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 E Paddington,
In your post you say that you have been dealing with anxiety and depression for many years so i gather that you may have had therapy for it and understand the physical effects of nausea, feeling faint etc come from the “Fight or Flight” hormones that flood the system in response to the perceived threat that anxiety creates.
I am thinking that your question pertains more to the gurggling sounds from your tummy that are called “ borborygmus” in medical speak. They are totally harmless and just reflect gas produced by your gut flora and fluid moving in your bowel but I understand that they can be embarrassing.
The “treatment” may be to keep a food diary and see if you notice them occurring more or less in response to certain foods. My thought is that you may find some ideas on how to reduce them through this. A dietitian may help you with this too, but remember it is harmless and we all have it to some extent.
With meditation and relaxation, I’m not sure if they have any affect on this condition. They do on irritable bowel… but this is a different thing. It certainly cant hurt and it would be great for your anxiety !
Good luck and know that we all have that gurgling tummy .. i just put a hand on mine and say “Sorry, hungry! "

[Dr_Kim]

Hi
It’s tough when you feel you have tried so much but still haven’t come far but I love your fighting spirit.

The fact that you are willing to have a go at something else and keep trying to find answers is really amazing and inspiring.

You are right that not every type of therapy is going to work for everyone. Some times one person responds to psychotherapy, another to medication , another to an exercise, diet and sleep regime or a Mindfulness program. Or some need a combination of these. Others need to try many types or practitioners before they hit on the right psychotherapy, others needs to try many medications before they find the right one for them and still others find none of these help.

The thing is that there are so many possibilities and so many combinations of therapy options that I am glad that you haven’t lost hope .

Group therapy is a great option as is joining any type of group - maybe even ones through your local council that may not be directly mental health related but maybe just more about a group activity.

People often feel better when they can get involved with something and feel part of something ( like with the men’s shed organisation for example which has helped many indirectly with depression)
So I wonder if getting involved in anything that you have a vague interest in would be helpful and possibly reduce some of your symptoms .

I feel your local GP or council will have better ideas about what is available locally but you could Also look at this list for ideas
https://www.beyondblue.org.au/the-facts/suicide-prevention/helpful-contacts-and-websites/support-groups

https://www.blackdoginstitute.org.au/getting-help/clinics-support-groups/our-support-groups

[startingnew]

Oopsy im sorry I think i missread one of my meds the MOA one is apparently a tetracyclic antidepressant but cant be used with moa meds. The site i was reading just kept saying moa med so i looked abit further and it said its a newer med and goes under the tetracyclic antidepressant

One site says one thing and another says another thing.

Just wanted to clarify that part so its the correct info.

[ctjbns]

Hi Dr Kim,

I have a simple (well, maybe not so simple) question. Why is suicide considered wrong? Why the mental health act gives everybody so much power to stop someone from taking their "own" life? I perfectly understand that under certain circumstances, depression, bi-polar disorder, etc... suicide is not the answer, but if someone has simply lost motivation to live, why should they be treated like a patient? After all, everybody dies. What is so wrong with wanting to choose one's time and way of dying?

[Sophie_M]

Hi Everyone, 

Just wanted to post this here as a reminder of the checklist to consider when posting in this thread!   

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.”

[Manza]

Hi dr Kim

i was looking for some self help books that are easy to understand for the average person on self esteem and positivity. I found one today called self under siege but wasn't sure if it is basic enough or more for professionals

thank you

[Dr_Kim]

Hi Starting New,
I love that you call yourself “starting new” as it makes me feel that in spite of the limited hope that others seem to give you , you still give yourself a chance at finding a way forward. 
Your story sounds really difficult and i can see why you are disheartened.

I am going to suggest a couple of things out of left field.

It seems you have really tried to manage the anxiety/ depression aspect of your mental health super hard. You have tried all sorts of medications and you have either not been able to tolerate the medication or they don't work. They psychotherapy alone didn’t seem to be enough from what you were saying.

So maybe, I wonder if you might think of changing the focus of your efforts from dealing with your anxiety/ depression, to managing another aspect of your mental health - your BPD. This is managed NOT via medication, but via a programme called DBT ( Dialectical Behaviour Therapy ). This is a practical skills based outpatient programme that usually is group based and runs over a year. I wonder if you could talk to your psychiatrist about being referred to one near you. I’m not saying this is the one answer to all your problems, but it might be something you haven’t tried and worth a shot. 

I also wonder if you have worked really hard on the lifestyle aspect of treatment. ( I told you this advise would be left field!) It seems that you have really invested hard in medication and psychotherapy but the third aspect of healing in my books is lifestyle stuff. Im talking about 
- exercise 
- diet
-sleep
- daily routines 
- mindfulness.

