Ask Dr Kim | Archived live chats

[Chris_B]

Good afternoon everyone, Dr Kim is here and we're ready to start.

Welcome Kim, our first question is below:

I am a 23 year old female with contamination-focused OCD. Do you have any advice about how I could deal with anxiety over my boyfriend's health? He is the only person I kiss and share drinks with, which means that if he does get sick, I will be likely to get infected. I really love and care about him, so the anxiety is not just about fear of contracting germs and illness, but also wanting him to be healthy and well.

[Chris_B]

Our next question is about the road to recovery after a breakdown:

Hi Dr Kim, I had a mental breakdown about 4 months ago now, I am on a high dose of SNRI's and a small dose of mood stabilizers, My depression seems to have gone but I still have no drive and no motivation to do anything. I find nothing exciting everything seems so mundane. Is this normal?

[Dr_Kim]

Not knowing the details of your condition and your meds ,I am a bit hesitant to make a call on what is ok for you, but I will say that a lot of people do report feeling a bit “ out of it” on medication. As in, they feel less negative emotion, but for some people they also feel less positive emotion. So this gives the feeling of the “mundane” that you might be talking about.

I think you might want to discuss with your health professionals about the possibility of slowly reducing your meds so that you hit a better place .. where you can keep the depression at bay , but possibly get more positivity back . However , be aware that no medication is perfect , and sometimes we just have to accept some side effects as a downside .

Also , don’t forget to keep at the therapy and lifestyle factors ! Exercise, regular scheduled activities and meditation are super important.

[Chris_B]

Our next question asks, what do you do if talking doesn't help?

Dear Dr Kim, I recently read a story about someone who died after suffering from depression for several years, and it really hit home to me. The news ended with the reporter advising people with a problem to call LifeLine for help. From personal experience, I have spoken with Lifeline on 3 occasions over the past 10 or so years and although they do a fantastic job and listen with the utmost patience, for me, it doesn't help. I find that by expressing myself in words has the same effect but that is not what people like myself need at the time. I find exactly the same speaking with a Psychologist. I don't have a problem explaining my pain, I'm desperate to receive some kind of advice and I don't get that. For instance, if I'm having a problem with a family member, why would they want to talk or listen to me? How many times am I supposed to offer the 'olive branch' and have it thrown back in my face? I have had a bad run of health since 2004 surviving three Cancer operations. Two stays in a Private Clinic for depression and recently four stays in hospital with pneumonia within four months. Not one family member (including husband) offered any assistance with or after any of my health issues. Can you imagine how you would feel after undergoing an op. for stomach cancer to come home to be left to look after yourself? This part of my life is just the tip of the iceberg!

[Dr_Kim]

I think I get what you are getting at - that sometimes what you need are people to ACT , not SPEAK!

I think it is reasonable to want care and nurturing after major surgery and I feel bad for you that you felt let down by your family. I think what you are saying is that ringing Lifeline isn’t going to get Chicken Soup delivered to your door. However, the distress we feel about the soup not being there at least can be shared , validated and understood by someone, and that sometimes just makes us feel a tiny bit better.

I wonder if you may have to look at your physical support network so that you are not feeling so alone during times of need. Support groups, community nursing etc.

With respect to managing your family , you spoke about trying “olive branches” and having them thrown back in your face. I’m sensing a lot of unresolved issues in your family and wonder if you might want to free yourself from expectations and develop a more solid position for yourself with respect to this.

You might consider a longer term counselling to help you on this journey , a support group , or reading .. Maybe look at an oldie but a goodie- Harriet Learners “ A Dance of Anger” . It help you put some of their actions in perspective.

[Chris_B]

And our last question for today, about the frustrations involved with medication side effects:

Hi Dr Kim, I am taking an SSRI and have been for a few years. I have experienced moderate weight gain as a side effect. I also have a friend who takes a similar dosage and is experiencing the opposite, quite a large weight loss. I have read a lot on the internet about this and I realize everyone is different, but they have never gone beyond this simple explanation/statement. What I would like to know, why different people react so differently to different medications?

[Dr_Kim]

This is a really interesting question and we get asked about this all the time.

The studies show that when you do a trial and divide people into 2 groups - half on SSRIs and half on placebo , about the same proportion gain, lose and remain stable with respect to weight .

What we conclude about this is 2 things .

1. the population is constantly varying its weight - some people are loosing , some are gaining etc whether they are on meds or not.( But the people that are on meds are usually quick to attribute it to the meds! )

2. when people are depressed , it can affect their appetite . Some eat more , some eat less. When they are treated with an SSRI , it can normalise their mood and their eating regime , so that they once agin eat normally and so they can feel like they are putting on weight ( or loosing weight) but in fact it is probably just a return to pre depression status quo.

Having said all of that , I will add that I have heard anecdotally from many patients about weight gain or loss on various SSRIs that do seem to be directly attributable to the medication. So although it might not be backed up in the data, I do hear about it in my practice!

As to WHY it might be different on one person and not another , I really don’t know , but if it is really bothering you , I would discuss it with your Dr as you might even consider a trial of a different SSRI just in case you get a different response ( if you can stand going through the hassle of changing medications!)

[Chris_B]

Hi everyone, Dr Kim is here to answer your questions for the next hour. First up this week:

Most (or all?) plans for wellbeing seem to include a component of social support. How is that supposed to work for someone who doesn't want to share problems with the people in their life, and finds maintaining friendships to be too much effort?

[Dr_Kim]

Good afternoon everyone!

Social supports are important in people's journeys to better health , whether physical or mental, as there are times when we all find that that encouragement or new perspective is really helpful.

