topic Got a question related to mental health? ASK DR KIM in Treatments, health professionals and therapies

Got a question related to mental health? ASK DR KIM

Chris_B — Tue, 23 Aug 2016 00:50:16 GMT

Hi everyone,

This is a thread for asking questions of our resident GP and counsellor, Dr Kim, who pops into the forums regularly.

PLEASE NOTE as per our community rules, Dr Kim won't be able to answer questions about medications, these are best discussed offline directly with your mental health professional.

UPDATE - 01/03/2018
BEFORE YOU ASK DR.KIM PLEASE CONSIDER THE FOLLOWING POINTS:

Dr Kim's time is limited! We cannot provide an ongoing dialogue with Dr Kim in this thread - one post/question per person please
We'd recommend you have a look through the forums before posting here to see if your question has already been answered by Dr Kim, our other members, or if there's information about it already on the beyondblue website. If a question pops up that has already been answered previously, or if alternate resources are available, one of our moderators will reply and direct you to the link.
When writing your question, imagine you are speaking to someone in person i.e. provide a clear and detailed post with enough information that outlines how Dr.Kim can help you.

Background

After 20 years of experience working as a GP, Dr Kim realised in 2003 the aspect of her work she enjoyed most was talking to people and understanding the way they think and behave – and so she underwent training in counselling and therapy, where she now solely works.

Her experience includes working with a wide range of mental health issues including anxiety, depression and adolescent mental health.

“Given my training I also see couples, siblings, parents with their children and entire family groups,” she says. “In this work I hope to give families the skills to understand one another and have the strategies to communicate and manage relationships that are distressing them. I believe strongly that best therapy is achieved when there is trust in the therapist's ability but also their genuine desire to understand and help.”

Got a question related to mental health? ASK DR KIM

Wanting_to_help — Tue, 23 Aug 2016 10:45:44 GMT

Hi and thankyou

I will try be brief

i have anxiety and depression have since having pnd with first baby almost 7 years ago but is now managed and am managing well

my question is for my sister in law

she is suffering depression at the moment after a bad end to a bad relationship she has a nearly 2 year old daughter and all the family support

but my question is she seems to be pushing her little girl away she seems to just want to sleep all the time I'm talking will drop her child of at say 8:30 in morning will go home to bed and sleep till 5:30 at night she loves her child and adores her but just seems to always need to be away from her and wants to sleep all the time and if mother in law says no she gets cross

guess the question is how do we best help her she is seeing councillors but seems to be getting no were my mother in law is so stressed and dosnt no the best way to help her we all just want to help but fell by having her child for all the time we are making it worse How do we help

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geoff — Tue, 23 Aug 2016 18:18:05 GMT

hi Dr.Kim, I just want to ask a basic question and that is 'why do people always feel so tired' when they have depression. Geoff.

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geoff — Tue, 23 Aug 2016 18:22:29 GMT

hello Dr. Kim, most of us know that we pretend to be happy when we are with other people in depression, I've gone through this just as so many others, we can laugh and it seems to them that our depression has gone, but when these 'friends, family' leave, we once again collapse which surprises them and probably angers these people who are supporting us, so that's when our support stops, because they can't understand why one minute we can enjoy ourselves and then suddenly go back to our little dark hole.
Why does this happen. Geoff.

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Dr_Kim — Wed, 24 Aug 2016 06:38:25 GMT

Wanting to help said:
Hi and thankyou

I will try be brief

my question is for my sister in law...

I can understand why you are so concerned for your sister in law and her child. It sounds that either your sister in law is using sleep as an avoidance mechanism or she is unwell or having a response to a medication or a drug that is very unwelcome.

You have rightly alluded to the fact that children really do need their primary care givers attention during their formative years. It is really important for children to believe that they can trust their caregivers to support and nurture them both physically and emotionally when they need it. No parent does this 100% of the time in a perfect way, but if you feel that this is not happening to a large extent most of the time for this child , then I think it is important to draw attention to this for the child’s sake by gently raising your concerns with this mum who you state loves this child dearly.

