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]

Pixie15 said:

Hello Dr Kim,

I am not sure if you can help me.

I am uncertain if I have anxiety because I am in a difficult relationship or in a difficult relationship because I have anxiety.

There are a couple of alarm bells for me here .. 
1. You are frightened to share with your partner that you are seeing a counsellor. 
2. Your partner resents you doing new things
3. You feel his depression robbed you of trusting your own judgement.

So ... You need to look after yourself first before looking after him . Just like when an oxygen mask drops in a plane they ask you to fix yours first before attending to children or those less able. 

What I'm saying is STOP putting his needs before yours. You sound like someone who can attend to your needs if given the chance as you state that you made positive changes using tools your therapist gave you. If you don't, you may feel a sense of growing anger or anxiety as your needs are regularly put in a bottom drawer so you can attend to him . ( check out Brene Browns excellent YouTube on boundaries below)

I am also concerned about why your partner doesn't seem to have your interests in heart in the same you that you have his. Is he worried about the impact his mood disorder has on you and your ability to overcome your social anxiety? Have you asked him ? Is he unaware or uncaring ? Are you being protective of him or do you have a fear of rejection that makes you unwilling to openly put your feelings forward.  I know I am being really provocative.. but I want you to dig deep and trust the feelings that come up . 

You may have to work with your therapist again to really uncover YOUR true needs and learn to trust that they are just fine and as valuable as anybody else's.

So in summary - dig deep , uncover YOUR needs and find the strength to assert them in your relationship, whilst simultaneously being open and understanding of the man that he is. Sounds hard but who said relationships were easy ? Not me !! 

[Dr_Kim]

Andrew 985 said:

Hi my partner is suffering from double depression and agitated anxiety and has no energy . She spent 3 months in hospital and had ect which has caused her jaw to clench and she just cannot cope with life at present . She keeps asking me to help her but I can only do so much and find this exhausting

I wondering if there is anything else I can do , I am her full time carer

thanks

 What a load ! My first response is "your poor partner" . My second response is "poor you!" 

I'm pretty sure you don't just want a pat on the back and a validation that you are doing a great job caring, but can I please start with that as I think that carers are often under recognised in our community for the incredibly tiring and taxing work they do.

Depression and anxiety at the severe end of the spectrum requiring hospitalization and ECT is a serious illness and one that can take many months or years to heal from. Some unfortunate people never fully recover but have to just learn to "live with it". 

So where does that leave you?

Well , my advice is that this may be a very long journey and in order for you to have some quality of life, fun and adventure in YOUR life , you may have to seek that outside of your relationship and home for a while whilst your partner battles her illness.

I'm not being heartless or cruel , as I actually believe you will be a kinder, more loving partner if you ensure that your own needs for personal growth and fun are met . 

This may mean finding hobbies or groups that take you away from your partner but allow you space to refresh yourself. 

Along with this, make sure you stay physically fit - eat healthy, exercise, sleep and do a regular meditation group or app - try Headspace or Smiling Mind .

You alone can not cure her . There is nothing more you can do as long as you feel her health professionals are trusted and  are doing their best. However, you staying happy, healthy and positive in yourself will allow you to have the energy- both physical and emotional to stay by her side through HER journey . 

Ps Carers Australia does have some info for carers that may be of value to you.
 

[B2B]

Hi Dr Kim

I know you don't answer questions about medication buy this is a general question I'd like to ask. I was just wondering if ssris can be used with snris? seeing my Dr on Thursday just wondering if this is a possibility

[Dr_Kim]

Little Cavvie said:

Hi Dr Kim

My psychiatrist has reduced my sleeping tablet by half, with the view to cut them out completely. I have been on most sleeping tablets during the last 2.5 years. I have not been able to get to sleep at all and it's 2am.

Hi LC,

Sleep disorder is a tough one but really important and you should be commended for trying to work at establishing better patterns. Sleep deprivation or poor sleep/ wake cycles have been implicated in poor mental health so it's important to tackle it in the same way one tackles healthy eating or exercise. 

Getting off the sleeping pills may be hard but not impossible. Your brain is in the habit of relying on the tablet to do the work of settling it down for the night .. so you need to start implementing good sleep time habits again to signal to your brain that "ok , it's time to shut down the think engines for tonight" . 

We humans have a number of ways we do this .. often revolving around forming habits to trigger melatonin release. Melatonin is the brains natural sleep hormone. 

Think of the best way we put babies and young children to sleep .. we give them their dinner and a bath at about the same time , put them in their pjs and read them a book in a darkened room. Make them feel safe and secure with a "goodnight kiss" and then leave them .

The same principles apply for adult sleep hygiene- decrease stimulants towards bedtime (e.g. no coffee after lunch ) , start your regular bedtime routine at  about the same time each night and do things that trigger your brain to know that bedtime is approaching- a warm shower or bath, a nice book , darkened windows, relaxing sounds ( like rain or waves) .. and then allow yourself to lie there peacefully.

Getting up every day at the same time will help the brain in its training . If you sleep in till 11am or 2 pm, it's going to sabotage the bedtime regime because at 11 pm the body won't be ready for sleep yet .

