Question: How can i help my litlle brother who's an addict ; depressed ; have suicidal thoughts and lost the meaning of his life

William Anderson Says...:

The best thing to do is find a close-by addictions counselor who is licensed to provide mental health counseling and make sure he or she is available to give you an appointment right away if you are able to convince your brother to go with you. Then, in a loving and caring way, tell your brother, in a face-to-face meeting, that you love him and you are very concerned and want to see him get better from this crisis, that you know life can and will get better if he takes this step. Take him, not send him, for this appointment and be there with him. If he refuses, call your local crisis center, describe the situation and ask them what to do. Do all this today. Don't waste time. It's important to do this right away.

Question: How do I keep sane whilst helping my adult son with depression

Penny Bell Says...:

Caring for someone who is depressed can be exhausting, demanding, and rewarding, all at the same time. As a support person you may feel the need to be the emotionally strong one at all times, but this can come at the expense of your own wellbeing. For this reason it’s really important that you look after yourself as well so that you can be the best possible support to your son.

The way that you can do this is to put time aside just for you. Make sure that you’re physically active in ways that you enjoy, get enough sleep, stay in touch with friends and family who can encourage and support you (caring for someone with a mental health problem can feel quite isolating). And if possible, find a local support group that you can connect into, as well as supportive counselling.

Accept that you will experience a range of emotions such as fear, confusion and guilt. You may feel a sense of powerlessness because you can’t fix or change what is happening for your son or make him feel better straight away. Accept that aspects of the situation are beyond your control and allow yourself to feel your feelings, as difficult as they might be.

Caring for a family member can put strain on the relationship between you so it’s important to care for yourself in that respect as well. This may mean creating boundaries – there’s only so much you can do as a support person. This can be frustrating, especially if your son is resistant to being supported. Keep an open dialogue that acknowledges your feelings whilst encouraging your son to seek other support services as well.

Learn as much as you can about depression – learn the facts so that you can understand what your son is going through and how this affects his behaviour. Avoid using phrases such as “cheer up”, “snap out of it”, “it’s all in your head”, or “you don’t look depressed” as these will make him feel worse. Instead, check in with him by asking if he wants to talk about it, listening (without giving advice) if he does, and assuring him of your continued support.

Keep in mind that your son doesn’t want to feel the way he does – he has an illness that, like any other illness, is largely out of his control to fix. Let him know it’s ok for him to have depression - he is most likely thinking that he must be weak or a failure for having depression - and that you don’t think any less of him as a person.

Have faith in your son’s willingness and ability to recover from his depression, particularly when he doesn’t. Ask him what makes him feel better and gently encourage him to explore these and other options of how he can feel better, for example going for walks, exercising in other ways, taking his medication regularly if his doctor has prescribed it, going to his therapy sessions, and congratulate him when he does things that will help him to get better, because getting motivated to do anything is hard for him.

Question: Hello, I am writing to you because I read a question that someone had asked you a few years ago which was similar to my situation but not exactly. My 26 yr old son lives with me now and suffers from severe depression which is getting worse all the time. Since high school he has entered school multiple times but never finished. He moved to a larger city for almost a year and seemed to be happier then, met a girl he really liked, decided to go back to school.... He was in a very high pressure and stressful program and in the semester before what would have been his last he fell apart. He dropped out, came home and that was nearly 2years ago. About 14 months ago he broke up with the girl, said it was too hard to keep a relationship going if he wasn't going back to school where she lived and that she wouldn't want to stay with a failure like himself. Since then he has sunk lower and lower. He constantly lives in his head which is not a happy place. He beats himself up over all the failed attempts in the last 8 years since high school. Last fall he got a job, minimum wage and I think it perked him up temporarily but he quit it 2months ago and has done nothing. He doesn't do drugs and drinks very minimally. He was very addicted to a video game as an escape from reality but the last weeks I haven't seen him playing it much. I begged him to take some classes at the local community college and he has been doing that for a month now. So that is the history briefly. He says the constant mental chatter never ceases and that he will never be able to meditate. He has no friends, except his best friend who lives away and is about to get married. He goes no where and does nothing except school now. His health is starting to be affected. He eats very little, usually 1 meal a day, if that. I am single and I do not have the funds to support him. I paid for his school with a credit card. I have been able to get him to go to the chiropractor for his back which I also pay for with credit card. He has done minimal counseling the first year he was home, but he doesn't believe there is any help out there for him. He is loosing hope and he has said to me many time that it isn't worth it, that there is no point. I'm a pretty upbeat person but this is getting really, really hard. My other son also suffers from depression he is only 21. He also entered college right out of high school and didn't make it through the first year. We did get him treatment which he kept up for about 8 months after that he stayed home for another year. He went back to school last year, nearly dropped out in the spring semester but stuck it out barely getting by. He is back there again and is on meds and seems to be doing ok. I just have stay in touch with him regularly and try to make sure he's alright. Honestly, this almost sounds like a plea for help for myself, but if my kids are doing well then I can easily get on top of the world. I just don't know what to do for my oldest son that is at home now. He feels he's wasted the past 8 years and just can't get out of that place and he won't seek help. He has no joy, no goals, no interests and has virtually cut himself off from all emotion. He is basically shutting down. This situation would be a tragedy for any young person, but it is even more so for him because he is brilliant, an extremely intelligent and very handsome young man. I have to say that where we live I'm not sure we have access to quality mental health care anyway, but I would find the means somehow to pay for it if he were willing to get help.

