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.”

[Dr_Kim]

Hi Elizabeth
Sleep is a common issue and handled in different ways by different doctors and often there isn’t one “right” way but just different ways that work well for some and maybe not so well for others.

The first thing I would want to know is if your sleep issues are new or long standing ? We would want to have realistic expectations of goals and some people are naturally poor sleepers and others have traditionally been great sleepers ( which I define as those who get to sleep easily and feel rested when they get up).
Most of us lie somewhat in the middle and have some good night and some poor nights and muddle along with some days that we feel rested handsome days that we feel tired.

The trigger to intervene with medications for comes when sleep hygiene measure have failed and
1. the patient is finding the sleep pattern intolerable or
2. the sleep routine is causing a lot of anxiety or
3. there are intervening health issues that are causing the sleep deterioration and it needs attention for the sake of their health or
4. There is a sudden trauma that is overwhelming and someone needs help to sleep do to a sudden extreme loss or grief.

I think that you need to talk to your psych about your situation .
Do you have any other strategies other than sleeping tablets for our sleep? Have you maybe thought about a really strict month or 2 or sleep hygiene together with Melatonin? http://www.cci.health.wa.gov.au/docs/Info-sleep%20hygiene.pdf
It always look like really obvious advice but its actually really hard to do!

Sometimes this can shift the brain into another gear with sleep but it isn’t easy and you may need support. There are psychologists that specialise in this e.g. http://www.msdc.com.au/MSDC/Insomnia.html .. but google your nearest or ask your GP about it.

It seems to me that the only real way of working out if the tablets are a good thing for you is to do a sleep diary for a month using them , them do a diary for a month or so without them and see what happens… you may also then have some excellent information for any sleep psychologist that you end up seeing for help in implementing a sleep hygiene routine with you.

I hope this little info is a bit helpful in deciding your next step… its never easy when you have conflicting advice so I hope I didn’t add to the confusion.

[Dr_Kim]

You are being a super girlfriend for writing in to us and asking about how to help your boyfriend. That is the first step so congrats on doing that.
It is going to be important for him to start to learn to regulate his moods a bit better so that he doesn’t hate himself , and so he doesn’t worry the people around him.

So where to get this help?

1. I’m not sure if you are school age or Uni age, but if you are you can try going through a school counsellor or a Student Health Service.

2. Headspace would have psychologists available that would have expertise in this and see people aged 14- 25. I would suggest going along with him to the first appointment so they know what he is like from some else point of view.
https://www.headspace.org.au/

3. the Reach foundation has some great programmes that you guys might like to look at
http://www.reach.org.au/

4. Ask him to book a double appointment at his GP . Go with him if he wants you to and both of you take a list of your concerns to them. I think asking them to help you with a Mental Health Care Plan is a start as they will find a psychologist who can help him regulate his moods better.

5. Call the Beyond Blue Helpline if you are still confused!

So I think it is great that you are taking steps to help him be happier and feel more stable but I don’t think you should make it your entire responsibility . He’s lucky to have you but part of the getting better is him owning it, believing its real and believing that he needs to do something about it. He shouldn't just do it for you.

[Dr_Kim]

Hi There ,
I am really impressed with the way you are tackling this difficult diagnosis. You have been super honest in noticing the ambivalence that many people with Bipolar have as the treatment does in fact “ kill the high” and that is often quite challenging for the person involved to do.

So you should be super impressed with yourself for putting your LONG term mental health and functioning before the IMMEDIATE enjoyment of the high of the mania .

Now it is all new to you. The diagnosis, the medications and the fine balance between feeling contained and under control on the meds but not having too much of them so you have bad side effects from them. Don’t be hard on yourself for not knowing how to make sense of all this stuff as it takes time and experience to know exactly what is going on. I am again really impressed that you use a mood monitoring App as this is giving you further clues as to what is going on.

The exact question of whether these are these discrete episodes or part of the same bigger one is hard to answer and I’m not sure if it has absolute clinical relevance as I think you should treat the symptoms that you have in front of you . It seems that is exactly what you are doing … you have decided to see your GP and increase the meds . WOW! Go you! that is brilliant self awareness and management. Your new psychiatrist will almost certainly be tally impressed and wish most of his patients were like you- mindful and able to take action. Ask them any questions you have . I am sure they will be happy to work collaboratively with you to create great outcomes .

dr

[Elizabeth CP]

Thank you Dr Kim for your reply,
Unfortunately the last time I saw my psychiatrist we had a lot of urgent of issues to discuss so we had limited time to discuss sleep issues. My psychologist is ill so my appointment was cancelled so I have to wait for a month before I see anyone.