I gather you find that the people in your life are not appropriate to act as that sort of support for one reason or another and you are not alone in either having NO supports or the wrong sort of people to support you, or even well meaning people but giving the wrong sort of support at the time!

One of the ways around this is by using on line help or forums or even a moderated community support group . These people are usually understanding as they have often been through something similar and tend to “get it” , so it can be comforting that you can feel understood. Its not a guarantee and you may need to try a few different groups or options until you find something that works for you but at least it gets around the need to use your friends for this support.

Check out  eHeadspace, Beyond Blue chat  or a list of community support groups at The Black Dog Institute

[Chris_B]

Our next question is quite an involved family story:

Have a family member with diagnosed and inherited Paranoid Schizophrenia (had it since late teens - now 34 years old). She has a long documented history and confirmed by 3rd parties - at workplaces, churches, a neighbour and now her family - of making false allegations or accusations of what she thinks is violence and abuse against her - mostly things like perceived sexual harrassment or any scolding of her or children or if anyone disagrees with her views - often on controversial moral topics and arguments she initiates, also using ideas from her social science and psychology studies - her rights, - it is seen as psychological and emotional abuse, bullying etc.  

In the last 2 years she took out false and vexatious intervention orders against family members over this - called out police and other authorities falsely on them and ended up with IVOs on her also over the incidents she initiated and the harassment, and she recently breached these -now also facing police/court.  Yet she is continuing the same behaviour making very malicious allegations against an elderly parent (mid-70s) who is her informal carer - who also cooks for her and provides free housing (living at home) and is coerced into even paying her car bills (servicing, insurance etc -amounting to thousands a year) - and this is despite them being a pensioner and she having disabilty pension, and income from other sources.

The things she has done I believe to be elder abuse - as well as financial, she has affected them emotionally, psychologically and caused physical stress (parent was in shock, fell and hit their head and an ambulance was called - when read IVO against them, doctor says has elevated blood pressure, and at times they are being taunted by her still -that she will take more legal proceedings against them and put them in jail and stay in the house -letter she sent also to a relative).   Parent now avoids her and has at condsiderable legal cost taken IVO against her and now has to attend court to defend themselves.

However, despite all this her parents think they can still keep her at home and somehow get her to cooperate with court orders (which she thinks don't really apply to her but to others) and I believe she will use any mutual court order, if comes, malicously against this parent to continue harassment and to aggravate them into breaching the orders.  

I and other family members, as well as a mental health case worker, have hence advised for parent to call psychiatric triage and have person reassessed (as saying she is also non-compliant with diagnosis - trying to change it by changing doctors etc -mentioned at court) and also referred to a residential mental health longer term facility where she can learn life skills -financial etc and independence while having monitored treatment. However parent is unwilling to call them -feeling initimidated by person and thinking they have to keep them at home - cultural reasons as well.

Also as in past triage has come, person has presented well (uni student) and no action was taken, but that was before this IVO was put on parent. Won't even call seniors rights to get help for themselves.  Person is not a physical danger to anyone or themselves but is in all other ways mentioned above causing serious stress to whole family (other relatives and family friends avoid her too) - so is triage likely to take some action and would they be able to get her current psychiatrist details to get the referral to residential care or order her to do so - if she refuses to go? Otherwise, how else to proceed with getting help for this person and her parents (other parent also has same illness but well managed).

[Dr_Kim]

What a difficult situation for your family and I think for everyone in the community.

We all have to think about getting the balance right between the lights of the individual for self determination and privacy, and the right of the community members to not be harmed. My understanding is that health and law professionals are very reluctant to deny a community member their freedom and “take some action” by placing someone into the care of a hospital or other facility against their will, UNLESS they are clearly that unwell that they are an imminent  danger to themselves or others.

This means that many people in our community who have mental health issues stay untreated or under-treated and do not seem to make what many people would consider to be rational or reasonable life choices and behave in ways that most of us would not. Unless they are breaking the law or are a danger, I’m afraid, that there is little we can do.

I would concentrate your efforts on the people around this sadly unwell women. Give her parents and family the support, understanding and love they might need to cope with the incredible distress at witnessing their child behaving in such a difficult way and state your views and concerns, but then allow them to make their own decisions and be respectful of this as we have the right to this.

This illness, paranoid schizophrenia, is so devastating to people’s thinking and behaviours when  poorly treated ( and many patients refuse treatment as they are unable to rationally see they are unwell) that it doesn’t surprise me that this person may be behaving in a way that seems outrageous to you. However, sometimes we just have to let it go as we can’t “fix" people against their will.

To support the family members, it may be things like helping them insulate themselves financially from her, or making sure they have respite options when things get too tough at home, or just helping with dropping in a meal every now and then. Making sure the local police are well informed about the situation so if they are called in a violent situation, they have a “heads up” that there is a person who is mentally unwell and unstable in the home.

Make sure the family keep documents of what has been happening as everything can get blurry, and also that they check in regularly with their own GPs as its so important that they look after their own physical and mental health during this stressful and chaotic time.

Do not be afraid to ring a CAT team again if the person deteriorates further and you feel another clinical assessment is necessary. Just because she presented well once, does not mean they will not come again and check up on her a second time. Also, just because someone has refused treatment or help in the past , doesn’t mean they will always refuse help, so it is important to keep the door open for the patient , so she can walk through it when she is ready. She is more likely to do so, when she feels people are “ on her side” and really care about her, then when she is being forced into it because nobody can see her point of view.

Ultimately though, if these parents want to keep there now adult child in their house at the expense of their own stability, finances and peace, I’m afraid that is THEIR choice and you might have just accept that and respect support them in that choice even if you wish they would do something different.

Look after yourself and know that even seasoned professionals don’t have easy answers to this one , so please don’t feel you have failed your family by not having a solution.