Rev. Christopher Smith Says...:

When your children are suffering, it is something that a caring parent does not like to see. Parents like the person asking this question can be defensive and realize that it is sounding like it is about them and not their children. This may in fact be the most appropriate place to start. If the young adults were engaged in addictive behaviors, the actions described might be seen as codependent. Being able to truly address these situations as the children's situations and to keep responsibilities where they belong is the first component of a healthy response. As a parent, you have to be healthy yourself and be coming from a good emotional place to be providing the best responses possible.

Having said that, it is important also to have a good evaluation as the starting place to getting help and for the child to believe that help can actually make a difference. While this can only really be done by someone local who can do this in person, there are some things in the description of the oldest son's experience that I would want to know more about to ensure that we were going down the right path and optimizing the chance for him to find a way back to wholeness and peace. I would want to know more about the "constant mental chatter". I would want to know more about his historic goals. What supports have helped matters in the past? This gives more direction.

Depending on what is going on for the young adult, things that seem positive may in fact not be. If there was a lot wrapped up in prior attendance in a quality four-year school and being almost done may mean that there are greater negative impacts to being back in community college than the positives that are initially thought of (especially until work is done that helps to guide a particular direction and helps to begin to heal older wounds). Also, what supports have been accessed for the fact that serious mental illness with these impacts would certainly meet the criteria for being a disability.

Question: Hi Dr. Schultz, My son, late 20's, took a medical leave from work to attend a partial hospitalization program, he had been in therapy and feels stuck. He has been extremely frustrated with himself for not feeling like he could follow through on recommendations. He's been diagnosed with depression, also ADHD (Inattentive type) and anxiety. He tried medication for a little more than a month, then had difficulty refilling the prescription and is no longer on medication. In the meantime, he has lost his job due to downsizing. He no longer receives therapy and has not followed through on a few job leads. I find myself worrying way too much about the situation. I have a hard time not offering support, and find myself trying to help him prevent this situation from getting worse. I need to know the best way to be supportive. Please give me some suggestions...

Dr. Richard Schultz Says...:

Hello
and thank you for addressing these important concerns to me.
 

First,
I wish to say that I am truly sorry to hear about your son's recent struggles,
and about the stressful impact his challenges are having on you. There really is
no way to go through life as a sentient being and NOT encounter such a conflict,
especially if one is living in awareness and is closely connected to others.
 

After
reading your question, I was left with many of my own, regarding family history,
severity of his symptoms, the nature of your relationship with your son, etc. Therefore, in
order to write an appropriate reply, I had to make some assumptions. Where you
find these to be baseless, feel free to disregard that aspect and use what is
helpful.
 

First,
with regard to your son's treatment, there have clearly been too many stops,
starts, misfires, and abrupt treatment changes during these last few months to
reasonably expect a positive, stabilized outcome. This is unfortunately not
uncommon. In addition, no specific treatment plan seems to be in place for him
at this time.
 

So, I'm
thinking it may be a good time for a do-over. Your son's first order of business
is to establish a solid working relationship with a clinical psychologist,
preferably one with a CBT perspective, and one who also knows a thing or two about
meds. A
clearer diagnostic picture (likely involving some additional testing or formal
evaluation) will be of immense help in guiding proper treatment; depression,
anxiety, and ADHD, can all overlap, exacerbate one another, and/or enable the
others. A sharp quarterback/clinician is needed to call the next few plays, to
clarify the sequence at work here, and to identify the next best point of additional
clinical intervention, layered atop the therapeutic base.
 

