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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5334
Experience:  Dr. Mark is a PhD in psychology in private practice
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I probably need to speak with a psychiatrist. My

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I probably need to speak with a psychiatrist. My psychiatrist I normally see is in Wilmington, NC. I have recurrent major depressive disorder and I'm more depressed than ever. However, I'm at my parents' house in SC, and she says because of her schedule and stuff, when I'm not there, I need to find someone around here to see. I'm on Risperdal 2 mgs, Lamictal 300 mgs, Wellbutrin XL 300mgs, Prozac 80 mgs, and Xanax XR 2 mgs. I have panic, major depressive disorder (recurrent), panic, OCD, and stress.
JA: How long have you been feeling this way? Have you reached out to anyone about this yet?
Customer: Just my family. Well, I tried to let her know last week I may need Risperdal increased but she said she couldn't see me until the 27th and she said I should see someone around here but it started getting reallly bad Thursday and I'm sleeping all the time and just so upset and not hardly eating, and have been throwing up, and just not wanting to do anything, even not wanting to talk to friends.
JA: Anything else in your medical history you think the psychologist should know?
Customer: I have gastroparesis. Oh, I was hospitalized twice for depression in 2012 when it got super bad where I was suicidal. I don't feel suicidal right now so i don't need hospitalization. Because of the gastroparesis, I've lost friends, jobs, and now my house. I kept fainting a lot so it wasn't safe for me to stay at home alone so that's why we're selling my house. I always feel like a burden to my parents' anymore.

Hi, this is Dr. Mark; I'll be glad to help you with this issue. To give you the best answer, let me ask you:

What specific question can I help you with?
Any extra information that will help, feel free to share.

Dr. Mark

Customer: replied 4 months ago.
I'm not really sure. I just don't really know what to do. I just don't know how to get out of this deep depression, and I tend to get self-destructive when I get really depressed and lose hope. I don't see her for 17 days and I don't know what to do in the meantime. Last time I got like this, I started sleeping around and stuff. I'm just scared of going out of control and I don't know what to do. I'm sorry, you might not be able to help me either. I'm sorry for bothering you.

Your question is important and thank you for clarifying. I have a few more questions, though:

First, you seem to have a lot of pharmacological treatment. But are you getting any psychotherapy?

It seems from what you are saying you need more than the meds management that your psycihatrist is doing; you need active therapy with a caring therapist. Are you in therapy at this time?

Have you had therapy? What is your history with therapy?

I'm concerned with your statements about losing control, becoming sexually unstable, etc. This is more typical of Borderline Personality Disorder, which sometimes can be misdiagnosed. Has it been brought up?

Dr. Mark

Customer: replied 4 months ago.
I don't think borderline personality has been brought up. Yeah, I have a therapist I see monthly. She's really good. She's in Wilmington, too. I usually schedule appointments with her at the same time I schedule appointments with my psychiatrist.

Hi. My answer is going to be long and that is because I want you to recognize that there's a lot going on here, not just something for medications treatment. I don't think that once a month is intensive enough for the severity of your depression or emotional pain. But that is something for you to discuss with your therapist. I want to help you stabilize the best you can while you're away at your parents town.

First let me say that I can imagine how confusing, distressing and even scary this situation must be for you. You are clearly a courageous person. But you don't feel very strong now, it's clear. I therefore want to begin by telling you that this is not a contradiction: that you do not feel strong right now does not negate the truth that you are indeed a courageous, caring person.
What seems to happen is that your emotions get overwhelming inside. And all these emotions need to come out.
Emotions don't just disappear: they store up and the pressure builds up. And then they begin to leak out if you don't let them express themselves in healthy ways. And that appears to be what's happening at this time now.
And they're coming out in the ways that emotions will if they're not given a healthy way to come out. Therefore, we have to get you to a situation where you can let your feelings out in a healthy ways. That means a combination of work on your own and psychotherapy.
Psychotherapy is important because anxiety and depression are often the result of these unexpressed emotions. So therapy is an important way to manage the emotions. I will also at the end of the posting give you a technique you can use on your own as well for when you are feeling anxiety and depression and working on avoiding the undesirable activities and behaviors.
Let's work on the five ways you can begin to build a behavioral program for yourself: diet, exercise, spiritual life, motivational reading and psychotherapy. The first four are to help you feel more involved and in control of yourself and what's going on inside. The psychotherapy can actually teach you skills and give you tools for managing your symptoms.
Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. And lean meats only. No fast food restaurants, no fatty foods. See what I mean about getting involved in controlling what's happening? With diet changes you are treating your problem with respect: you are acknowledging you need to make changes to get your body feeling better. It will help you feel more in control again.
Vitamins can be useful for moods. A good quality daily vitamin, for example. One of the most important supplements is Omega 3 fatty acids, either in fish oil or capsules or in flax seed oil. Buy good quality. The clinical dosage is 1,600-3,000 mg daily. All these things you should get at the biggest and most frequented health food store and ask them for the best brands they trust in terms of quality.
Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Pretty amazing isn't it? I told you it would require work, but what you put in to it you will get out of it. Your doctor will verify the research results showing the benefit.
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 anxiety and depression, all those unexpressed emotions.
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. 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.
Another 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 discuss with your therapist a more intensive course of therapy that can begin to deal with the overwhelm of emotions you face that lead to behaviors you don't want and to other symptoms.

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 anxiety is 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. Bonuses are always appreciated! 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, ***** *****

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:
o chest
o abdomen
o entire right arm
o right forearm and hand (making a fist)
o right hand
o entire left arm
o left forearm and hand (again, making a fist)
o left hand
o buttocks
o entire right leg
o lower right leg and foot
o right foot
o entire left leg
o lower left leg and foot
o left foot
6. for the shortened version, which includes just four main muscle groups:
o face
o neck, shoulders and arms
o abdomen and chest
o 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. Bonuses are always appreciated! 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 and other Mental Health Specialists are ready to help you

Hi. my Skype name is mmishory.

So you can add me to your contacts and we can schedule a time for our talk there.

Or we can schedule via email:

***@******.***

Hi. I've sent you my contact information.