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]

Help Me Rhonda said:Hi Dr Kim, my partner has borderline personality disorder and myself have just been diagnosed with Bi Polar II. My partner is "crazy" to live with and I just want to "run for the hills". I love her deep down BUT I don't know if I can live with her disorder, ANYMORE (she is doing my head in). I know it is a difficult question to answer but with us and our conditions is it "sanely" possible for us to live together longterm. Thankyou for your time. Re-Mark.

Hi there, you ask a really good question. Ultimately only you can answer it but here are a few things to consider.

It is extremely hard to bear witness to loved ones seemingly self destructive behaviours and not be able to somehow help them affect change . We often see this situation in the area of addictions. However it is also somewhat true in the arena of mental health. People do need support and care when they are acutely unwell and often rely on family and friends to see them through these times.

However, relying on others is a tricky model to see one through life.  Ultimately it is the person who needs at some point to confront the illness and take steps to manage it and be as healthy and happy as possible so as to able to not be so reliant on others , as even the best of us can become exhausted with this role over time.

BPD is a tough one as it is often entails a long and difficult route for the person to see their role in the chaos and take responsibility for it. Her best bet to find a therapist or an outpatient programme that specialises in DBT ( dialectical behavioural therapy) . Be aware though that progress is often slow and is dependant on the participant’s effort.

So that leaves you to decide about your own boundaries and self care. You are clearly worried about “doing your head in” . My feeling is that you need to be honest with yourself about what you can and can’t cope with . What are your own capabilities and abilities to manage the chaos? If you feel that you can stand by and weather it in order to be with her, then that is a reasonable reason to stay. If you feel that you can’t , then you might really need to consider leaving.

Why? Because unless she is committed to changing her emotional responses and coping mechanisms , it is unlikely that YOU can do it for her , even with all the love in the world. 

I hope this is helpful . It may be important for you to discuss all this further with someone. Maybe check in with your GP and get a referral to a counsellor to talk it out further if you feel stuck.

[Dr_Kim]

Moonstruck said:

Dear Dr Kim.. often read on Forum about others' experiences with meds...mainly anti depressants it seems. is there anything else available for anxiety...or just anti ds for the depression?

Its really tricky and I think often confusing as to the indications and triggers for medication use. It is often not explicit as why a doctor decides that medication is likely to help one person but less likely to help another, and although there are guidelines, a lot of it relies of clinical assessments. You see there is no clear cut blood test or levels doctors can do in this area like they can in many other areas of medicine. 
 
In Diabetes management for example, if someones sugar levels hit a certain point , its likely they will get a diabetic medication to help reduce it . However , even in that situation,  lifestyle factors are not ignored and healthy diet and exercise are really pushed. Also, clinical judgement does come in as not all doctors will start the medications at exactly the same point with every patient.
 
So in mental health, the lifestyle factors and therapy and even MORE important and often mean that if they are not being attended to, most medications may not help anyway. Secondly, its not like you can have a blood test and be shown to have a certain level of depression your blood , so doctors working in this area have to try and piece together from information and presentation , what might be going on and what might help. 
 
I am not able to get into the head of your treating doctors but is it possible that may be they
1. believe you have anxiety and / or depression but don’t feel that it will be responsive to medications like SSRIs
2. believe that they may be responsive but only if there is first attention to lifestyle factors and therapy 
3. they feel your symptoms that you attribute to anxiety is actually something else ( like past trauma for example) 
4. worried about the side effects in your particular case
5. think that you are somehow able to develop the skills to manage this without medications.
 
I don’t know but I wonder if it is time to maybe sit down and ask your psychiatrist calmly what they think your diagnosis is and if in their experience it is amenable to mediation . If not , why ? If so, why in your case do they think it is not appropriate? 
I certainly think that a calm and open conversation about it is better than trying desperately to self manage with little bits of mild sedatives or ( god forbid!) going back to poor coping strategies like alcohol. 
 
You sound like you have come so far on this journey and you have done amazing things like give up alcohol and find yourself a medical team . I understand you sense of frustration. I just think that writing down all your questions or taking your post and my response into your doctor might be a start to having an honest open conversation about your treatment plan. 