For
you personally, I urge you to begin practicing constructively entitled self care
immediately, particularly in regard to your son. By setting reasonable
boundaries between you two, you will help you, help him, and help your
relationship with him. You'll do nobody any favors by getting burned out, by
putting up with too much of what you don't need, or by bending over backwards
too far.
 

In
any case, your own efforts are best spent on adding structure to the
arrangement between you and your son; a specific, quid pro quo "behavioral
contract" (and I strongly suggest putting this in writing) that clearly outlines
your individual and collective goals for the near term primarily, and for the
mid-term secondarily. This will outline the resources and contributions each of
you is willing to expend in service of your collective goals regarding your son's general functioning and mental health care, what you are
asking for in return, and what contingencies or consequences will be triggered
by failure of either party to deliver. I don't know what currency
or weight you have in this relationship (residential, financial, or other), but
these are your power chips, and they will most likely require some
leveraging.
 

As
you well know, your role with your son cannot be that of therapist, even if you
were a professional. Any dynamic in which are experienced by him as lecturing,
preaching, shoulding, criticizing, or judging, is destined to do more harm than
good. Even if he does outwardly tolerate such a stance, oppositional or rebellious feelings
and behavior are likely to arise in him, against you, which is counter to the
intrinsic motivation you want to help him cultivate for himself.
 

Aristotle
wrote that "nature abhors a vacuum," and the concept is relevant here. The less
you do to fill the vacuum of your son's unmet needs, the more room and incentive
there will be for him to step forward and do it himself. Avoidance is a key
element in anxiety, depression, and ADHD, so your son is surely experienced at
ways to dodge the rough spots or perceived challenges in his life. Whatever you
do, you don't want to enable ANY such avoidance behaviors as that just makes
"the monster" (which is nothing more than his own pain) even bigger and scarier
for him. So, no ducking, bobbing, or weaving around such monsters, as these
actions only strengthen the anxious thoughts and feelings.
 

Each
time aversive sensations are experienced, humans are strongly inclined to
withdraw. By artificially LOWERING this anxiety level, through any means other
than facing and "habituating to" the feared situation, negative reinforcement
and avoidance behavior will be strengthened. The short term reward of "relief"
determines behavior most powerfully.
 

My
final suggestion to you is to seek out a psychological consultant of your own.
Having your own "go-to professional" will provide you with objective,
behaviorally wise guidance you'll need to stop yourself from filling the vacuum,
while maximizing your son's motivation to do it himself. You will also get
useful instruction on creating and implementing the behavioral contract. Your
own therapist can also teach you to understand how this situation "hooks" you so
strongly and painfully, and help you learn how to unhook yourself from worry,
sadness or frustration about your son.

I do hope that some of what I have written is of help to you. Please do keep me posted on your situation, and feel free to let me know of any additional questions you may have.

Sincerely,

Question: My son has become isolated over the last decade or so and I believe he is depressed but I do not know how to help him. He is 32 now and he does not have any real friends or social life. He had a steady girlfriend that lasted for a few years after the end of high school but nothing since then. He comes over for dinner with us on Sunday nights. It used to be like clockwork but lately he has been skipping visits here and there. I have tried to get him to come over more often since we are retired and have lots of time but he says he is too busy with his programming work. This does not really make sense since he barley makes ends meet. Since he started coding at home in his twenties he has forgotten how to be social in the regular world. I suspect he is depressed since he seems apathetic about everything and he does not take as much care into his appearance as he used to. To be frank, it smells like he has not showered for days when he comes over. When I try to press him on how he spends his time he gets defensive and retreats into a shell and when I tried to get him to talk to someone and I said I would pay for it he got very angry and upset and left early. This was last week. I wish I knew how to help him break out of this but I just don’t. What is my next good move?

Penny Bell Says...:

It does sound as if your son is suffering from a mental health condition, possibly depression, and has been for some time. What you’re noticing now is that this depression seems to be more entrenched, and he’s becoming even more isolated. I can understand how worrying this must be for you, and how powerless you must be feeling in the situation.

Symptoms of depression include loss of interest in enjoyable activities, staying home more, withdrawing from family and friends, difficulty concentrating at work, feeling overwhelmed, indecisiveness and lack of confidence, sometimes increase of alcohol or drug use, loss or change in appetite, sleeping difficulties, feeling worthless, increased irritability and moodiness, and feeling unhappy most of the time.

