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 Missjo,
Obsessional thinking is a common form of anxiety . It often comes as part of a “package” with other types of anxiety thing too. So its uncommon for people to have Obsessional thinking and/or panic disorder and/or generalised anxiety and/or social phobia etc etc…

Obsessional thinking is a form of OCD. You get the repetitive thinking without necessarily having to act out on them with compulsions. But its still really powerful and super intrusive in someone's life .
These obsessive thoughts are often violent, sexual, or fearful in nature. The thought may change depending on the situation , but once they've entered your mind, you'll often do anything you can to shake it.
Some examples of obsessive thoughts include:
Fear of getting sick.
Thinking about hurting a loved one or stranger.
Focusing on some type of aggressive sexual act (with someone you know or strangers).
Need for organization or symmetry.
Worry over little things (did I lock the door, etc.).

People have tried many types of therapy to try and manage these thoughts . Some people find the “ACT” ( Acceptance and Commitment therapy) model outlined in the book “ The Happiness Trap’ by Russ Harris very helpful . Other find heaps of exercise and meditation / mindfulness. Some do well in intensive individual therapy . Others like group therapy . I have found that there is no one model that works for everyone but the combination that suits you is going to be totally individual. Be warned though that many of my patients with this degree of obsessional thought have needed medication to try and tone down the level of intrusiveness of the thoughts.
Talking to your GP about this or getting an opinion from a psychiatrist could be very helpful.

So in summary , you are not a violent or bad person because you have these thoughts but you understandably need support to withstand the thoughts and learn to manage them better. Get professional support as they do wear you down .

[Lunastar]

Hi Dr Kim,

i was suffering with really low/anger every time I was due for my period and I went to my GP and she put me on medication and that really helped me for a while. Iam still on it so I’m still Nice lol but now Because of problems in my relationship (these have been going on for along time) I’m feeling more sad/angry/frustrated and also I’m paranoid he is up to no good all the time. Is it time for me to get a different medication or is it more of a counselling issue. I’m not sure if I have depression or Anxiety, people seem to know what they have but I just feel like I’m being stupid.

Thankyou for your time

[21yearsandcounting]

Hey Dr Kim,

Got kinda a difficult question. I was diagnosed with depression when I was 12 years old, I'm now 33 and it has never gone away. I've taken numerous medications, multiple therapies, and nothing has worked. I now know that it is Persistent Depressive Disorder with major depressive episodes, also known as double depression. I've now reached a period of my life where I have gone past exhausted and am now depleted of any motivation to continue with life. I'm currently looking at euthanasia options in Europe.

How can I help my family understand that this isn't a rash or irrational decision due to the influence of my depression, but a fully thought out plan that I have made over the last three years that I've decided to put into action? How can I minimise their hurt??

21yearsandcounting.

[nyanxieties]

Hello Dr Kim,

I have suffered from anxiety disorder since I was 11 years old, I am now 27. I have been on medication (anti-depressant) for this since that age, but of course it is no magical cure and I still go through very rough patches.

About a year ago I was at my GP's office and receiving my blood test results. My cholesterol was a little high (at 7) and I was told that if I didn't control it I would have heart disease by the time I was 40. Hearing this made my anxiety come into play in my conscious and subconscious. I began fearing having a heart attack and developed symptoms - chest pain, left arm pain, palpitations, etc. Basically any symptoms I read about on Google I began experiencing. I went to the doctors and have received an ECG, holter test (24 hrs), echo cardiogram, as well as a cardiac stress test all coming back that everything was fine (except my fast heart rate, which I was diagnosed with Sinus Tachycardia. A side effect of my medication is a fast heart rate). I was put on a beta blocker to try and help this (doesn't work). I also had an incident I had chest pain so went to the hospital where I received tests that night (ecg, blood test, chest xray) and once again everything came back normal.

But my obsession with having a heart attack is so strong it occupies most of my thinking time each day. I am convinced the doctors have missed something or misdiagnosed me. Most times of the day I can feel my heart beating strongly in my chest, and can feel it in the base of my throat. This fear is driving me crazy and has made me feel hopeless and depressed.

I know heart related illnesses are common in anxiety, but are my particular symptoms common? Should I get all the tests done again? I've been told no matter how many times I get the tests done with positive results, I will still not be convinced, which I have a feeling is probably true. Is there anyway I can get through this intense fear of having a heart attack/failure?

Thank you for your time.

[Dr_Kim]

I have found that anxiety is often really mean and also a bit illogical at times .
What I mean is that it can choose a theme to “punish” you with that in your healthy or logical brain you know is not real .



I see this a lot with all sorts of anxiety. For example, recently a patient of mine had peanut allergy when she was young and now her anxiety makes her suspicious of any food served on a restaurant. This is despite her healthy brain saying that she has 1.Grown out of the allergy and 2. Been reassured by the chef that there are no peanuts in the food .
But the anxiety doesn’t care . It still gives her the message that the food could harm her and she shouldn’t eat it.



I think the same sort of thing is happening here. Your logical brain is saying “ I’m fine , my risk of heart disease is pretty low and I’ve been investigated so many times that if there was a problem it would have been detected” . But your anxious brain doesn’t care about logic ... it just keeps on with its same old story of “ You’re in danger , something terrible is happening or about to happen “.



The 2 main forms of tackling these thoughts are to
1. Identify them and then challenge them or
2. Identify them and then let them go / ignore them /minimise them.
These methods are covered well in the books “Change your thinking “ by Sarah Edelman and “The Happiness Trap” by Russ Harris .
Have a look at these 2 approaches and see which one suits you better . You might like the guidance of a trained therapist to help you as it is a lot of work to shift stubborn and entrenched thoughts.