Don't watch the clock ( take all phones or clocks out if your room ) 

Don't panic about how much sleep you are getting but just be happy that you are working towards your goal . Even if you only get s couple of hours , DO NOT NAP the next day .. stay up and do it all again the next day .. eventually your brain gets the message !
It can take weeks or months but it is worth it as feeling rested is so important.
I know you may have heard of some of this stuff before and it's true there is no "magic" one thing that always works .. so try everything and find what works for you ! 

 

[Dr_Kim]

B2B said:

Hi Dr Kim

I know you don't answer questions about medication buy this is a general question I'd like to ask. I was just wondering if ssris can be used with snris? seeing my Dr on Thursday just wondering if this is a possibility

Hi , I feel that current thinking on this is that we tend to push one medication at a time to its maximal dose if it is tolerated by the patient and see if it works. If so, great. If not, you slowly withdraw that medication and try another. If you had side effects on the first medication, then the doctor will try and tailor the next medication to avoid that side effect if at all possible. GPs are used to doing this as the response rates to any one medication are not great - ball park 50-75 % , so we are used to trying this and that until we find something that works. If its getting really trick , referral to a specialist is a good idea.

Using more than one medication at a time is done, but usually by a psychiatrist for very treatment resistant depression or anxiety .You would want someone who is really on top of these medications and can mange the increased risks of side effects that can occur when you start to bundle these meds together.

[SourceShield]

Dr Kim.

I have just read many of your amazingly powerful and holistically-intelligent responses.

You care.

I think I love you for that already.

I don't trust people very easily at all.

I feel hyper-vigilance, even when I am online.

And yet...I am also confident, assertive and brave at times as well.

I get the complexity of life.

And that we tend to complicate things, more than we actually need to -

- so, I need some advice about, Procrastination.

I get bursts of energy to do one thing...go hard.

Next minute, I'm distracted by...the cute guy in boardshorts!

I know that this is human.

To be so easily distracted.

What I am asking for is some practical-application tips, please?

I'm really good with that kinda advice.

Love practical application.

But, also if you'd have or know of any great resources - podcasts, books etc...

That I may be able to watch and listen to - Im a visual and oratory learner.

Most Polynesian people are, interestingly enough!

Thanks.

Also, tips for not smoking marijuana so much?

I enjoy it.

Im not here to discuss that.

I just need to smoke less.

I feel a big part of ALL of this is limiting beliefs.

I can be a bit of a cocky-man!

And, that works in reverse too...I believed myself in believing the beliefs!

How does one forget limiting beliefs?

I dont expect you to know all the answers, but any links to other teachers or professionals, would also be gratefully received.

Most days - I am actually fine.

But....other days, forget it!

How does one, manage best on those days?

The autism is something that is actually only just becoming more comfortable with me, but I forget that people on these forums dont actually know me.

My brain forgets that - its not important to me.

You'd know that 'sincerity' is more than just important to someone with this kinda brain.

But, sincerity isn't that important to others, due to whatever reason, and if I feel that people have attacked me or judged me, even on this forums...I dont get angry, I just get really frustrated.

And, because I know how to use words, in a way to express...I can come across as hostile.

Part of me, the egoic-me, kinda likes that...I use the hostility as a shield.

Its the hyper-vigilance.

I never felt safe.

And now I feel that its time for me to let this limiting belief go, please help, if you can.

I really do genuinely appreciate your work.

I hope that youre having a great day, but if not...know that we are here for you too!

MuchLove

[Julio60]

Hi Dr Kim.
I found your reply to Pixie15 quite relevant to a situation I am in. ​I am constantly bending and changing my behaviours to suit my partners wishes. As much as i sometimes find her requests or "boundaries" confronting I do convince myself that she has a valid point and I have found some of those changes to be in my favour (at least I convince myself of that) Currently I am suffering some pretty bad bouts of anxiety as our relationship has suffered some meltdowns, usually some behaviour of mine will trigger a massive reaction from her. When things are good they are great, but when they go bad they explode. We have made up a number of times, i am usually the one to go running back with flowers and apologies because I just can't stand the thought of being without her and alone, before me she had been alone some time and is comfortable with that. After seeing the video you posted I thought, hey I can relate to that, she is setting boundaries and when I break them she lets me know, however I am not setting boundaries for myself and I feel that my needs are not being met. I seem to need that constant reassurance that our relationship is good, she assures me it is apart from my behaviours which I need to sort out and I am working hard on, however part of the problem is my anxiety and depression and it just seems to be a vicious circle at the moment. How do I go about breaking this cycle?
How do I go about setting boundries? I am afraid she will take it the wrong way and think, as she many times does, that it's all about me!
There are many things I do like about her, in spirit she is a kind and generous person and I would go as far as to say that I may even love her, a word I use with great caution, however it may just be obsession. I am just so confused, some tell me she is emotianally abusing me but i don't want to accept that. What sdo I do...?

[Merci]

Hi Dr Kim.