Knowing how to help someone with a mental health problem can be challenging, as you have discovered. Your son may not be aware of the impact his behaviour is having on others, and talking about this may be a way to encourage him to do something about the situation. This should be done in a sensitive, non-accusing and non-blaming manner, using ‘I’ statements such as: “I’ve noticed that you’re not coming over as much on Sundays” or “I’ve noticed that you’re not spending as much time with your friends”.

Finding the right time to have a conversation with your son is important – when he is most comfortable and likely to be attentive, and you are less likely to be interrupted. It’s possible that he is feeling a great deal of shame and embarrassment about the thoughts he’s having, and this is the cause of his defensiveness. Reassure him that you have no intention of judging him, only helping him. You may wish to tell him you have found some reliable information which will help put things in perspective, which you could give him to read in his own time (there are some great articles here at Choose Help). If however you continue to experience his resistance to your offers of help, there may be a family friend or relative you could ask to raise these issues with your son.

Offering to go with your son to visit his doctor for a check-up could encourage him to seek help. Before you go to see the doctor with your son make a list of your concerns, including any questions you have, to be discussed during the consultation. Accompanying him to the appointment may also give you more of an idea of what you can do to continue to support your son whilst he is in treatment. If you cannot persuade your son to visit the doctor with you, it may be helpful to go on your own, to find out what avenues there are for your son and for you that are available to help him.

If your son refuses all offers of help then you can continue to support him, make information available and be prepared to discuss things if and when he is ready.

One thing that’s vital is that you take care of yourselves. Make sure that you find time for fun and recreation, to be with friends, and to spend quality time with each other that doesn’t have your son’s issues as the focus. Caring for your own mental health could also involve obtaining counselling for yourselves.

I wish you all the best in your efforts to help your son and the task that lies ahead of you.

Question: How do you motivate behavioral health change in the family?

Dr. Richard Schultz Says...:

Hello and thank you very much for addressing your question to me. 

As your question is almost word for word the very title of a recent answer I provided to another reader, and because you have provided no detail to your question, I am left scratching my head and a bit confused.

Perhaps you hit send too soon?  Changed your mind? 

In any case, if you would like to elaborate on the question, I will be glad to consider answering it. 

And just in case you did NOT read the previous reply, here it is:

http://www.choosehelp.com/experts/depression/depression-richard-schultz/if-not-for-yourself-then-do-it-for-me-motivating-behavioral-health-change-in-the-family

Sincerely,

Richard E. Schultz, Ph.D.

www.drschultz.org

www.mindsetdopc.com

@mindsetdoc

Question: I have an adult family member who has been diagnosed with severe clinical depression and anxiety. She is very cooperative in terms of going to therapy and taking the prescribed medication. But when it comes to actual necessary habit changing, she doesn't budge. For example, her CPAP sleep apnea machine just collects dust because she says she can't sleep with it on, and she smokes CONSTANTLY - every 10 minutes or so. My questions are: 1) When someone is in such a horrible condition - pretty much comatose 24/7- is it an appropriate time to try to get them to stop smoking? She is very sensitive to even the slightest bit of "stress". So would trying to quit just be compounding her troubles? 2) What do you think of using cigarettes somehow as bargaining chips to get her to use her cpap machine?

Dr. Richard Schultz Says...:

Hello and thank you for addressing this important question to
me. 

As we Baby Boomers continue
to age (at least us lucky ones!), challenges and concerns such as this, which
revolve around adherence to medical treatment, and the relationship between
family members, caregivers and healthcare professionals, will occur
exponentially more often.  I also
believe that the mental health community can and should be called upon to
help.

I am quite sorry to hear of your family member’s medical and mental
health challenges, and it is easy to understand why this situation is pretty
miserable for you both. She is at perhaps the most deteriorated position of her
life, and you are very justifiably concerned, thus attempting to motivate her to
help herself and heal, and encountering resistance along the way. 

Unfortunately, it does not sound as if your relative is at this
time exhibiting a very strong will to adhere to the lifestyle and behavioral
challenges that would be optimal, given her existing medical conditions and
habits.  This is a delicate and
precarious dynamic indeed, especially when someone so emotionally close to the
patient, such as you, is also trying to be the cheerleader, coach or
motivator. 

In considering the best intervention for helping your relative, I
would want to consider many factors. 
These include: a) the degree to which she is manifesting symptoms of
depression that are NOT being successfully treated by current medications and/or
therapy, b) the degree to which her behavior is a deliberate choice based on her
current existential crisis (for example, she may not wish to prolong her life
and may in fact wish to hasten her death by smoking and not using her CPAP,
among other related behaviors), c)the level of  her accurate and complete understanding
of the deleterious and synergistic effects that her untreated sleep apnea and
continued smoking are having on her; and d) the degree to which her seemingly
rebellious maladaptive behaviors are in some way a reaction to perceived
attempts on the part of others to “fix” her (this last point often termed
“iatrogenesis,” wherein treatment or help actually makes the problem
worse). 

