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Ask Dr. Z Your Own Question

Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5099
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I feel like I have been wrongly diagnosed with major depression.

Customer Question

I feel like I have been wrongly diagnosed with major depression. I have epilepsy and then was diagnosed with major depression. But I am having a lot of symptoms and I feel like I have been wrongly diagnosed
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.

DoctorZ :

Hello I believe I can help you with your concern of possibly being wrongly diagnosed

DoctorZ :

May I ask why you believe that you have been wrongly diagnosed and what symptoms you are currently experiencing?

Customer : Thank you. Well first of all, I was on depakote for my epilepsy and I was weaned off that and became severely depressed. (Basically the depakote was stabilizing me.) I started self-harming and have been hospitalized twice, and even have suicidal and homicidal thoughts. I see a psychiatrist and psychologist. I have been on Prozac, and then Zoloft with abilify. Nothing worked so I was out back on the depakote to see if that would stabilize me. I have had many side effects, including fatigue, irritability, lethargy, somnolence, severe weight gain, and I even believe I have been hallucinating.
DoctorZ :

Okay, I am sorry that you have been experiencing those symptoms. Well typically depakote is used to treat seizures (as seen in epilepsy) and to treat bipolar disorder (as it is very effective in helping relieve symptoms of both the manic and depressive phases). Rarely is it used to treat just major depressive disorder. Can I ask have you ever experienced the opposite of depression, like you were on top of the world, had racing thoughts, felt your were talking really fast, etc...

Customer : Yes. To be honest, I have thought I had bipolar disorder. I know that bipolar disorder is usually misdiagnosed with depression because people think that when they have symptoms of being manic, they just think it is part of the depression. Anyways I do have recon thoughts and sometimes I feel like my mind stops. Like I can't change my thoughts. I feel like I am focusing on one thing for a period of time Nd can't change it, no matter how hard I try. Along with the racing thoughts, I feel that sometimes my sleep patterns change. It is kind of hard to tell because I feel like I am so sedated on drugs, the anticonvulsants and antidepressants. Before I was on anything I stayed up until 3 or 4 in the morning and then finally got tired to go to sleep. Now, I am ALWAYS TIRED. I fall asleep normally around 8, 9, or 10 p.m. Rarely I stay up later. But I seem to wake up every night at the same time, specifically 3 a.m. And sometime it is hard for me to fall back asleep. To be honest, I feel that if I wasn't on so many drugs, it would be EASIER to tell if I was truly manic or not. Doesn't that make sense? And sometimes I do spend money on money that I don't have really. For example, I remember months ago I randomly wanted to buy make enhancement pills. And I used my debit card and I didn't have that much money. Hours later, I finally realized what I did and had to hide the fact I bought them from my parents. I saw my psychiatrist last week and he evaluated my for bipolar disorder, but said "we'll you definitely do qualify for a mood disorder already, but it is too soon to tell if you are bipolar."
DoctorZ :

I definitely agree with you that sometimes bipolar disorder can be misdiagnosed as depression because the manic symptoms are often overlooked, the symptoms typically only present themselves for a couple weeks on average so they can be missed, and the medications can mask any bipolar symptoms. It sounds like that you have definitely experienced some symptoms that are commonly associated with mania. I went to a conference a few years back that discussed the comorbidity of depression, anxiety, and bipolar symptoms with individuals that have been diagnosed with epilepsy. Studies show that with individuals diagnosed with epilepsy are 6 times more likely to have symptoms of bipolar disorder,so I think the likelihood of bipolar disorder is definitely a strong possibility as you have suggested. In addition, depression and anxiety symptoms are also more prevalent as well, so I think your concern of your symptoms and a possible misdiagnosis is valid. I will attach the article here for you to read as well

DoctorZ :

One medication that I have seen help both the mood symtpoms and is also an anti-seizure medication is Lamictal.

DoctorZ :

The side effects are typically not as serious as the ones with Depakote, in case you wanted to try that as I believe you do not like the side effects of depakote.