[save197]

Hello Dr. Kim,

I have anxiety and sometimes depression also in combination with a diagnosed mental illness which I was sectioned for in my life time five times. I stopped seeing mental health as I don't trust them because they put me on a depot injection and gave me breasts. I need surgery to put my chest back to normal but I can't afford it. Can I overcome anxiety and sometimes depression without medication - i.e. just by positive thinking (law of attraction) or do you think it is a good idea that I see a psychologist? Suicide has crossed my mind sometimes but I will never carry it out because of the consequences in the after life.

[GlowingAura]

Hello, I really hope I'm posting this in the right spot.

To start off, I'm really afraid of dying. At night I'm always paranoid that some stranger will come into the house and hurt me/my parents. I'm only 12 and I know it's not good for me to think about this, that's why I'm here.

I just get scared that one wrong move in my life could ruin everything. In the past few weeks, I've gotten really superstitious and have started to think about the meaning of life more which is scary. Nothing too bad has happened yet, and I still get enough sleep, but how can I get rid of this mindset before it gets any worse?

Side note: I've always been anxious, and I've been sleeping with my mum in the same bed since I was 5. I'm turning 13 this year and want to improve myself!

[Dr_Kim]

save197 said:

Hello Dr. Kim,

I have anxiety and sometimes depression also in combination with a diagnosed mental illness which I was sectioned for in my life time five times.

Hi there and thank you for your question. 

I think it is hard to be precise as I don’t have all the information but my feeling is 2 things

1. You are right that there is no such thing as the perfect answer to mental health problems. If you get a depot injection , it may help some difficult thinking patterns , but it may have some unhelpful side effects that people don’t like ( e.g. Gynecomastia ). Looking for a solution that is easy and side effect free but also does the job is most unlikely - something is going to have to give. 

2. Severe depression and / or anxiety is sometimes hard to get rid of completely but can often be quite well managed with a COMBINATION of medications AND talking therapy AND lifestyle changes ( like regular exercise and good diet).  Its another one of these situations where it is less likely to be one miracle thing that makes a difference but a slow burn of a number of things together that slowly help to correct the thinking and feelings.

So the reality is you have to make choices about what sort of life you want to lead and what sort of mind you want to have and what is more important to you. Sometimes we can’t have it all - we have to choose between the improvement of the thinking and the side effects we feel in our body . Is that fair? No . Is it all we have at the moment ? Yes. I wish there was better medications and things for you but unfortunately at this stage it sounds like your health care professionals are trying to help you but what they have is far from perfect.

[Dr_Kim]

GlowingAura said:

Hello, I really hope I'm posting this in the right spot.

To start off, I'm really afraid of dying. At night I'm always paranoid that some stranger will come into the house and hurt me/my parents. I'm only 12 and I know it's not good for me to think about this, that's why I'm here.

Hi, I’m so glad you wrote in to us. I don’t think you are “ paranoid” or “superstitious” , I think these are masks that your anxiety is wearing . Its tricky that way . It can masquerade as other things but in fact these thought patterns are a form of the anxiety that you said you have had for a long time. Anxiety can make us think things over and over again even when we don’t want to and even when its a bad thought and even when a part of us knows its ridiculous and hates that we are thinking it. 

This style of thing is called “ obsessional thinking” and is really common in people with anxiety. You feel weird about the thoughts of dying and someone coming into the house. Thats normal, but people with anxiety, instead of filing the thought away under  "yucky thoughts” and closing the drawer, somehow they keep opening the file up again and again. Its super annoying but you are right to think that its important to learn skills about how to manage the thoughts. 
Please please speak to someone about it.

Does anyone in your family have a similar thing ? Would they understand ? Would they be able to help you to get help ? 
I suggest getting to your GP and getting a referral to an adolescent psychologist who will teach you ways to deal with the thoughts. Its going to help you heaps over the years in knowing what to do. 

If there isn’t anyone in your home to help you , ask someone at your school , like a school counsellor or year co ordinator.

If you don’t know what else to do , you can always ring a Headspace near you and ask for help https://www.headspace.org.au/ or use their eHeadspace service if you are a long way out of any town centre.

You can absolutely improve yourself … get the right help for the thoughts and you will feel heaps better. 