Please to not approach it in a blaming way as many people with mental health problems can’t help the way they are feeling or behaving and feel guilty already about not being OK. I would approach from the point of view of the child and clearly look at what the child needs and how you might be able to support her to provide that for her child.

Also discuss with her if SHE is concerned about how tired she is and if SHE would like to be able to tolerate or enjoy her child more at the moment. It may be that she would like to be present whilst her child is being bathed or fed but doesn’t have the energy to do it alone, so maybe having someone to come over and help her would be a first step.

Maybe she needs to see her GP and discuss this symptom of exhaustion and the impact its having on her life. The GP and therapist may be able to discuss together with her whether all medical issues have been excluded and when a trial of medication may be necessary.

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Dr_Kim — Wed, 24 Aug 2016 06:39:27 GMT

hi Dr.Kim, I just want to ask a basic question and that is 'why do people always feel so tired' when they have depression. Geoff.

Thats a really good question and I’m not sure if a neuroscientist would cringe at this answer as it is a bit basic .. but it’s how I understand things.

When we are depressed , the neurotransmitters in our brains are not at the right concentrations at the right places. Neurotransmitters are chemicals that carry messages from one nerve cell to another. So with the lowered concentrations of neurotransmitter in the space between the nerve cells, the nerves find it hard to “jump the gap” from one cell to another . This is why people with depression can also find it hard to concentrate or study. I think it also makes people tired.

Another reason may be that depressed people may also have some level of anxiety together with their depression. I find they can travel together ! When people are anxious, they produce hormones like cortisone and adrenaline which are the “fight or flight” hormones which increase heart rate, breathing rate, blood flow through large muscles etc.

This increased activity which goes on “under the radar “ often without us really even noticing it can drain our batteries a bit and leave us feeling tired out as if we have been running away from something dangerous!

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Dr_Kim — Wed, 24 Aug 2016 06:40:27 GMT

hello Dr. Kim, most of us know that we pretend to be happy when we are with other people in depression, I've gone through this just as so many others, we can laugh and it seems to them that our depression has gone, but when these 'friends, family' leave, we once again collapse which surprises them and probably angers these people who are supporting us, so that's when our support stops, because they can't understand why one minute we can enjoy ourselves and then suddenly go back to our little dark hole.
Why does this happen. Geoff.

I have had this discussion may times with family members . They can be a bit stumped with a diagnosis of depression when they saw the person laughing with a friend just 2 days ago!

I think many people believe that a depressed person must have a frown on their face and be crying most of the time or else they do not have a mood disorder. This is a little bit simplistic. Mood disorders are diagnosed mostly by how someone thinks or feels inside their heads. How they view themselves and how they interpret the world around them.

The impact that these thoughts / feelings have on their behaviours may influence whether the depression is considered milder or more severe , but many people with depression still manage to do regular things in their lives and even can "have a laugh with friends” .

Only the most severe end of the spectrum have this thoughts ALL the time EVERY day and are rendered completely unable to partake in any type of normal daily activities.

People with depression often tell me that they live behind a kind of facade or mask where they can “put on a brave front “ for a while and go to social functions and act normal but it is exhausting for them. They are usually having to coach themselves to keep up the mask and keep the pretence going to looking normal, not only for everybody else sake , but so they can hide the illness and fit in.

So I guess I would explain that depression, especially in the mild to moderate forms, is not an absolute state. It is something that can ebb and flow a bit, that one can have good days and bad days, but also that what people see on the outside isn’t necessarily what is happening on the inside for people.

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james1 — Wed, 24 Aug 2016 06:51:19 GMT

Hi Dr Kim,

I realise it may be different for different doctors, but what is your opinion on the place of a GP in someone's mental wellbeing?

I ask because I've had a history of bad GPs and it's getting to the stage where people including my psychologist are suggesting I talk to my GP about medication.

The trouble is, my GPs have always tended to be script happy, out the door, types.

So I don't actually know what a "good mental health GP" is actually there to do. Talk? Support? Prescribe? The boundary between GP-Psychologist-Friend-Support is really blurry to me.

I hope that's enough of a question to know how to respond!