Customer : Thank you so much. I told my psychiatrist I feel like I have bipolar disorder, and then he evaluated me. But he says it is too soon to tell. But you are like another person who says I might have it. I know it is too soon to tell but I feel like I am so confident that I have something else. I just wish I could get off of all the medicines to be sure. And yes, thank you for the article, I have heard that most people with epilepsy are more likely to develop bipolar disorder.
Customer : And also, I do have severe anxiety. When I was with y psychologist I became severely anxious and started talking faster and faster just to get my point across.
DoctorZ :

I understand your frustration, but I think one reason why your psychiatrist doe not want you to stop the medicine is because the self-harm behavior, and suicidal/homicidal thoughts may return again and I think psychiatrist does not want to put you through that

DoctorZ :

You mentioned that you see a psychologist, you can ask to do a personality assessment (e.g. Personality Assessment Inventory (PAI) or Minnesota Multiphasic Personality Assessment (MMPI-2)) and this can provide objective evidence of manic behavior that may push your psychiatrist to agree that you have bipolar symptoms present.

Customer : Yes. I understand. Two days ago I went back to my psychiatrist. And I have recently just seen my neurologist as well. Like I said, the plan is to go back onto the depakote hopefully to stabilize me like before, and then get off all of the antidepressants. But I have been therapeutic on depakote for about one week, and don't feel any better. And also, I do know that a withdraw symptom of getting off of depakote is people can develop suicidal homicidal/suicidal thought, AND weaning off it can even trigger mania. I jus don't feel like I am getting properly treated you know? Because none of the antidepressants helped, but made me worse. Specifically I developed fast heart rate and palpitations, to the point where my heart rate went up to about 130-140 and I had to go to the hospital. So yes, we both know the plan of switching the antidepressants to depakote, BUT, I feel like I have developed mania. AND, the antidepressants weren't working alone because I do know that you also need to take antipsychotics with bipolar disorder. Can you tell me what I should do?
DoctorZ :

i apologize i was having technical difficulties with my internet connection

Customer : It's okay. So what do you think, based on everything I told you.
Customer : You there?
DoctorZ :

i agree with everything you mentioned regarding depakote and the withdrawal effects and mania. unfortunately psychopharmacology is not an exact sciencevand there is a lot of trial and error. I would mention if lamictal is an option for you. Also you are right about the antipsychotic medication and you can ask if that will help the effectivness of the depakote. Risperdal had been shown to help the effectivness of depakote. And you can always ask for a second opinion from another physcian. This can provide you with a fresh perspective

DoctorZ :

Also are you on liquid depakote?

Customer : Thank you. And no, I am takin a pill. Generic depakote I think. A small pink pill with small black writing on the front.
DoctorZ :

Okay sometimes liquid depakote is more effective, so you can also ask your psychiatrist about that.

Customer : And I will mention it, but I just hope the doctors will listen. I have recently done so many changes with my neurologist. He just counter weaned me off of zonisamide, and I am now taking vimpat. And then he out me back on depakote, so I just hope if I mention this that he will want to do it.
DoctorZ :

Yeah unfortunately there may be a lot of trial and error and I know you feel like a guinea pig at time, but it may take some time to find the right medications for you and the right combination of medications

DoctorZ :

I think providing your physicians with options and new perspectives are a good way of approaching the situation

Customer : I just don't really know what to do. I think my psychiatrist is the best bet but be just thinks I am trying to self-diagnose my self, and that I should stay off the Internet. But I am so confident that I have something else, and no changes seem to be made that help.
DoctorZ :

Every doctor I know will say to stay off the internet, but I think sometimes the internet can help a doctor see evidence that they did not think of. And sometimes doctors do not spend enough time with a patient or ask the right questions, and the patient may feel inclined to look on the internet for answers.

DoctorZ :

You can also print out that article I gave you and give it to your psychiatrist to read

Customer : Is there anyway you could contact my psychiatrist? And try to explain everything to him? I feel like I won't say everything right and will miss things. Besides, he will probably be more convinced that I have it if he hears all of the information from a licensed psychologist, rather than a kid.
DoctorZ :

Of course I can mention your symptoms and concerns to your psychiatrist, do you have an email address for him? Now due to medical privacy laws he will not be able to discuss your case with me, but I can give him information.

Customer : Thank you so much. I will get his email for you. But I just feel like he will get offended. The fact that I had to go to somebody else.
DoctorZ :

I can put it nicely in my email that you were just concerned about your symptoms and that sometimes you forget to mention these things in your appointments with him. Also professionals usually do not get offended when seeking a different opinion, they are just concerned about giving you the best treatment possible.

