to do it myself.

Dr. L :

Right now you have some emotional impairment and you are working to solve this with medication. AGain...a very healthy choice.

Customer:

How long will this take to conquer

Dr. L :

I hear your frustration. I wonder the same thing. But because I don't have access to your records, nor are we face to face...I have no answer. I am sorry. It would seem that you should have gotten better care.

Customer:

do you think if I confront that psych that it would help me

Dr. L :

You wrote that you had a bad experience with the therapist you saw. Is there any possibility of seeing someone entirely new? Someone with the right credentials and skills to help you.

Dr. L :

Let's think about that idea a minute.

Customer:

I do not know....trust in the system is really an issue

Dr. L :

Confronting that person might help you take back your power. What you essentially did was to give that person the authority to control your life. Now you realize that choice left you filled with self-doubt, so much so that you can't sleep and have anxiety.

Dr. L :

Do you feel that you could sit down with this person and stay in control of the discussion? In one respect, you were manipulated into thinking you were weak and incapable. Do you feel strong enough to stand up to this person and tell them how wrong they were about you?

Dr. L :

And yes...trust is a big issue here. That psych violated your trust in professionals.

Dr. L :

And that will take some time to repair.

Dr. L :

The down side of confronting the psych would be that you would not feel strong enough to voice your concerns and you would be re-wounded.

Customer:

I do not know if I am strong enough at this point but I almost feel that it may be necessary to do so but I am not sure I could do that face to face

Dr. L :

Okay. Would you be able to write down your thoughts and feelings? And then mail them to this person?

Dr. L :

Or would you be able to do a face to face if your husband or another support person were with you that would make sure you got everything off your chest?

Dr. L :

Please also know that you have the right to file a complaint with this person's licensing board.

Dr. L :

That might be another way for you to reclaim your power.

Customer:

I could do the mail thing. I think I would start crying if it were face to face and I think it would be costly and hard to set up. I know she would not see me for free to solve this

Customer:

I had not thought about filing a complaint. Would they go over my medical records if I did that

Dr. L :

Well...the tears would be healing tears for sure. Because underneath the anxiety and depression is a whole lot of sadness.

Customer:

I know

Dr. L :

They could demand your records from her, but you would have to sign a release of information...a standard form.

Dr. L :

Are you okay with having them see your records?

Customer:

If I did not sign a release than they would not be able to see them? Correct? I really do not want people to go over my records. They are personal

Dr. L :

As I think about healing for you and a return to healthy functioning, I think you really need to address the sadness. You have been "ripped off"...you have been kept on medication when you likely could have gotten off, you have been told to not trust yourself...and there is much more of course. This would be the role of a good therapist...to help you uncover and deal with the sadness.

Dr. L :

I understand. The review of your records would be done by professionals whose only interest is to document what the psych did or did not do. They would not be reading them to understand you personally...the entire focus would be on the psych's actions.

Dr. L :

They would want to know if she made the correct diagnosis and treated you according to standard protocols. It would all be about her.

Customer:

I can bet you a million dollars she did not document those comments she made to me

Dr. L :

And you are very likely right about that! Still..they would be able to look at how many visits you had, how well she monitored your medication, the length of time on medication and such things.

Dr. L :

For them it is about process...and if she followed the correct process.

Dr. L :

Certainly they would want to hear what you were told and how her words impacted you.

Dr. L :

And they would likely comment on that as well. I would trust that they know the file does not contain all that was discussed!

Dr. L :

So...one thing I would like you to do each day upon rising is to spend a few minutes writing down what fears you have that morning. Put them on paper. Look at them and decide if they are true or not. Most often our fears are unrealistic and will never happen. So putting them on paper gives us a chance to see them in black and white and think logically about them.When they are floating around in our head they seem much bigger and more real then they really are.

Customer:

I can do that

Dr. L :

Great!

Dr. L :

Do you believe that this will help.

Customer:

I will try anything at this point. I wonder if I called her if that would be able to help. I think doing one of the things we discussed will help me put this behind me. I did tell my primary care MD and she was very apologic and upset that the medical field did that

Dr. L :

I'm glad to hear that you got validation from your primary! That validation was important.

Customer:

It did feel good but still have the panic attacks upon waking maybe confronting her is the best course

Dr. L :

A phone call might be another strategy to consider. Again...I would urge you to have a support person with you to ensure that you are able to get things off your chest and not be further manipulated or hurt.

Dr. L :

It does sound like one of the biggest stumbling blocks for you right now is this person. She robbed you of your confidence and that set the stage for this terrible battle you have been waging.

Dr. L :

Telling her how she harmed you would seem to give you fresh confidence in yourself and help you trust yourself again.

Dr. L :

Also...writing down your fears when they come...and examining whether they are true or not will also boost your confidence by putting you in control of your life.

Dr. L :

And that's the biggest change that needs to happen...you need to be in control of you!

Dr. L :

I would encourage you to reconsider therapy when you feel ready to take that step. Processing all the hurt and anger will be extremely beneficial. At the same time, you need a thorough medication assessment. Often physicians do not have adequate training in determining the best medication for anxiety and depression. That is the role of a psychiatrist. A second opinion on this is warranted given the fact that you are taking several medications at once and are concerned about prolonged use.

Customer:

Do you think talking to a priest would help just as well as a therapist? I just do not know if I could trust someone again

Dr. L :

Truthfully, unless the priest has had training as a mental health professional they will not have the same level of skill. However, if you feel emotionally safe with your priest..then by all means talk to him. What you need here is validation....someone to hear you out and to offer you comfort and understanding.

Dr. L :

Perhaps in time as you become stronger...a therapist will make sense. But for right now I hear you saying that it's too big a leap. That's fine. No pressure. No rush.

Dr. L :

I do want you to consider getting a 2nd opinion on the medication though. Unless you really trust your physician and feel that they are understanding your concerns, I think getting a review of what you are taking and how it is working..or not working...would be important.

Customer:

Thank you so much for your time and understanding! It has helped me put things into perspective and to work on the underlying cause of my fear. Uncovering it is a big step and I appreciate your help with that. Are those medications usually prescribed for this condition

Dr. L :

Yes. The medications you are taking are typical. But what must be considered is what your symptoms are, how these medications work in combination, how your individual body reacts to them, what is the correct dosage for your body and your symptoms, and so forth. So by saying that these are typical medications that only addresses part of the story.

Dr. L :

The use of medications is much more complex.

Customer:

I understand. Thank you again for your help. I will think about the 2nd opinion

Dr. L :

I am glad I was available to help you this morning! I appreciate your willingness to respond to my questions and to be so open and honest about your experience.

Dr. L :

If you should ever want to chat again, just ask for me by name.

Dr. L :

Take care!

Customer:

thank you

Dr. L :

You are very, very welcome!

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