James

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Ouat — Wed, 24 Aug 2016 07:40:13 GMT

Hi this is my first time posting. I have been suffering from anxiety and depression for the last few months and its only getting worse. I have been thinking and worrying contantly about my health and was wondering if your thoughts can create a sensation by obsessing thinking.

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Shaz1 — Thu, 25 Aug 2016 02:00:30 GMT

Hi,

I've been having treatment by my dr and physcologist for a few years for severe depression and anxiety. I'm at a loss what to do/try next. I freeze whenever (which isn't that often) I have appointments with either of them. I can't talk and they may say something that's totally wrong, but I can't speak up to tell them.

I don't have a support system other than those two professionals. How do I break the walls down again to try and get help?

I've been treated as I'm not worthy my whole life, people generally do not like me. My physcologist said its the depression speaking. I don't believe it, I know when people ignore me, make some excuse to not see me. Etc

Guess I'm just trying to figure out how to live "happily" by myself?

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Dr_Kim — Thu, 25 Aug 2016 08:16:18 GMT

james1 said:
Hi Dr Kim,

I realise it may be different for different doctors, but what is your opinion on the place of a GP in someone's mental wellbeing?

James

Hi James,

I am both happy and upset to hear this question. Happy because it gives me an opportunity to discuss what expectations you can have of your GP in this arena , but upset as I think your experience is unfortunately all too common in the community.

I think a “ good mental health GP “ is one who makes you feel
1, They care and you feel they are genuinely interested in your health.
2. They are on the journey with you (and your team) i.e.. organise reviews and or meetings
3. They can listen
4. They have time
5. Can explain the rationale for what they are advising.
6.Also importantly can sort out what of your symptoms are due to your mental health issues and what might be something else. eg if you are tired , is it because you are depressed or have Iron deficiency Re medications: So may people worry about the effects of anti depressant or anti anxiety meds that it is important that you feel your GP is monitoring you closely so you feel you understand the meds and are prepared for any possible side effects.

How do you find these magical GPs ?. They are often found through word of mouth, so ask around. A GP who is “good to talk to" is a good start and one who has been in a practise for a while is also a good lead sometimes as continuity of care is important.

Sometimes Community Mental Health clinics, Headspace clinics or even Emergency Departments have names of GPs that be helpful,and I noticed that the Black Dog website has some info on choosing a good GP and then a link to a website to help people find a GP and other mental health professionals in their area.

ALSO.. Always start with a double appointment when you meet your new GP ,so you have time to give them a good history and they can get to know you.

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Dr_Kim — Thu, 25 Aug 2016 08:17:11 GMT

Ouat said:
Hi this is my first time posting. I have been suffering from anxiety and depression for the last few months and its only getting worse. I have been thinking and worrying contantly about my health and was wondering if your thoughts can create a sensation by obsessing thinking.

Yes , your thoughts can “cause a sensation” by obsessing and i think that is exactly what they try to do with anxiety and obsessional thinking . They try to distract you from your healthy thinking by saying “ Hey look at me!” "Over here!”.. at the expense of the other kind of “normal" thoughts that you could be thinking . So I guess you could say anxiety thoughts are drama queens and attention seekers!! The content of the obsession is not really relevant I find in clinical practice.

The first step to manage this is to develop "mindfulness" or an awareness of the origin of the thoughts in your head. Start to notice the thoughts in your head an see if you can distinguish thoughts that come from the anxiety part of your brain from ones that come from the healthy or rational part of your brain .

Once you can start to become cleverer at sorting out the thought origin you can then develop different strategies for the different thoughts.

For rational thoughts, by all means, give them due consideration, but if the thought is coming from the anxiety/ obsessional part your choices are to challenge it (CBT) , accept it (ACT) or distract yourself .

You could challenge the thought with asking yourself what evidence you have for those statements, or just accept that anxious thoughts are going to pop into your head and accept them as part of your internal landscape (oh , hi anxious thought !! you again !!) , or get busy to move away from them .

These techniques are covered by therapists or for a start ,you can read up on them in Sarah Edelman's book "Change Your Thinking" or Russ Harris' book "The Happiness Trap". Headspace or Smiling Minds apps are great for development of mindfulness.