It’s a complex picture, to be sure, and one that must be
holistically considered prior to initiating any new “solution.”  These are the kinds of challenges that
psychologists and psychiatrists face every day, and we ideally bring to the
table a wide repertoire of possible interventions to address them, taking into
account the big picture.

In this case, I would suggest you begin by doing less to solve
these problems.  That’s right, I did
just write that! I suggest you immediately reduce the amount of attention, and
emotional and behavioral energy, you devote to this relative’s challenges.  Think of it as “cleaning the slate” or
“cleansing the palate” in a way, whereby you till the field before making a new
planting.  Based on what you
describe the current dynamic to be, my guess is that doing so will do no harm,
and, more importantly, will actually be helpful to you, your relative, and to
the relationship you share. Sometimes, believe it or not, simply doing less to
fix a problem is, in and of itself, the best fix for the problem. 

After a few weeks of tilling have occurred, it is time to plant! You will begin by approaching your
relative and inquiring as to whether it might be okay with her if you were to accompany her to
at least part of one of her therapy sessions.  You will frame this request as stemming from your love and concern for her well-being, your awareness that your "helping" behavior has probably been at times frustrating or annoying or disrespectful to her, and your desire to do more of what helps and less of what doesn't.  You need not mention the CPAP or smoking issues during this conversation; keep it general and, if necessary, mention a condition or symptoms cluster that you KNOW she wants to change.

I don’t know if you (or any other readers) have ever done this or asked to
do it in regard to a relative’s psychiatric treatment, but such “guest appearances” can
be very illuminating and constructive, IF they are handled sensitively and ethically and at the election of the patient.  Benefits may be experienced by the patient, by the guest, and by the guest's relationship with the patient.  It is possible, I suppose, that the therapist in question (if
indeed true psychotherapy is happening, versus simply medication management and
a very brief, supportive check-in, the difference between the two being QUITE
dramatic as it concerns the influence of the care provider on the patient) is
not even aware of the CPAP or smoking issues, is not focusing on these
areas because the patient seems not to be troubled by them (or is intentionally
avoiding discussing them), or because the patient has expressed a desire NOT to make change in these behaviors. 

And if
your relative is NOT receiving solid, empirically-informed psychotherapy from a qualified
professional, this will ideally be sought out as soon as
possible (perhaps yet ANOTHER motivational challenge; you are going to get good at this!). In any case, the point of participating more actively in the
patient’s treatment is to still demonstrate your concern, but at the same time
to also access the expertise and influence that can be delivered by the care
provider (be it as “expert,” “the only one who really listens to me,” “my
friend,” “benevolent and respected authority figure,” etc.). Let the therapist
and the intervention be "the enforcer" of whatever plan us put in place, given,
of course, that the patient responds receptively to this request to go to
therapy with her. 

Some strong words of advice: Please consider exactly how you will word your request to the patient very carefully before
doing so, and run it past a few others whom you trust, as your first chance will
be your best, and thus the stakes are high.  If any hint of control, punishment,
disrespect, insensitivity, or criticism is present in the request (“I want to
talk to your doctor so that I can tell them what a 'problem child' you are”), it
is likely not only to fail, but to re-exacerbate the dynamic between you and
your relative. This is how therapists are trained to deliver treatment, in a very thoughtful, client-centered manner.  Thus, such Motivational Interviewing (a specific clinical approach that has been widely researched and practiced) is not only an important aspect of helping someone seek treatment, but also a very powerful component of the treatment itself.

Further, do not
attempt to discuss these challenges with the care provider without first consulting the patient and securing their informed consent (assuming that the patient possesses reasonable mental competence; if they do not, conservatorship or power of attorney may be needed). No licensed care provider is legally or
ethically empowered to share information regarding the patient with anyone without
such consent unless it is in the context of an acutely emergent and life-threatening circumstance. Perhaps even more importantly, any perceived violation of your relative’s
reasonable rights would be likely felt by her to be infantilizing and would certainly do more
harm than good, for example by only further strengthening her resistance to your suggestions.  In fact, even if
the patient agrees immediately to let you speak with her physician or therapist when she is
not present, I would still recommend that you not do this. The goals here are to help the patient change AND to empower her as the AGENT of such change.  