I have had problems with sleep for a long time. I try to follow the recommendations re sleep hygiene. Unfortunately once I am overtired I struggle to sleep even following all the recommendations. Also when very stressed I struggle to relax preventing me from sleeping. Fatigue has a huge impact on my mental health setting up a vicious cycle of sleeplessness -fatigue-stress- more sleepleessness & more mental illness. The sleeping tablets were prescribed as a circuit breaker for this cycle. To prevent dependence I avoid taking them two nights in a row & take them no more than 2 -3 nights a week. I only take them if I can follow the recommended sleep hygiene ie going to bed at the correct time & taking time to switch off devices at least an hour before.

I am recovering from a physical injury. Initially I was on strong pain killers & muscle relaxants which also ated as a sedative. Once the pain reduced enough I stopped taking all medications to clear my system of all the medications & their effects. By this time the medications were no longer working well as my body had got used to them. This meant my sleep was very messed up & I was extremely tired. I am still feeling tired & went back on the sleeping tablets but with limited success.

The sleep diary is probably a good idea.
I need to overcome my fatigue so I can cope with the stresses in my life which are quite significant.

[Alexandra_P]

Hi everyone,

im 12 years old and my mother recently got into a relationship with a really nice man but me and my sisters feel a bit left out. I am 100% supportive of her relationship but my sisters are not. They are being very horrible to me. I keep feeling really upset and my house isn’t a very happy place.

. After school ended i got a call from someone saying that someone who i love (im not going to name them) had been fighting cancer for two years and i took their presence for granted. They thought that they were going to die while i worried about if i was going to get a lift to school. The worst part is, i feel like crap and can't tell anyone, not even my own mother. I am so sick of being sleep deprived because of this stupid family and its issues and not eating because "I don't feel like it" I feel so depressed and the only place that people are truely happy right at this moment in my life are at school where i constantly feel i'm not good enough and ill never be good at anything. Every night i pretty much cry for a bigillion reasons and none of the people i love even know it. I just wish they'd for once ask me if i'm okay or sat down with me without yelling at me. They say that i'm too sensitive but really i honestly take feedback so harshly i go to extreme lengths and i'm sick of people telling me that who i am isn't good enough.

Love, Alex

[Dr_Kim]

Hi Alex
I am so glad that you wrote into us . It shows a lot of initiative and strength to be able to ask for help when you need it .
There are a couple of the things that strike me about your post .
Firstly, you seem to have really high expectations of yourself. Which can be good if it drives you on to push yourself to be your best , but can also be bad if you always put a really high bar up and then feel you never reach it so feel like a failure.
You seem to believe that you should be able to take care of everyone else’s feelings . You are 12.
The other thing is that you are mad at yourself for worrying about things like a lift to school. Again , you are 12. And this is totally appropriate for a 12 yr old to be worrying about .

At 12, it’s totally ok to not be caught up in other people’s problems and be concerned about caring for others. It’s such a difficult time in a persons life - full of social and emotional challenges and it’s hard enough just looking after your own emotions , never mind any body else’s !
It’s ok and normal to want and need caring and nurturing. To want someone to check how you are going and care if you are coping . You are 12. But to be honest , even if you were double or triple that age , the need to be seen , noticed , cared about doesn’t really go away .
I suggest that see your school counselor or go to your local Headspace or your GP or use the eHeadspace to discuss how you might be able to explore this more .( if it helps, take your post and this reply otherwise you )
It might help you to work out more fully what your aims are and how to work towards them . How to work towards being kinder to yourself and getting the closeness and caring that you ( and all of us ) need .
You are not “ too sensitive “. You are simply a loving kind person who also wants to be loved and noticed. In my book, that’s just so wonderful and will mean you will be a great person to know ! I wouldn’t try and get rid of that quality but you may need guidance in how to make it work for you, not against you.
Alex , you deserve to be happier. Go and find the support so you can reconnect with your family in a healthier way .

[mintyren]

Hi Dr. Kim,

New user: In a nutshell, my husband & I are at our wits end.