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Dr_Kim — Thu, 25 Aug 2016 08:18:26 GMT

Shaz1 said:
Hi,

I've been having treatment by my dr and physcologist for a few years for severe depression and anxiety. I'm at a loss what to do/try next. I freeze whenever (which isn't that often) I have appointments with either of them. I can't talk and they may say something that's totally wrong, but I can't speak up to tell them.

I feel so bad to hear you say that and I think your Dr and psychologist would too. I guess they are trying hard to make you feel you can trust them but the inability to trust and the suspicion that no one genuine cares for you I suspect started way before either of these people even met you .

I suspect that these feelings you have about not being worthy started way way back (something like attachment theory might be at play here). Maybe your self esteem took a beating many many years ago when you were not made to feel ok and worthy by the primary people in your formative years.

Not knowing your history , I can only take a wild guess at what is going on , but I think your psychologist may be onto something when they say that there is a voice of depression ( or low self esteem ) in your brain that gives you incorrect interpretations about the world. The seeds of doubt about yourself were likely planted a long time ago( by who I don’t know) and should have been weeded out by your primary care givers when you were way too little to do it for yourself. It is not your fault.

Now, you are left with an overgrown tangle of a brain garden !!! It is giving you all sorts of crazy and NASTY messages that should not be there .. It is time for you to get the pruning shears out when you see one of the nasty thoughts , visualise yourself snipping it iff at the roots!

I know I’ve simplified things and I’m not suggesting its easy , but please don’t blame yourself for the brain mess, start to push aside those nasty thoughts and start with a bit of trust in your Dr / Psychologist . Tell them gently next time when something isn’t ok … and trust the relationship you have will withstand the challenge!
Also, if you can , please look into meditation, relaxation, yoga or any mindfulness course or app ! It will help .

Got a question related to mental health? ASK DR KIM

JRBanks — Sat, 27 Aug 2016 12:37:02 GMT

Hi Dr Kim. I am a 24/yo male, and I would appreciate your advice on what I think is a current undiagnosed mental issue of my own. I have a problem with missing details, which seems to be getting worse. Here's a few examples of what I mean:

- I'll be engaged in conversation with another person, whom I am listening intently to. During the conversation, I'll make a statement which the other person in the conversation made only moments below. The issue is not because I was not listening, but for reasons beyond me, my mind simply does not register certain details of a conversation as they occur. This gives the other person the impression that I am not listening to them, even though I am holding on to every single word that they say.

- When writing emails, I'll review it before sending. At the point of sending the email, I am certain that the email is 100% spelling and grammar correct. Then, after reading the email again after it has been sent, I'll notice extremely obvious typos and mistakes. Again, for some reason, my mind does not register this when I am in the act of doing, like my conversation example above.

- When putting the dishes away from the dishwasher, I'll check each dish and utensil to make sure they are clean before putting them away. In the act, I am certain that every item I am putting away is clean. However, after I have finished, my partner will point out that the dishes still have dirt on them, even though I swore in the act that they were clean.

- The three examples above would suggest that I'm simply a careless person, with a poor memory and a poor recall of details. I wish the answer was that easy! Many, many people have commented on my ability to recall very fine details, usually dates, times and places almost instantly from any point of a conversation. In most cases, I am recalling these facts many years after I learnt about them. With that said, I am very confused as to why I can recall a date, time and place from history, but can't differentiate between a clean and dirty fork!

My personal hunch is that I may have undiagnosed autism. I speak with a mild stutter that I cannot control and I do have issues with anxiety. I think that the points I've stated above are aligned with the symptoms of this condition, but I would like to know your professional opinion as I am no doctor!

Got a question related to mental health? ASK DR KIM

Doolhof — Sat, 27 Aug 2016 22:18:55 GMT

Hi Dr. Kim,

I am loving this thread. Thank you so much for giving your time to us all in this meaningful manner!

I have been diagnosed with depression, PTSD, BPD, unresolved grief, stress and anxiety issues. One thing I have trouble handling at times is disassociation.

