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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4887
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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i have all of the depression symptoms , and well i cant go to a psychologist because my pa

Customer Question

i have all of the depression symptoms , and well i cant go to a psychologist because my parents wont approve , and the depression is on a higher level , i tried committing suicide twice ,and i am a self harmer for 5 years now .
how can i go to a phycologist without my parents knowing , how can i tell them .\and if possibly advice an online phycologist ?
Submitted: 10 months ago.
Category: Mental Health
Expert:  Dr. Z replied 10 months ago.

Dr. Z :

Hello

Dr. Z :

I believe I can help you with your concern

Dr. Z :

I am so sorry that you have been feeling this way and exhibiting these symptoms of severe depression, I can imagine how distressing this must be for you

Customer:

yes its very stressing , it began to affect my sleep and my school performance

Dr. Z :

I do agree that if you have been having these severe symptoms of depression that seeing a psychologist/therapist would be very beneficial for you. May I ask why your parents are against you seeing a psychologist/therapist for help?

Customer:

because they think that going to a phycologist meaning that you are crazy , and sick , i tried to change the way they think but they wont accept it .

Customer:

also because of the culture we live in

Dr. Z :

I understand that, and well you can approach it like this. I do this with resistant patients or resistant parents for my adolescent patients. I usually say that going to a psychologist does not mean anyone is "crazy," but that they just need a little help and guidance. Also having a mental health disorder is no different than having a medical disorder like heart disease or diabetes, except this is one is in the brain, the most complicated part of the human body, so this is why it is difficult to treat. Going to a therapist can help lessen the symptoms of depression and can possibly "cure" it too.

Dr. Z :

So usually I like to compare mental health to a medical disorder where everyone will see a doctor to give people perspective

Dr. Z :

Another thing you can do is also try online therapy with qualified therapists if you like.

Dr. Z :

Or you can try self-help therapy, where I can teach you some good techniques that can help you with these depressive thoughts and point you to some websites that have further good self-help therapy techniques too

Customer:

like what ?

Customer:

i've tried talking about it but it made it worse ,

Dr. Z :

Talking about it with your parents made it worse?

Customer:

yes , and with one of my teachers

Dr. Z :

Well i would like to teach you techniques related to Cognitive Behavioral Therapy (CBT). This is the most effective and evidence based therapy to date that can treat depression effectively. CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen.

Dr. Z :

I am sorry, I think you are right that it can be the culture and how some individuals are not as open to mental health treatment as other cultures.

Dr. Z :

So this link may help you, it contains a technique I use with patients called a thought record. It will help you keep track of any negative thoughts you have. You put the negative thought on paper, the emotion accompanying, the evidence to support it, and the evidence against it. Then I want you to come up with an alternative thought for the situation (more objective and plausible). This will help you change your way of thinking to be able to think more positive and not automatically go to a negative type of thinking.

Dr. Z :

In addition, these two worksheets are very good at helping lessen depressive symptoms. It can help you focus on the big picture and the objective/positive thoughts and outcomes.

Dr. Z :

Also individuals with severe depression have a poor coping mechanism, so this worksheet will help you develop a better coping strategy to manage your symptoms better.

Customer:

i've actually tried this one , i am currently on it , i wrote down negative thoughts but it only went away for short amount of time , and went back even worse than before

Dr. Z :

Did you focus on the alternative thoughts though?

Customer:

yes

Customer:

because a lot of events are happening , and happened before , which affected me with time

Customer:

and it always repeating itself

Dr. Z :

Would you say that the cause of this depression is past trauma in your life?

Customer:

but the past is what made it

Customer:

yes , past and present also

Customer:

the present is just repeating my past and making it worse

Dr. Z :

I am so sorry to hear this, may I ask what exactly is repeating for you to continue to cause this depression you are feeling and making it worse?

Customer:

it is hard to explain but i'll try

Dr. Z :

Take your time, there is no rush on the chat and I have no time limits

Dr. Z :

I will write down one last CBT technique to help you overall though. In addition, individuals with severe depression have symptoms of low self-esteem and I think that replacing your self-critical thoughts with more positive self-beliefs will help you. This worksheet can help with that.

Dr. Z :

Are you still there?

Customer:

yes i am here

Dr. Z :

Oh okay, I just saw that you went offline, that is why I was wondering

Customer:

do you still need the reasons or the cause ?

Dr. Z :

Well only if you feel comfortable telling me, if you do not than I can continue making treatment recommendations for you.