Customer : Okay thank you. Hold on, please
DoctorZ :

No problem

Customer : Okay we'll I can't seem to get find his email, only a number. Would you still call him and talk to him?
DoctorZ :

Sure I can call him later this afternoon around 1PM Pacific Standard Time

Customer : Thank you. I don't know if it his personal number or probably an office number, or just the number for the place. You know what to do though.
DoctorZ :

Yep I know what to do. Just some clarification questions, what is his name? And your name isXXXXX?

Customer : (XXX) XXX-XXXX
DoctorZ :

Oh wow, the number did not show up on the chat, i guess the website does not like phone numbers

Customer : Dr. David Huang. And yes It is. But also, he already assessed me for bipolar disorder, could you try to say nicely that you assessed me to and that you think I may have it but the symptoms may not be easy seen.
Customer : 609
Customer : 272
Customer : 0909
Customer : Did that show up?
DoctorZ :

Yes it did, okay I will make the call later in the afternoon. Most likely it will go to his voicemail, but I will still give the details of your concerns for him

Customer : Thank you so much. This really means a lot. When you call him can you message me back and let me know how it went.
DoctorZ :

Sure no problem, I will leave a message on the chat for you after I call

Customer : Thank you
DoctorZ :

No problem, I am always happy to help

Customer : I'm sorry but could you just evaluate me a little more.
DoctorZ :

Sure, anytime. My goal is to help you

DoctorZ :

Do you have other symptoms that you have not mentioned yet?

Customer : Thanks. Well I don't know could you just please evaluate me for everything. I don't know I'm not trying to self diagnose like before but I just think there are so many possible things I could have. For example like I said, I feel like I have been hallucinating, and I told my psychiatrist and pschokogist, and they didn't really seem to care. They just think it will get all better because I am back on depakote.
DoctorZ :

Well can you describe to me the hallucinations that you feel you had?

Customer : Well one time I heard music. Not like a song or anything but I was laying in bed and all of a sudden heard the sound of a bass drum going boom boom boom. I heard it really faintly, and it went away after a little while. Another time I felt like bugs were crawling all over me, my legs, arms, even in my ears. Another time I was in bed and I heard the sound of like a Hypnosis sound. And I was paranoid and thought somebody was trying to hypnotize me. And yesterday, I was in the car with my mom and I smelled a really bad smell, and asked my mom if she smelled that, and she said "no, smell what?" And a lot of times I see people or things moving in the corner of my eye and when I look nothing is there. I told my doctors the ones I had and they kinda didn't really take it into any concern. Any thoughts?
DoctorZ :

Okay well I know you mentioned earlier that you thought these hallucinations could be a side effect of the Depakote, so that is always a possibility. Hearing music and sounds are not typical hallucinations of psychosis if that is your concern, typically auditory hallucinations are of voices speaking to you. The hearing of music and sounds could be caused by your medication or anxiety, or even both of them, but I would not be concerned of psychosis with those. The feeling of bugs crawling on you has been associated with your medication use, they are typically like tingling feelings like bugs. This side effect usually goes away in time. The bad smell is a common symptom of seizures and epilepsy, so I would not consider that a hallucination associated with psychosis. And lastly the people or things moving at the corner of you eye is called an illusion, it basically believing something is there when it is not...illusions are common and are experienced by everyone. A visual hallucination are usually right in front of you that you can see and no one else can see. For instance have you ever seen a beautiful mind with Russell Crowe, he had visual hallucinations of people right there in front of him that he could see straight away and not in the corner of your eye. I think a lot of these symptoms are associated with anxiety, possibly the anxiety of being misdiagnosed.

Customer : Well so you think the fact that I have extreme paranoia and am scared to take naps, and an am taking abilify to help it, isn't a symptom ?
DoctorZ :

I think it is related to your anxiety, paranoia and anxiety often go hand in hand. Especially with everything you have been going through. I do not think that you have a psychosis based on your symptoms

DoctorZ :

I just left a message for Dr. Huang and expressed your concern over you possible bipolar symptoms and medications. I asked over the voicemail if he could reevaulate you and possibly provide you with more reassurance over your treatment plan.

