Got a question related to mental health? ASK DR KIM

[Chris_B]

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.”

[Sophie_M]

Hi Sheryld, we can't provide referrals for practitioners here on the forums. You will need to see a GP to get a referral to a psychiatrist, so we would suggest starting with your local GP and advise that you need to see a psychiatrist who has bulk billing available, they can assist you further from there. If you need further assistance with practitioner referrals, please call our support service on 1300 22 4636.

[Wakai_senshi]

Hi, Dr. Kim I don't know if it's right to ask here but basically I've been diagnosed with depression, anxiety, OCD, Agoraphobia and remember having symptoms since I was 12, I'm now 26 while I've had periods of getting better in the last few years I've felt like I'm not gaining any ground against it anymore, I don't take medication because I feel it mostly just masks the issue and mostly get negative side effects from it so it isn't worth it. I've tried counselling also seeing psychologists and psychiatrists but the times I can get out and see them they suggest stuff for me to try like "I want to see you try some sports" or "think about this instead" it really doesn't work, I've also been to a clinic and pshc ward but the atomosphere there made me feel 10x worse so I lied to leave as it wasn't productive in helping me at all and I struggle to show up for most appointments for specialists etc which in turn they get fed up with trying to help me and I'm stuck back at the start again. on top of that this new requirement to work on disability (DSP) which is a joke (because agoraphobia, how silly is that when I struggle to get outside). So I feel like I'm being constantly pressured and prodded to do more than I'm currently capable of and I feel like I have no room to concentrate on getting better to the point of basically not wanting to exsist anymore it's like I'm smothered and surrounded and always panicking (it's making my anxiety worse).

Sorry about the extremely long message but I hope that will help with your answer to my question which is, what else can I do?

[Hoping4Recovery]

What is the difference between moderate and severe depression? What are the differences in symptoms? How are they diagnosed differently?

[Dr_Kim]

Hi There, Wakai senshi.

What a difficult spot you are in . The way i see it .. your internal bullies , your "anxiety brain", have you hostage ! They are kind of like terrorists that have taken your rational brain hostage and are forcing it to think and behave in certain ways or else it will punish it with symptoms like panic and feeling sick with anxiety. Its a vicious circle because if you try and defy them, they punish you with more symptoms.

I know it sounds like the advice you are getting is like trying to hold back a tidal wave with your hand, but neurobiological research shows that “neutrons that fire together , wire together”. What that means is that the more you think and behave in a certain way, the more automatic that becomes for your brain. Your challenge is to change the “automatic response” from “I feel sick and anxious and this doesn’t help so I’m going to stay home" ( and picture the “terrorists “ in your brain celebrating the victory as they succeeded in getting you to think the way THEY wanted !!) I know this is hard , but I’m going to survive the temporary discomfort and do this” ( and picture your healthy brain celebrating its victory over the terrorists!!) .

Now this pathway of victory needs to be repeated 100s and 1000s of times to be laid down as automatic . Like if you were learning piano .. you wouldn’t expect to just sit down and play a piece perfectly straight up . You need to practice and practice and eventually your fingers just move “ automatically “ .

So, maybe try to open up to the possibility of change and relief from your symptoms .. but with small steps of wiring healthy neuronal patterns together on step at a time . The things that aid this process are things like exercise , healthy diet , sleep and mindfulness ( and for many , the right medication ). Also look at support groups to keep encouraging you on your journey.

Its hard work and often 2 stripes forward , one step back .. but keep wiring those healthy pathways and weed out those “terrorist” thoughts !

[Sophie_M]

Hi Hoping4Recovery, we'd suggest having a look at this section of our website to answer your questions: https://www.beyondblue.org.au/the-facts/depression/types-of-depression

[geoff]

hello Dr. Kim, lovely to talk with you again on a very busy post.
When does someone know that the AD they are taking has now become too strong for them, that is the dose they are taking and for the doctor to know when they need to lower the dosage, not to stop taking them because that's another issue. Thanks Geoff.

[Dr_Kim]

Hi Geoff, Medication dosage for antidepressants is often really hard as its not like some tablets where you can do blood levels and check it is the “right” dose. It is pretty much a clinical observation of response vs side effects that decides the dosage .