Once in the room with your relative and her therapist (or psychiatrist or other care provider), you can begin, very gently and
diplomatically, to express some of the concerns you have about the patient's
well-being, speaking ideally about YOUR feelings and concerns versus
making allegations or complaints about THE PATIENT’S behavior and adherence issues.  The care provider can then assess the
situation and guide you and your family member in a clinically valid and
hopefully helpful manner.    

If this first approach does NOT work, and in fact even if it does,
I would suggest you find a therapist on your own, whom you can consult for
further intervention and coping strategies.  Ultimately, you probably have a
miniscule amount of control over what this relative, or any other person,
thinks, feels or does, however you may exert great impact by adjusting your own
stance. I would recommend that you seek out a therapist who is well-versed in
cognitive behavioral therapy, management of geriatric challenges, and someone
who also has grounding in family or systemic work (this situation being VERY
different from one in which an individual such as your relative seeks out a
therapist to address their personal difficulties with the CPAP or smoking
issues).  This clinical challenge
requires of the provider a far more fluid repertoire and understanding of family
and interpersonal dynamics, medical illness, and issues faced by elders than
might be the case in a simpler clinical situation.  This is all the more reason to find the
right therapist for the job.  And
remember, ALL THERAPISTS ARE NOT TRAINED OR CREATED EQUALLY.  Please know this. Perhaps the greatest
benefit to seeking your own consultation is that you can talk freely with the
therapist about the situation without worry of hurting your relative’s feelings,
making the situation worse, or dealing with the bias or allegiance of her
existing therapist.  This would be
akin to hiring a coach to teach you how to coach someone you love at, say,
pitching a baseball or playing a violin.

Before closing, I will say that your own points regarding the pros
and cons of various interventions are well taken.  Yes, although smoking is quite harmful
to your relative’s general and specific medical health and condition, it may be
far down on her own list of priorities, and the activity of smoking itself may
be a valued coping technique which might not survive the cut in a strict cost
benefit analysis.  Finally, the
concept of utilizing any type of “bargaining chip” to increase desired behavior
is really one best addressed by a qualified mental health professional.  There are a multitude of such strategies
that might be implemented and, although the right one may help, the wrong
attempted “cure” may indeed end up doing more harm than the disease it was
designed to treat is actually causing (see “iatrogenesis”
above).

I do hope that some of what I have offered has been of assistance
to you, and I wish you, your relative, and the entire family, peace and strength
moving forward.  I also want to say
that your relative is lucky indeed to have someone in her sphere with as much
concern for her well-being as you clearly do.  I only wish there were a zillion times
more family members out there than there are who have the caring and judgment to
“Choose Help.”  Nice plug there, eh?
Don’t worry, this is not a paid gig for me, so that isn’t an ethical violation!
J

Please do feel free to write again with an update on the situation
(I get very few of those, unfortunately), or if you have any further questions
or issues.

Sincerely,

Richard E. Schultz, Ph.D.

www.mindsetdoc.com

www.drschultz.org

@mindsetdoc

Question: Hello, I am a 23 y/o female and I don't know what's wrong with me, l am a big time overeater. The only reason I am not obese is because I exercise. I'm always preoccupied with food. I'm always thinking of what I will eat next. After having my child I started taking phentermine and that has been the only time in my life that I did not obsess over food. l don't know if I'm depressed, have Social anxiety or what my deal is. There is absolutely no time for me to be depressed. I do'nt feel sad. Mostly, I feel like a zombie going through daily routines while shoving processed food down my gullet. 1 also get this weird brain fog that happens when ' believe I'm possibly anxious, like around people. As a nursing student one instructor told me l needed to pay attention and the worst part is I do try but my head sometimes gets cloudy, and 1 will just feel this overwhelming fatigue. I'm going to start a job as a RN soon and feel this foggy brain is going to make everything So much harder. I hate not being able to pay attention, always eating, Worrying I'm going to mess up. I would like to ask my PCP about Wellbutrin but I feel embarrased asking.

Dr. Richard Schultz Says...:

Hello, and thank you for addressing your question to me. 

I am truly sorry for the suffering you have experienced in regard to your relationship with food, and other troubling symptoms of symptoms of anxiety and depression.