[GuardianAngel]

Hi Dr Kim

Recently I have felt really upset and just overall feeling down all the time. Because of pressures at school and home I feel like I want to cry most of the time. At school I have become stressed out to the point where I don't even care about my grades any more, and I have begun to give up on the subjects that I used to love doing. I spend so much time helping my friends and making sure they feel loved and supported but I feel as though no one checks up on me, and that kind of makes me feel irrelevant.

However, I do still love listening to the same music and playing the same games, and I often do find myself happy for small periods of time when I am laughing with my friends.

I avoid talking to people about my problems because, when brought to light, they seem insignificant and stupid. But to me, however, they seem like the whole world is collapsing in on me and I have to do my best to hold it up.

I guess I was just wondering if this sort of thing sounds like a mental illness I should be worried about or treating, or rather if this could simply just be a bad couple of weeks

[Dr_Kim]

GuardianAngel said:

Hi Dr Kim

Recently I have felt really upset and just overall feeling down all the time. Because of pressures at school and home I feel like I want to cry most of the time.

Hi,

This is a really good question and I applaud you for being so able to stand back and really think about things and try to take stock of what is happening.
 
Its true that it could just be a couple of bad weeks and if you have normally been pretty good before and this passes in  a few days, then i think you can put it down to a “ bad phase ‘ and move on . 
 
However , if this feeling lasts and you are still “feeling down all the time” and “want to cry all the time” … then I think you need to attend to it. Even people with things like depression or anxiety have times that they can laugh with friends, so it doesn’t mean that if you have some bright spots in your week, you can’t possibly be depressed or distressed. However , you don’t need to have depression in order to get help with things that are on you mind and feeling hard. 
 
So when I say “ attend to it” , what I mean is to talk to someone about what is going on and try and sort out ways to manage your emotions better , make sense of what is happening better, feel more confident in your responses and learn know to look after yourself a bit better ( it sound like you are great at looking after others but maybe not so great at looking after yourself)
 
This someone might be a school counsellor, a trusted adult , a GP or a psychologist. Your GP can give you a referral to a psychologist if you feel this is right for you. If you have a Headspace centre near you , you can go there for help with this. Or you can write to them via the eHeadspace service if you are in physically unable to get to a centre or a GP office for help. https://headspace.org.au/
 
You have made a wonderful start in getting better by writing to me , so now take another step and tell someone who is a position to help you get the assistance you need to feel strong and happy again.
 

[Byathread]

Hello and thanks for your time.

Im struggling to maintain full time work due to absence as a result of my depression.

Do many people with depression work pt time?

I have had trouble with attendance at work for a long time. Is this some thing others struggle with? If so what do they do?

Thank you

[Dr_Kim]

Byathread said:

Hello and thanks for your time.

Im struggling to maintain full time work due to absence as a result of my depression.

Do many people with depression work pt time?

I have had trouble with attendance at work for a long time. Is this some thing others struggle with? If so what do they do?

Thank you

This is a real issue for so many people in the work force who have to juggle the reality of getting to work and making a living with the reality of the limitations of their health ( physical or mental)

I think it is ideal to try to maintain a connection to the work force if you possibly can as I wonder if without work, ones sense of worth, supports systems  or self esteem can suffer. However it also suffers if you feel you are not doing a good job and letting everyone down because of your health situation. 

 I take your point that there are times where 
a) one just does not feel up to coping with the rigours of the work place or 
b) looking after ones health requires an investment of time. 
So I think you may need to really have a big think about this and then take on board opinions you trust those that know your health status well  e.g. family and your health professionals .

After checking with your GP and psychologist , maybe think about approaching your work place with a plan for reducing to part time work if you feel that
a) you can afford it 
b) your work place can accomodate it 
c) it will allow you to get a better handle on your depression by maybe investing more time for exercise, diet, rest, mindfulness, hobbies, and generally make you feel healthier and happier.

You may even think about talking to your workplace about trying it as a time limited option so that you can work to maximise your health and return to full-time work in a stronger way.

Many people do work with mental health issues such as anxiety or depression but there are many who can’t. It would be great for it not to have to be an all or nothing situation. I think your idea of taking a good honest look at your situation from many perspectives and seeing if you are able to present an option to your work that may allow you to be at your work less hours but in a much more productive way might be a great idea.