Our 20yr old son refuses help with his mental issues. He's been heavily self-medicating for a few years with marijuana & alcohol...dangerous amounts. He is angry ALL the time, unless he's been smoking. He fly's into rages that lead to property destruction (i.e. smashed windows, doors, cars, etc). He works with his Dad as a tradesman but is totally unreliable. He gets paid Friday afternoon, but come Sunday, he is bombarding us with txts/calls asking for money. He is nominated as a habitual traffic offender by law. He has been in a tumultuous relationship (off/on) for over a year & now she is pregnant (due in March) but we don't know if our son is the father. She has supposedly been diagnosed with BP + others. Neither of them are fit to be parents. They aren't even able to care for themselves (basic hygiene is a struggle). Neither of them have a fixed address...The way he treats/speaks to his Dad (including on the job), is absolutely disgusting/unwarranted/unnecessary/disrespectful/hurtful. He & I now don't speak because he doesn't like what I have to say (I don't pander to his every whim like Dad has to) & also because I am just so angry with him.

Our son "couch hops"...staying with us one night, with the girlfriend the next & the rest with friends, depending on where he ends up that night. He is completely narcissistic & is an expert in manipulation. He begs, borrows & steals from anyone he can to get what he wants. He is now gambling on top of his drug & alcohol intake (mostly pokies). He blames everyone else for his bad choices & seems to expect the world to just hand him everything. His older brother (by nearly 4yrs) & younger sister (by nearly 3yrs) feel like they don't have a brother anymore because he is so intolerable to be around.

Over the last 5yrs we've tried to get him help...GP's, counselling, hospital mental clinics, psychologists, psychiatrists...I take him to the initial appointment/s, he gets a script for anti-depressants & never follows up (I think he sells the scripts). My husband & I don't really sleep anymore...waiting for a 3am doorknock from the police saying he's hurt someone somehow...We are emotionally exhausted...we don't know what to do or where to turn...how do you help someone if they have no interest in helping themselves, especially when there's a baby on the way? We love him, he's our son, but...#toodamnedhard

Thank you in advance...

[Dr_Kim]

My heart goes out to you. 
This is a terrible situation and my advise is not going to be about your son as I figure you to be some one who has done everything you can there.
 
My advise is going to be more about you and your husband. 
I suggest asking your friends or GP to help you find a wonderful therapist ( I think a family therapist would be a good bet)  . Go alone and/ or with your husband. 
 
Work on  a few things including
1. The grief of the loss of the the dream and hopes of the imagined son. 
We all have an idea of our children in our heads when they are little - we have hopes for them . We put in so many hours of work to try and get them to be their best selves. So when they don’t get anywhere near that imagined adult, there is a grief . A sense of loss of all those hopes that you had for him , and for your family . One hopes of a happy close family and when one of the children is clearly not going to be part of that picture , its time to let that go and create a new idea in your head of your family and what is going to be like . 
A good therapist will help you with this. 
It sounds callous, but i think trying to push and squeeze him into anything that you want him to be is probably going to fail at tis point.
 
2.Work with your husband on a “new narrative" for your future . 
What is it that the two of you want form this next part of your lives ? You might need to bring this phase to a close and enter a new chapter of you “ narrative” .What brings you joy ? fun ? creativity ? How do you both see that future as a couple ? as a family ? as individuals ? Are the visions aligned or miles apart ? Again , a good therapist can help you look at this and feel like a team and understand where each other is at. It might be time to turn the page and see where the next chapter takes you two!
 
3. Create clear boundaries for your son. 
Its not black or white .I don’t think you need to fully be responsible for him or disown him but you do need boundaries. And this is not to be mean , but so you can be kind - check this out
https://www.facebook.com/theworkofthepeople/videos/10153967066765682/
 
4. Finally ,You need to work out what what to do about your grandchild ( if it is your grandchild and that might need to be sorted out) . Once you have discussed grief and had a discussion about how you envision your future and found some places for joy, then you might work out what , if any , place this child has in your lives . If he or she has a place YOU and your husband get to decide how and under what conditions that happens . I would set boundaries from the onset . 
 
It is one thing to feel your son and his partner are unable to care for themselves but if at any stage you feel the child is not being taken care of it is your duty to report this to your GP or http://services.dhhs.vic.gov.au/families-and-children
 
I hope this has been helpful but the general message is to LOOK AFTER YOURSELF and your marriage and create some good clear boundaries that you and your husband can agree on. 
 

[LuLu_]

Hi Dr Kim

here are my questions

Is recovery a choice? If it is a choice should we feel guilty for not making that choice?

I was diagnosed with severe depression and moderate anxiety this year and i am feeling a lot of guilt because I don’t really want to get better even though I know it hurts people to see me like this.

thank you

lulu

[Yayeet]

I’ve had stress for a year now, often whenever the problem to leading my stress comes up to me I try and avoid it because I think it’s too much.