Customer : Okay thank you. But if I am hallucinating at all aren't I supposed to be on medications for them? Because they started right when I started having depression. (Basically weaned off the depakote)
DoctorZ :

The thing is I dont think you are traditionally hallucinating, I believe most of your symptoms are an illusion and associated with extreme stress and anxiety. Adding another medication would most likely cause more problems then make you better. To help with anxiety, there are anti-anxiety medications, and therapy can help you develop coping mechanisms that can manage the anxiety

DoctorZ :

I think that you have anxiety over the possibility of being misdiagnosed and that can lead to a type of hypochondriasis

Customer : Yes, I have been prescribed vistiral. For my anxiety, paranoia, agitation, and fast heart rate. But that basically just truly sedated me and makes it so I have to go to sleep.
DoctorZ :

Then I would encourage in therapy to ask for techniques to help with your anxiety, there a lot of them that can be very helpful

Customer : I have heard of that. Do I think I might be a hypochondriac? I constantly look online and look on Web Md, and look for things wrong with me. And if I have one symptom of that I think I have it. I ALSO mentioned this to my psychiatrist but that was when he told me to stop looking on the Internet and stop trying to self diagnose. I don't know.
DoctorZ :

I do not think you are a hypochondriac, but I do think the anxiety over the uncertainty surrounding your mental health issues lead you to search for answers, which can lead to anxiety. The hypochondriasis is more of a symptom of your anxiety, not the cause of it. I do agree that you may want to stop looking at the internet for answers because it can turn into an obsession which is not healthy

DoctorZ :

Did you read the post I made when I said that I called Dr. Huang and left a voicemail?

Customer : Yes I understand.
Customer : Can I ask you though. Based on everything I tell you does it seem like I was wrongly diagnosed?
Customer : And yes I did read that. I hope he will understand that I went to another psychologist for another opinion and won't take it the wrong way. But it's just because basically I feel 99% chance that I have something else.
DoctorZ :

I think your physicians are on the right track, as you said bipolar is often misdiagnosed for depression because the symptoms of mania have been presented yet or are often overlooked. I think because of your symptoms, I would give a stronger evaluation of bipolar disorder, and your physicians are aware that bipolar disorder should be considered, so that is a good thing. Also currently you are on a mood stabilizer and that is beneficial too, rather than just being on an anti-depressant.

DoctorZ :

So overall I think your physicians are doing a good job, but I would lean more towards bipolar disorder based on your symptoms right now. But the positive thing is that it appears from what you are telling me is that they are leaning that way too, just albeit more slowly.

DoctorZ :

Also on the voice-mail I was very kind and basically expressed your concerns and asked the doctor to reassure you and possibly reevaluate you if possible. I did not blame him or accuse him of anything, I was only making a suggestion to benefit you. I dont think he will take any offense to my message on your behalf.

Customer : Thanks a lot. And yes you are right. I feel like I should lean towards bipolar, based on my symptoms. And yes, please give me a deeper evaluation for bipolar.
DoctorZ :

Well i meant if I were your physicians I would lean to giving you a stronger evaluation for bipolar disorder that can be associated with you diagnosis of epilepsy. I would give a psychological assessment, like the PAI, I mentioned earlier to help me confirm that diagnosis.

DoctorZ :

My opinion is that I think you doctors will be diagnosing you with Bipolar Disorder soon, I think they are just taking a wait and see approach right now

Customer : Okay your right. Could you just evaluate me now though using the PAI?
Customer : Because I don't see my psychiatrist until the middle of August and my neurologist for a couple of months. So I just think it will benefit me if I get the evaluation as soon as possible.
DoctorZ :

Actually no, its a paper and pencil instrument we use that has over 300 statements that you have to answer. Then we put those answers on the paper in the computer to get the results. Then I spend time reviewing the results and interpreting them. Unfortunately none of this can be done over the internet, it has to be done in person.

DoctorZ :

What about your psychologist?

Customer : Okay, I understand. And I see my psychologist in about 2 weeks. But I can only do the assessment with my psychiatrist right? Or can I with my psychologist?
DoctorZ :

Actually usually only psychologists can perform those assessments, they are more qualified with them then a psychiatrist. You can call your psychologist and mention that you would like to take a personality assessment and they hopefully your psychologist will be able to help you with that.