Let me first tell you that you are so NOT alone in your struggles. In any given year, more than 25% of the U.S. population will meet criteria for a mental health diagnosis (anxiety being far and away the most common of these).  Although lifetime prevalence statistics are typically underestimated due to a variety of factors (treatment is not sought, diagnoses are not made, and mental health problems are simply under-reported), a great many of which stem from precisely the sense of embarrassment and shame you have described feeling, it is estimated that between 65% and 85% of the global population will experience at least one episode of mental illness during their lifetime. It is sadly puzzling that so many people continue to think of themselves as “defective” for experiencing what almost everybody else ALSO experiences. I suppose we must conclude that feeling strange is a very strong sign of normalcy.

Before writing further, I must advise you that a variety of medical conditions and syndromes can “masquerade” as mental health issues, and visa versa.  So please do get thoroughly checked out by your doc to rule out pharmacological, metabolic, hormonal, neurological, thyroid and other potential conditions that can impact mood, hunger and eating behavior.

So, it’s drill down time. I am now going to address your issues far more specifically. I will err on the side of directness, and I ask for your patience with this.

One can develop the cyclical pattern of preoccupation, obsession and compulsiveness you describe in regard to just about any other at least temporarily stimulating behavior (drinking, gambling, having sex, working, fighting, shopping, stealing, watching porn, etc.).  Regardless of the circumstances under which you developed such an uneasy attachment to this particular realm of behavior, however, let’s please be clear about the research which states that you were NOT born with this problem, but that you learned it.  And you have been practicing it diligently, daily and during almost all of your waking hours, for a very long time. Well, we get better at whatever we practice, and we are always practicing something.  So, sadly, you are now an expert.  But that need not define you beyond this moment.

With approximately 99% of human problems, overt, active and even aggressive solutions will yield success (getting out of a burning building, selling widgets, moving furniture, protecting yourself from an assailant, getting out of debt, etc.).  When applied to internally driven problems of thinking, feeling and behaving, however, such solutions typically fail, and usually cause these problems to persist and  worsen.  Thus, your attempts to zealously control your weight, via compulsive exercise, taking phentermine, or practicing periods of eating restriction, have all been associated with increasing distress and stuckness. This outcome is wholly consistent with the behavioral principle of negative reinforcement.

You wisely suggest that your own underlying tendencies toward insecurity, depression and anxiety, all of which you seem to want to suppress or negate versus address, are likely related to the eating issue, and to the layer of additional worries and pressures to which it gives rise. Well, I think you are right. You are treating yourself like someone that has no right (or time) to truly allow her painful feelings (no time to be depressed?), so you consequently feel as if you are walking through life like a zombie (which is, in fact, a clearer sign of depression than is crying and feeling sad), and the hungry, otherwise ignored part of you, is fighting back. That which is suppressed will be expressed.

Finally, experiences such as “brain fog” and other related neurologically located phenomena (lightheadnedness, dizziness, mind going blank) are common accompaniments to anxiety and are, in fact the direct result of your central nervous system’s fight or flight mechanism kicking in.  These symptoms typically occur within the context of social anxiety disorder and panic disorder, and generally respond well to empirically-supported psychological treatment when delivered by an appropriately skilled practitioner. 

So, most importantly you need, and will most likely derive significant benefit from, good solid treatment.

Most essential in this regard will be establishing a strong working alliance with a qualified therapist who can help you understand, disentangle and address these problems (which, again, do all appear to be related). I would therefore advise you to seek out a psychologist with a strong cognitive-behavioral perspective, who can demonstrate to you rather quickly (hopefully within the first meeting) that they have a solid conceptual and technical grasp of what has been going on with you, as well as a sound initial treatment protocol(s) to propose in response.  You also need to feel reasonably comfortable and connected to this therapist as the working alliance is a major mover in therapeutic success. 

With regard to psychopharmacological intervention, this is also likely to be at least somewhat helpful, and may give you some relief for your symptoms while you are on the medication.  This may also, in turn, give you greater resources for the work required in psychotherapy. I have worked with WAY too many people on psychotropic medications alone who have not made sufficient progress because they are not supplementing their meds with psychotherapy.  Meds can be great, but they don’t teach us new ways of thinking or feeling.  In summary, medication is not proven to be a sufficient standalone treatment for the condition you describe.

You may begin your search for a provider by consulting your PCP (please give yourself the opportunity to be honest about your struggles; your self will appreciate it!) about behavioral health professionals well-known to the PCP, or from trusted friends and family.  You may also elect to review popular therapist search engines such as those operated by Psychology Today, ABCT, ChooseHelp or the American Psychological Association. 