My family feel like strangers to me. I look at my husband and wonder who he is and why we live together.

My parents stay for a weekend and I wonder who they are and feel like we have no connection apart from titles like Parents-child.

I can attend training at a volunteer place every week for months, not go for a couple of weeks, return and wonder who everyone is and what am I doing there. Like they are all strangers even though I have been attending for years.

I can go somewhere I have been hundreds of times and suddenly feel like I have never been there at all.

Most days I feel like I am in a movie, playing a part. There but not really there. No real sense of connection. It is hard to explain. I've tried talking to various professionals about it, have tried stuff like mindfulness, but still feel the same.

My family and friends don't know how I feel about them. To me it would not matter if I never saw them again as they feel like strangers to me. It is a weird way to walk through life.

Thanks for listening!

Cheers from Mrs. Dools

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Just Sara — Sun, 28 Aug 2016 01:12:30 GMT

Hi Dr Kim;

My post relates to two things I've discovered that's helped my anxiety/panic/depression.

1. During a conversation with a friend, I was trying to explain how confused I felt and the words; "It's as if I've developed PTSD from having PTSD symptoms" came out of my mouth before the thought. After talking this over with my friend, I felt so much better realising I'd been panicking about anxiety etc developing due to how devastating my previous experiences had been. I'd be triggered from slight shaking or too much coffee for instance and off I'd go. After this conversation, I'm mindful of physical triggers and tell myself it's just coffee etc and do something productive. This has really reduced symptoms.

2. I'm on antibiotics for an infection and have been taking a lactobacillius replacement for the gut flora it affects. I've found I've become more calm and balanced in my thoughts. I went off the replacement to see if there was a difference, and there was. So I'm back on Inner Health Plus daily and feeling much better.

These two things aren't spoken about on this forum often and I'm wondering if there's scientific or psychological understanding of my success.

Many thanks

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Cayden — Sun, 28 Aug 2016 18:27:58 GMT

Hi Dr Kim,

Im having a lot of trouble trying to talk/explain/understand about what i believe is my undiagnosed depression.

Okay so after nearly 3 hours of writing and rewriting this i believe ill settle with: When im having a bad day i feel so certain that i do have depression but by the time i convince myself i need help, i dont feel so bad and start doubting how bad it really was despite the exact same thing happening within a couple days of it. Keep in mind, I know this kind of thing is common with depression, but that knowledge only makes me doubt myself more because.... its like i think i subconsciously make it up because i know about these symptoms? Its very confusing and frustrating.

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Dr_Kim — Mon, 29 Aug 2016 23:18:54 GMT

JRBanks said:
Hi Dr Kim. I am a 24/yo male, and I would appreciate your advice on what I think is a current undiagnosed mental issue of my own.

Hi JRBanks, You present a symptom which could be a few things I guess depending on the context in which it arises.

It could be part of an Autism Spectrum issue as people with this disorder have issues with communication and social interactions. Sometimes people on the Autism spectrum are trying so hard to be in the conversation that they are concentrating on what they will say next, and in doing so, loose concentration on what the person is saying right at the moment.

This leads to a disjointed conversation where it seems that you have not been listening but you have in fact been engaged with your own thoughts. You don’t mention other things that people with Autism have though like repetitive behaviours, obsessions or sensory problems, or issues with comprehending the emotional worlds of others . Also it doesn’t quite explain the email or dishwasher issue. It may be useful to talk to your parents to talk about your early years and if you had any of these symptoms in your early childhood … It could give you clues.

The other possibility that comes to mind is dissociation. This is a psychological activity that occurs when then mind kind of “checks out” of being really conscious of whats happening in the moment. From the outside you may appear “normal” but its like inside you are blank and memories of this times are often hazy.

The common and extreme form of dissociation is found in cases of trauma or abuse where, using very understandable and unconscious defence mechanism, the mind takes itself away from the present and goes “somewhere else”. But we all dissociate to some degree. A common example is when you drive a common route to and from work . Sometimes you arrive home and realise that you can’t really remember the drive, its like you were on “autopilot” and your mind was elsewhere. Dissociation is seen quite commonly in anxiety or other mental health issues , and it even has its very own disorder !