If you feel that you get the same response from a lower dose with less side effects , then i can’t see why you wouldn’t bring this to the attention of your GP and work to reduce down to that dose, at least for a trial period!

Symptoms that might encourage someone to look at reducing dodge are very individual , but some might be things like sleepiness or restlessness, persistent nausea or headaches, a groggy or woolly feeling in the head, or some sexual side effefts. GPs are usually pretty across common side effects and can advise you which might resolve with dose reduction, which to persist with and which need a change of medication.

[Showboat]

My wife took our two kids and went to stay at her mums yesterday. She has called back a couple of times to see me at home today and brought up the fact she thought I was depressed. For five years now I have been travelling for work and this year have reduced the amount of travel significantly. It has changed our relationship and I find I feel as though I have no significant part in the household. She has an Aunty who has been spending time with her in what she calls healing sessions. She says she is happy with who she is and believes I need help liking myself. I had two children in my first relationship and have had two children with my wife who are five and three. I have not seen my first two children or my ex partner since I left on 2002. I don't think that effects me as my parents have a strong relationship with them. I felt it was the only way I could handle it, by leaving and not looking back. I don't believe I could be a part time dad. I fear this is heading in the same direction of I don't seek help. I feel I am very low on the list of people she cares for. I can't stop thinking negative thoughts during the day and I do not sleep well. We do not have a regular physical relationship which makes me also doubt myself and says she needs an emotional connection before a physical one. I spend most days thinking negative thoughts about how things will end up and take everything she says to heart. I don't argue with her, but find myself walking away shaking my head or snickering. Which doesn't help the situation. I haven't called the line to help yet. Don't think I am ready for that just yet, so looking for any advice you have. I do not want to leave, I love them all dearly and want to make it work. I don't particularly like what I am doing for work and find my escape in going to the gym. She says my priorities are wrong and I need to change some things about myself. She is probably right. I feel as though I need to have a new shaft, work, where I live and some other things. But she will not move away from her family, so moving is not an option. I just feel as though walking away would be an easier option for me, but I can't bear the thought of not seeing my kids again. And knowing the way I think I would find it very difficult to have a part time relationship with them.

[Dr_Kim]

Hi Showboat, you have already made a significant move in writing to this post. So congratulations on that! It seems that your usual way of operating is to avoid a problem instead of meeting it head on, so writing in to read feed back is a big challenge for you and I applaud your bravery in taking these first steps.

The way you are, the “leaving and not looking back” way of being, didn’t just happen. It has become a part of the way that you have convinced yourself suits you and maybe you have have convinced yourself that it suits others too. I challenge both of these assumptions.

I think you really need to sit down with a trained therapist and work out how you came to be a person who walks away from troubles and puts up barriers to real honest interactions. It seems to me that somewhere in your past you were not trained or given the skills to know how to manage uncomfortable emotional situations. So you tend to avoid by either the gym or deflecting with walking away and snickering or literally walking away altogether ( from your first family).

Meanwhile in your head , you punish yourself with negative thoughts .There is another way of being. There is a way of gently trying to understand yourself and how you may have developed these bad habits of behaving and thinking. Once you understand that and can forgive yourself , you can start to build healthier new habits of thinking and behaving.

I truly believe this is possible but you have to be the one to work hard at it . You cannot do this alone.I suspect the roots of these old thought habits are a bit too deep for that. Find a good therapist via your GP and get to work sorting out how you can have a fresh start in your head without having to leave your beautiful children!

[radiojammer]

Hi, lately I've been crying every day, especially in bed at nights. I'm on anti anxiety medication but not anti depressants although I've been on them in the past. I'm seeing a psychologist but haven't got an appointment with her for another month. My marriage is bad and I will have to get a divorce when the kids leave home, my job is a constant source of misery to me (the organisation will not get me enough work and they say I have a bad attitude and I cannot convince them otherwise), my teenage son won't go to school and I have few friends to go out with so I have to do everything by myself when I'd prefer company. Does this constant crying mean I'm depressed? I did a quiz and the results were that I'm suffering from mild depression. I'm not suicidal but I do feel like a complete and utter failure. People don't seem to like me and I have no idea why, I am not unfriendly and enjoy talking to people. Would appreciate some advice.