Customer:

okay

Customer:

1-i was and still being bullied and harassed at school , 2-physically abused by my parents ,3-low self esteem and even bullied in my family , 4-being almost sexually abused by my brother , 5-being ignored by everyone ,whether school or at home , 6-betrayed by friends and family members

Dr. Z :

Wow, I am so sorry that you have experienced all of this and still continue to experience some of this. With the being bullied and harassed at school, there is a technique that I can show you to be more assertive with your frustration and anxiety to help you be more independent and confident. This will most likely lead to them stopping or lessening their bullying by a greater degree

Dr. Z :

The physical, emotional, and almost sexual abuse by family members will be tougher to handle because I know that in your situation you cannot show disrespect to your family, but it does not mean you have to take it either. Being assertive can help you still counteract their abuse and help you stand up for yourself.

Dr. Z :

Also if you like I would like to offer these books, if you can get a hold of them, they may be able to help you greatly

Dr. Z :

Also these two websites contain self-help therapy techniques that can help you as well

Customer:

are medications useful ? if so what type ?

Dr. Z :

I was just writing about medication. If you can get your hands on prescription anti-depressants. I would recommend a SSRI antidepressant called Lexapro at 10-20mg for you. This is the most effective antidepressant out there, it works fast, and also has the least amount of side effects too.

Customer:

well if i may add another information , i live in Arab country so i am not sure if the medication is available in my country

Dr. Z :

Other antidepressants that will help you are Zoloft (Sertraline,) Paxil (Paroxetine), and Effexor (Venlafaxine). Also you may benefit from a benzodiazepine, which help treat anxiety that is commonly associated with depression. Some examples are Lorazepam, Alprazolam, and Clonazepam

Customer:

and in the same amount ?

Dr. Z :

I think Lexapro (Escitalopram) is available in your home country, but those other medication should be too

Customer:

okay , so all of the medications?or just a few ? and how many times should be taken?

Dr. Z :

No not at the same amount. The dosages differ, but you gradually increase your dosages for each of the medication. For instance you would most likely start the Zoloft (Sertraline) at 50mg, but increase to an effective dose of 150-200mg.

Dr. Z :

No just one of the antidepressants, Lexapro (Escitlaopram), Zoloft (Sertraline,) Paxil (Paroxetine), or Effexor (Venlafaxine). But you can take one of the benzodiazepines that I mentioned with one of the antidepressants.

Dr. Z :

Your doctor would start you on the right dose at first with the medication.

Customer:

so 2 medications ?

Dr. Z :

You can take one antidepressant and one benzodiazepine. The antidepressant you will need to take continuously, some take it once a day or multiple times a day. For the benzodiazepine, you should only take as needed when your anxiety is really bad. This is because the benzodiazepine can be physically addicting and if you take it continuously for a sustained period of time, you will develop a physical addiction to it.

Customer:

okay

Customer:

thank you for your help

Dr. Z :

There is one more thing I want to show you. This is a link for something called Progressive Muscle Relaxation that can help you create a long term calm by using muscle tension and release techniques; it can help manage your anxiety and depression and is very similar to a style of meditation.


 


http://prtl.uhcl.edu/portal/page/portal/COS/Self_Help_and_Handouts/Files_and_Documents/Progressive%20Muscle%20Relaxation.pdf


 


http://www.guidetopsychology.com/pmr.htm

Dr. Z :

Anytime, I am always happy to help and be here for you. Is there anything else I can assist you with?

Customer:

if there is any , i will send you a message

Dr. Z :

Sure you are more than welcome to do that at anytime. Just put "For DoctorZ only" so that your question will go straight to me. I wish you the best of luck and I hope your depression resolves swiftly for you. Contact me anytime if you need anything.

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4887
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
Dr. Z and other Mental Health Specialists are ready to help you
Customer: replied 10 months ago.

i am on my to the pharmacy , i just need to know about the amount of the Escitlaopram , and the Lorazepam .

Expert:  Dr. Z replied 10 months ago.
Hello,

Start with 10mg of the Escitlaopram for two weeks and then you may go up to 20mg, but that is the max you should go. Use this medication daily. If you go to 20mg you can take 10mg in the morning and 10mg at night. Start with 10mg in the morning though.

Start with 0.5mg of the Lorazepam and increase gradually over time. You can go as high as 2mg, but I would prefer you only to use 1mg at most. And remember use this medication as needed only and try to use it at night because it can make your drowsy at first.
Expert:  Dr. Z replied 10 months ago.
Also please feel free to contact me at anytime if you have any questions or concerns at all too. I hope the medicine works well for you :)

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