Lastly, there are a few medical things that might need to be checked off the list , so a visit to a GP might be in order- rare , but possible e.g. some forms of epilepsy cause people to become vague for a short period of time.

Got a question related to mental health? ASK DR KIM

Dr_Kim — Mon, 29 Aug 2016 23:20:01 GMT

Doolhof said:
Hi Dr. Kim,

I am loving this thread. Thank you so much for giving your time to us all in this meaningful manner!

I have been diagnosed with depression, PTSD, BPD, unresolved grief, stress and anxiety issues. One thing I have trouble handling at times is disassociation.

Hi Mrs Dools,

Thank you for your kind words about the forum. I’m going to try and frame things in a way that i hope is new to you and I hope it is helpful, but I really urge you to try and build a connection to a therapist. I know this is actually part of your issue - as you feel totally disconnected but I don’t think a therapist would take your feelings personally, so its a safe place to discuss this stuff openly and I think it might be a relief to have it out on the table.

People who experience dissociation have often had trauma in their past which has initiated their brains ability “check out”. It starts as a defence against experiencing terrible things but can become a habitual. With you it sounds less like dissociation and maybe more like you have built walls around your emotional self.

Its interesting as its seems that your amygdala (the reptilian brain) is over riding your cortex (the mammalian brain). It sounds like you may have had a lot of difficulty in your past (I am extrapolating from all your diagnoses) and that maybe there was some trauma in your early life, or possibly a feeling that you couldn’t rely on people around you to comfort or support you when you needed them.

If this was the case, your fight or flight " brain starts to perceive connections as dangerous or unreliable. Your amygdala is a very powerful part of your brain and hard to override with just logic. It seems that you want to trust and connect with people and you desire to change the message or the habit that your brain has created for you. This part of your brain is stubborn, but does respond well to simple repetitive messages and “ body work” e.g. exercise or breathing/ progressive muscle relaxation techniques.

Remember that nerves that fire together, wire together .. so if you keep noticing and drawing attention to the separateness, it will become stronger .

I hope that you can put a big radar on your head that notices the opposite i.e. ANY connectedness you feel to anyone or anything, whether it be to your husband, your pet or to a song you like !! When you notice it, really notice it . When you do this you are wiring neurons together that note connectedness.

Do this for a start at least once a day , then up to 5 times per day .. until you are noticing and even recording any iota of connectedness. Your old sense of unconscious danger around this will finally get the picture that connections NOW do not cause threat.

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Dr_Kim — Mon, 29 Aug 2016 23:22:07 GMT

Dizzy@home said:
Hi Dr Kim;

My post relates to two things I've discovered that's helped my anxiety/panic/depression.

I am really pleased to hear about these positive break throughs for you.

The first one I totally get! Know your soft spots and your triggers and mange them ! You will feel so much more empowered.

Many people have more stress from the POSSIBILITY of something happening then from the thing actually happening . For example, people with phobias spend a lot of time worrying about “what if’s” and the smallest trigger can send them off when the thing they are actually scared about isn’t even happening. e.g. lets take emetaphobia (a fear surrounding vomiting - doing , seeing it etc) .

One can spend so much time worrying about it, that you can get just generally anxious, avoidant or even depressed because of it, and like you with the coffee shakes, even someone coughing in public can make them terrified! But sometimes the last time they actually were in contact directly with vomit might have been months or years prior .

It is the FEAR of the event that paralyses people. So if people can be mindful as you have been of the power of this trap and notice for e.g. ,that someone coughing is just a cough and its normal and its going to give me a fright , but its ok and Im alright .. breath in for 3 , hold for 3 out for 3… now get on with my day.

The second association - between lactobacillius and anxiety, I had to double check the literature. All I could find was some studies looking at the use of it in IBS (Irritable Bowel Syndrome), but not for anxiety. Having said this , I would advise you that if you feel calmer on it and if you can afford it , I don’t think it is known to be harmful to take over the long term so i can’t see a down side to you continuing it. Go you!!