I have been taking an antidepressant for the past few years to help with panic disorder. Since starting on it my weight has increased to an unhealthy level and I am extremely depressed. My dr sent me to an excersize physiologist (?) which is very expensive and I am really struggling financially as it only leaves me with $60 a fortnight to live off after I pay for it. After each excersize session I cry the whole way home and I spend the rest of the day suicidal, I am not sure if it's because of the financial strain or something else to do with the excersize or how uncomfortable I feel in a gym. I am wanting to stop taking the antidepressant to stop the weight gain but m doctor says I am just eating more because I feel good, but I don't feel good. I feel horrible. I have seen a dietition who has no reccomnedations other then to keep doing what I am doing. I am also scared to stop taking the antidepressant in case the panic attacks start again.

Is there a medication that stops panic attacks but doesn't make you feel depressed or gain weight?

I don't feel my doctor understands me and I don't feel that I am strong enough to pursue my point with him.

[Dr_Kim]

SourceShield said:

Dr Kim.

I have just read many of your amazingly powerful and holistically-intelligent responses.

Thank you for your kind words about my work with Beyond Blue.

I have put my finger on 3 major themes inn your post
1. procrastination
2. self limiting beliefs
3. hyper vigilance and not feeling safe.

I am not sure if you implied that you have been given the diagnosis of Autism or not , if so , that can definite put a “flavour’ of perception on the way you see and interact with the world that can make things really tough for you. If you do have personality characteristics that put you on the Autism spectrum , I do suggest that you get some specific therapy to learn how they may affect you and colour your vision of the world if both good and bad ways , just become more “mindful” of it. 

Ok so , lets start with Procrastination … Its a common one in therapy and can come form a few places. Sometimes it comes from anxiety / perfectionism kind of thing. Meaning that people get so frightened of making the wrong choice that they end up making NO choice at all! They just hang around on the starting line as that seems preferable to the anxiety of not knowing what place you will get in the race. 

Other times procrastination can come from low self esteem - that feeling of “ i’m bound to stuff it up” . Or sometimes its part of low motivation that can happen with depression or even medications or drugs ( i’m alluding a bit to your marijuana use here … it just may be a factor in this ??) 

The self limiting beliefs are just so common and runaround so many peoples heads… . they can be put there by early childhood experiences, together with personality style or community problems. Its hard to know exactly why they are in your head with out knowing you. I am going to refer you to a guy called David Burns who has done a lot of work in CBT ( Cognitive Behavioural Therapy) and has a great book called “Feeling Good”. For those that are Aural learners, he has free podcasts on https://feelinggood.com/2016/05/26/podcast-1-introduction-to-the-team-model/

The first 2 there deal with negative distortions in our heads and how to manage them. 

Hyper vigilance and not feeling safe. You mention this a bit and it worries me a little as this suggests that your “ flight or fight” responses are fired up and on alert way too much. This can sometimes be as a result of past trauma or maybe it is back to your brain not being able to make sense of the world in a way that allows you to feel calm in it. Its hard to know whether to direct you to more specific therapy or more general relaxation and mindfulness exercises… I think taking this post and my answer to your GP or therapist might help you to work out which one it is.

If you really just need mindfulness / relaxation, I highly recommend the Smiling Mind or Headspace apps, but done regularly for weeks or months to get results! ( oh and it really helps with the getting distracted easily thing too!! )
 

[Dr_Kim]

Julio60 said:

Hi Dr Kim.
I found your reply to Pixie15 quite relevant to a situation I am in. ​I am constantly bending and changing my behaviours to suit my partners wishes.

Firstly , let me congratulate you in becoming “mindful” of your situation, being able to stand above it and see it from a distance and really look at whats going on, but I hope also with some kindness to your self, as we all have strengths and weaknesses. 

It seems that you are becoming aware that there is a dynamic that is not 100% healthy in your relationship. Thats a tough and strong thing for you to acknowledge. You say your needs are not being met and I think a big clue could be when you said “  I seem to need that constant reassurance “.  

I have noted in my work that needing constant reassurance from  others that you are ok, or the relationship is ok, or your boundaries are ok, or your choices are ok …. means that something is not quite OK!!!

What I mean is that it may indicate that your inner voice, the strong “ego”, the internal sense of who you are is struggling. The person you are is not strong enough to say “ i know that what I think may not be perfect , but is OK . I know that my needs may be confronting, but thats working in a relationship, so lets roll up our sleeves and get to work!”.

It sounds to me , that at the first hint  that your inner voice may not be fully embraced , you shove it away, because you are frightened that its going to lead to rejection. Its not your fault that your reactions are like this. Sometimes it is due to our early experiences - in our family or with friendships, where we have learned to become accustomed to putting aside our true selves.

Well, it may be time to water the little seedling of the “ego” growing inside of you. It sounds like it wants to be stronger . It wants you to trust it . It wants you to not be frightened of rejection, to trust you have strength.. Develop that strength, that voice. Don’t worry about not being perfect, worry about not being understood, nurtured and seen ( by her and yourself!)

check out Brene Browns talk on vulnerability 
>
And you may want to also check out the book “Women who love too much" by Robin Norwood . Its a great book about relationships where one partner is definitely putting in way too much at the expense of him or her self.