DoctorZ :

The reason a psychiatrist does not give these instruments is because typically they are not trained in them, this is why it is important for a psychologist and a psychiatrist to work together to help and treat the patient

Customer : Okay, I understand. I just saw my psychologist Monday. I wish I knew this before. I will wait two weeks though, I know that a 300 question assessment will help.
DoctorZ :

I think it will help too. If anything it will give more information to help you

Customer : So basically what is the PAI? Is it only used to see if you have bipolar?
DoctorZ :

The PAI is one type of personality assessments we have available (another common one is the MMPI-2 or the MCMI-III). These are used to help give psychologists objective information on particular symptoms. It has measure of depression, mania, schizophrenia, anxiety, hypochondriasis, and so many others. Elevations on each of these scales can help determine a diagnosis and best course of treatment. I encourage you to look these up on the internet to learn more about them, I believe some details of them are on wikipedia

DoctorZ :

Here is the PAI one

DoctorZ :

MMPI-2

DoctorZ :

and lastly MCMI-III

DoctorZ :

There are others, but these are the most common ones that I have used and seen done

Customer : Thank you very much
DoctorZ :

So basically these tests are tools that we use to help us, much like a blood test is a tool for a physician .

Customer : I understand. So you think me taking this and I check off all the answers and symptoms and then when my psychologists and psychiatrists see the results that they will reconsider? Hopefully.
DoctorZ :

I think the results of the test can give your psychologist and psychiatrist a better idea of how to proceed next. I think it will add clarification to the symptoms you already mentioned.

Customer : I really wish I could take it online. After 4 months, I'm finally ready to get the proper treatment.
DoctorZ :

I understand your frustration, but these processes do take and patience. I know that's not what you want to hear, but you do find the right treatment I can guarantee that you life will be immensely better.

DoctorZ :

*do take time and patience

DoctorZ :

Is there anything else I can help you with today?

DoctorZ :

I see that you are offline now, but if you have any other questions or concerns, please feel free to ask anytime and I will be sure to get back to you as soon as possible. I hope I provided you with excellent service today.

Customer :

Hey I'm sorry I didn't response. dr huangs nurse called my mom and said dr huang got a call from some psychologist and she started yelling at my and I cut and ended up back in the hospital.

DoctorZ :

Hello I apologize for not getting back to sooner today, but I am usually online around 830 AM on weekdays. I am so sorry to hear that happened to you, would you like to discuss it further?

Customer :

If you want..

DoctorZ :

Well you rated me with a bad service, I am not sure how I gave you a bad service since I spent 3 hours with you last Friday. But I want to help you and if you would like to discuss this further I am here

Customer :

Because my mom found out I did this whole thing and she said that it was unnecessary when I am already seeing a psychologist and psychiatrist and told me to get my money back

Customer :

I'm sorry..

DoctorZ :

Oh, well then we could have asked to help you get a refund

DoctorZ :

I would have assisted you with that

Customer :

I have been in the hospital since yesterday. And then right when I got out my took my phone becsuse she said she can't trust me. I got my phone back because she needs to have contact with my because of my epilepsy. I'm sorry

DoctorZ :

I understand, I would have tried to help you get a refund if you needed it, but I see that posted something again this morning?

Customer :

Yes I did post another question. I am a hypochondriac and I just need answers. But I dont know if you should help me anymore because I need to get my money back and if I do you won't want to help me anymore because that's the whole point of you helping me. To get money.

DoctorZ :

Alright I understand, would you like me to refer you to customer service to get a refund?

DoctorZ :

That would be the best way for you to get your money back

Customer :

yes please

DoctorZ :

No problem.

Customer :

And one more thing could you just help me with the one question I asked so I can try to get a refund for that too

DoctorZ :

You would like a refund right away from that other question?

Customer :

Yes

DoctorZ :

Or did you want to discuss the issue with me first and then ask for a refund?

DoctorZ :

Sure no problem, it will just take a couple minutes as I type this up

Customer :

I just requested the refund for my question I asked. But could you help me with one more thing and then refund the answer I asked you?

DoctorZ :

Sure what is it?

Customer :

Well like in the question I just asked. I really have the urge to hurt animals.

DoctorZ :

Oh okay, so I will go to that question and help you then

DoctorZ :

Does that work

Customer :

Is this part of my depression and epilepsy? or of a whole other illness?

Customer :

And I already refunded that question

DoctorZ :

Not sure, it could be more a part of depression I think, but lets discuss it further on that question, so that this does not interfere with your current refund request

Customer :

I want both of the questions refunded can you help me with that

DoctorZ :

Sure, buts lets specifically go to the next question to help with that refund request

DoctorZ :

Oh someone answered you already with that question, so you can ask Elliot for a refund if you wish

Customer :

Thanks

Customer :

Okay I will. Will you refund this question for me?

DoctorZ :

Yep as soon as I leave here

DoctorZ :

It may take some time for it to process, but it will go through

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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
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  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
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