Your situation is complicated by the fact that anxiety symptoms and cardiac symptoms are often similar so that is an extra edge of difficulty here but with some great breathing exercises and well practised internal thought modifying processes, my hope is that you can “switch off’ the anxious physiology.

[fred4761]

Hi Dr Kim,

12 years ago I had a workplace harassment/bullying incident that took place over several months and that resulted in me having a breakdown. I have a diagnosis of severe Major Depression with Anxiety & OCD tendencies. I have not worked since the breakdown. I have my ups and downs however with the help of ongoing CBT with my pscyhiatrist, with medication and yoga/meditation I am usually ok. I was able to work through the trauma and put it behind me for the most part. However, every couple of years my insurance company requires me to see an independent psychiatrist for an ongoing claim. I then have to thoroughly rehash the events that led to my trauma and how it affected me at the time and how it continues to affect me in my day to day life. I am left reliving the trauma over and over again for the next few weeks and require extra sessions with my psychiatrist to get through it again. My question is, is there a type of therapy that can help me to deal with this past trauma to the point that I can talk about it without having to relive the pain and angst of it? Or will I always have to deal with a mild relapse after I talk in depth about what happened? Each time it feels like I have finally overcome/worked through what happened to me however it is then brought to the surface once again. I have talked about it with my psychiatrist but he is concerned that seeing a psychologist to work through the trauma will be detrimental as I will have to start at the beginning and go over everything in even greater detail. I would appreciate any thoughts. Thank you.

[Dr_Kim]

Firstly, I apologise for the time it has taken to get back to you.

I have read your posts and I am floundering a bit as to how to answer you. I know that you may have heard so many things in the past and I dont want to just add "more of the same” lame advice that hasn’t worked. However I dont really know the details of your situation and I am sure your story is very very long and involved and cant give you individual advice either. What I do know is that in my role as a mental health practitioner I feel really uncomfortable in giving up hope . I have seen so much in 30 years of practice. I have seen first hand people’s incredible resilience and their ability to reinvent and rebuild their lives after all sorts of adversity.

What a tough tough awful situation you are in though. I can hear that at times you just want to give up altogether but worry about your family . What a kind heart you have. And that is well placed concern as it is true that they would indeed be hurt. So, could I ask you please to call LIFELINE on 131114 to discuss with one of their trained counsellors.

My heart goes out to you . Wherever you are, I send you my hopes for any ray of sunshine through that heavy cloudy, sky you live under. I hope you find your hero story.

[Dr_Kim]

Hi Lunastar,

I apologise for the time it has taken to get back to you!

I am relieved to hear that you have a good enough relationship with your GP that she listened to you and took you seriously an trialled some PMS ( pre menstrual syndrome) medication .

I think you have answered your question though when you said that the problems are in your relationship and that they have been there for a while. You really need to get straight what is a relationship issue , what is a mental health issue ( depression / anxiety ) and what might be hormonal ( PMS) . I would go back to your GP and ask for
1. a medication review just to double check that you are n the right medications for you at this stage.
2. a mental health care plan / referral to a psychologist to help you sort out and clarify what is your mental health and what might be relationship based issues.

You are not stupid for not being sure .. as clinically there is a lot of overlap and often when someone has one , they can develop the other so we often see both in people anyway.

Go get yourself some help and you will feel much clearer I’m sure.

[sunandmoon1]

Hello Dr Kim,
I'm not sure where to start. Long story short, my boyfriend has depression. We live in different states and have known eachother for about year and a half now. Over this time, we've gotten to see eachother about once a month for a few days at a time. He has told me he's had depression for a couple years now however the year that we were together he seemed really happy. We connected like no other and genuinely felt like we were the one for each other and have made plans for him to move to my state. He has just been enlisted into the army and preparing to go to basic training. However, over the past 2 months i've started to notice that he's started to become very distant with me. Because i only see him once a month, it was hard for me to comprehend his actions until we saw each other in person. When we did finally see each other he told me his depression has come back and he feels like closing himself off for awhile. So he asked for us to have a break. I agreed, however its just been going downhill from there. I am the only person who knows of his depression because he doesn't feel comfortable enough to speak to his friends and family about it. I want to help him, yet i am so far away i don't know what to do. We message here and there and sometimes he tells me he wants to give up on life and that we would be better off without him. He sounds suicidal and I want to help him but I don't know how i can, because he also said he wants his own space and to be alone for awhile. He's just resulted to drinking and smoking to numb himself.
He leaves for basic training in July and I just want to get help for him before the time comes. Im just also worried that he's going into training with this mental state because it would be even more detrimental to his mental health. Is there any way i can get help for him? Or do you suggest anything that he or I could do that would benefit his situation?
I'm sorry this post is all over the place and has no structure.

Thankyou in advance

[Dr_Kim]

Hi Fred4761,
 
It sounds like you have a form of PTSD where your system finds itself on alert and feels “in danger” , even though the danger time has passed. It is really hard to cal your system down with logic alone as all sorts of primitive protection reflexes come into play.
 
I am thinking that assuming you may have tried more traditional methods, you may want to look at a interesting ways at looking at PTSD treatment called EMDR ( Eye Movement Desensitization and Reprocessing) . EMDR has a lot of good research behind it but doesn’t on the surface seem to make a lot of sense! It does however seem to work and it doesn’t seem to be difficult for people to do. Every big conference I have been to recently has reports on EMDR and it is far from “ flakey”.
 
I am just thinking that it may allow you to go through your past experience without the associated emotional fall. Have a look at it and have a chat with our health professionals .
 
http://emdraa.org/
 
You deserve to break free of your own physiology and the old 'warning systems” that keep telling you and your body  that there is danger right now , but it is only really an echo of old trauma from your past. 
 
My most sincere good luck on this journey.