So with exercise, that is getting a regimes that involves exercise a minimum of 3 times per week for over 40 mins / day . Doesn’t matter what sort- walk briskly, swim, gym….just get in there and do it like taking medicine!
Diet is a bit self explanatory as most people KNOW what a good diet is, they just dont always adhere to it. 
Sleep is a big issue and you sound like you are having major battles with your sleep. I dont know what medications you have tried and where you are with that and if your sleep issue has been properly diagnosed but if you are really battling inspite of basic sleep hygiene attempts and non addictive aides like Melatonin then you might consider a referral to a sleep specialist for further evaluation.
Daily routines involve having a good daily plan set out so that each day you are doing something you are proud of and caring for yourself and for others . 
Mindfulness- I could go on about this for hours .. but i won’t because I’m sure others have . Start with the Apps like Smiling Mind or Headspace … its well worth persisting for 6-8 weeks ...

After you get these things going, getting back into psychotherapy might be a good option .. always worth circling back and giving it another try as sometimes , when we are in a slightly different place , it can feel a bit different and the work can be more effective, so dont give up on it altogether.

I hope I’ve given you a few leads and ideas and I like your fighting spirit. Keep trying…keep going… its all part of this journey of yours.

[Dr_Kim]

Hi Sheba123
This is not uncommon that a person with the problem refuses to get help or is unable to have insight about their behaviour/situation. This is really frustrating for family and friends and at times also quite scary.

Much has been written about this , for example http://resources.beyondblue.org.au/prism/file?token=BL/0445

My general thoughts are this

1. Its great that you have noticed that there is an issue.

2. Its great that you care and are trying to get him help. He may seem disconnected but I’m sure on some level it makes him feel a relief to be a little less on his own with it.

3. Be creative with possible ways to get him to help
eg get a third party to ask him to get an assessment , maybe a trusted friend or cousin, uncle or a significant person in HIS life who he might respond to….
OR maybe do the trick of asking him to come with you to the doctor, not for him, but for YOU … because YOU are feeling anxious and it would help you if he as there while the doctor calmed you down. In that way you are taking on the role of the one needing help and asking him to be your support person. It just sometimes works if they then feel less like the spotlight is in them and their issues. (of course, you word the GP up before and book a LONG appt so there is time to manage the situation ) …
OR you tell him that given your level of concern/responsibility as a parent, doing nothing doesn’t sit right … but he can choose between going to any GP or psychologist of his choice.This provides him some level of control in the situation

4.If all else fails.. and it often does! .. then you may have to just wait a while and try everything again in a few weeks or months and tell him that you are still concerned and you wonder if he is ready to sort things out yet and make some changes . Just keep at it and let him know you are not giving up on him.

Please know that your situation is common and one that is battled by many parents and family members. Hang in there. I really hope that the time that your son can thank you and give you a hug is not far off..

Just a cautionary note though : If at any stage you feel he is not safe (as in suicidal), then please ring a CAT team via your nearest public hospital. They come to the house and do an assessment in your home in cases where people are unsafe or unstable and need assessment in the community as they are unwilling to come in for assessment.

[Dr_Kim]

Hi and thanks for this question.
I feel that I might need to put on my Aristotle hat rather than my doctor hat for this one as this is really a question of philosophy . Its a really good question though, one that has kept many a great mind arguing into the night over the centuries.

My take on it is this. Whereas I can see the argument in people's right to self determination, when people want to end their lives, it is usually because
1. Circumstances have turned against them and made things unbearable.
2. Their mental health is poor
3. Their health is poor and there is little hope of recovery

The thing is, leaving the right to die in the face of terminal illness aside, when people wish to die due to circumstances or mental health , the problem with the community validating that choice is that peoples circumstances and/or mental have the possibility of improving and so theoretically the person may have ended their life for something that they may well have overcome. In my view that is a great shame and very sad. I feel the person ( because of their mental state ) doesn’t believe things will ever be better …. but there are so many stories where that absolutely happened. They should be given the opportunity for their shot at that.

Your query about “ lack of motivation”. Well,, hmmm… I’m tending to think that in most of the cases I’ve seen the lack of motivation to live has not been an isolated symptom .It has been part if a bigger picture of depression, or poor circumstance. So I’m not sure that I have really seem it in isolation clinically . I have seen people who have little zest for life but are not actively wanting to die. My work with them has been around 1. why no zest? and 2. can we find a little zest?

I dont know if i’ve answered your question but i would suggest that looking for meaning in life is a wonderful pursuit and if you are interested in this maybe look at the School of Life website or Youtube clips.

[startingnew]

thank you Dr Kim, much appreciated