And to be clear, my advice is for you to begin with a psychologist or other professional trained in and practicing empirically supported cognitive and behavioral methods, and then consider the medication options, if desired and needed, after you have already begun to work with the therapist.  If you do find that medication consultation is indicated, the complexity of your combined symptoms do suggest that a psychiatrist could very likely be more useful than a PCP (as they are in almost every such case due to their knowledge of psychopharmacology that greatly eclipses that gleaned from the relatively brief training in such areas are received by internists or primary care physicians).  When and if it is time to identify appropriate psychiatric providers, you may request a referral from your new therapist, or your PCP.

The good news is that NOTHING in what you describe suggests that you cannot begin making change tomorrow. It doesn’t matter how long you have been suffering, enlightenment can still be yours. Psychological treatment is not rocket science, it doesn’t take forever, and the process is not even all that complicated. But I caution you; it will require very hard work (although not nearly so hard as the work you have already put into trying NOT to have the problems). Your personal motivation for liberation is key, and you will also have to be willing to accept the discomfort that comes from facing what you truly fear.  If you want anything else in your life more strongly than you want recovery, than your chances of healing are greatly reduced.  That’s the blessing and the curse of being free and of being human.

Finally, as a future health care provider yourself, you will be giving your patients a wonderful gift to the degree that you take the time to know and work on yourself, and you can then help others cope with their challenge in the ways that you will learn to cope with your own.

I wish you peace, luck and strength in your journey. Please do write back to update me on your progress or to ask any other related questions.  This may not only enlighten me, but may also provide support to the millions of others on behalf of whom you unwittingly write.

Thank you.

Richard E. Schultz, Ph.D.

www.mindsetdoc.com

www.drschultz.org

@mindsetdoc

Question: Hi Jim, I want to know that there is hope.. About 5 months ago, I endured an extremely traumatic and almost fatal birthing experience with my son. Shortly after I began suffering from postpartum psychosis. I was diagnosed with bipolar and mania. My sons father left me immediately when he began noticing my change in behavior. He took me to court to keep our son away from me because of the mental state I was in. I have since been treated and medicated, but I am only allowed to see my son twice a week and supervised right now. I really haven't been able to bond properly with him and I am afraid that he doesn't know I'm his mother and worse, I'm afraid that he thinks my ex's new girlfriend is.. On top of this, I am dealing with a severe depression derived from this situation. I had to move back home, I left my job, and my car was repossessed. I have a substantial amount of debt and unpaid bills. Not only am I afraid I'll never get my son back from this, I'm afraid I won't 1. Know how to take care of him if I do 2. Be able to provide for him 3. Be the mother he deserves. I spend a lot of time comparing myself to his father. He makes a lot of money, has a new car, recently for promoted at work. He has always been a materialistic snob and I know he is looking down on me.. I feel so inferior and just downright awful. I feel like I'll always be less of a parent. I have put on a few pounds and I no longer wear makeup. My hair is falling out. I hardly have the energy to even shower most days. I'm disgusted with myself. I am beat down as far as I can be and I can't get up. I want to recover from this. I want to have a car and a good job. I want to meet someone new someday and be happy. I want to be a good mom to my son and give him the best life that I can. And all of that feels impossible. I can't tell you how tired I am of hearing "everything will be okay" and "it will get better." I don't want to wake up in the morning I don't want to go on. I just don't see how things can get better. I am writing you to ask of you have ever known of anyone in a similar situation that has come out of it okay and ended up successful and happy. Or if you know of any resources where there are recovery stories from people like me. I need to see or to believe it. I need to have proof that things can get better for me. Thank you!

Jim LaPierre Says...:

Hello and thank you so much for reaching out! The short answer is yes - I absolutely have seen people rebuild their lives after losing absolutely everything - in fact, I've helped hundreds of folks do so. My first suggestion to you is to stop comparing yourself to anyone - especially to your husband. Doing that will only ever make you miserable. You don't have to have as much or be as much as he is (is he really all that anyway?). You simply need to become the healthiest version of you possible.

I recommend mantras to folks - something to center around that's real - example - "My best is always good enough."

I get it - what you're going through feels like a unique form of hell - but I assure you that not only have countless folks come through similar straits, I also say that we are the very best people. We who have suffered greatly love most fiercely.

Resources for postpartum depression - locally would be best identified by your doctor or psychiatrist. Nationally I would encourage you to contact NAMI for support resources. I would encourage you to consider group therapy that is specific to your diagnosis and I would urge you to ask friends or loved ones to hold you accountable for the changes you seek to make. This is a very hard journey - but you absolutely can do this!!

Blessed be,

Jim

Question: I have suffered for some time with Restless legs and am not on any medication as I taking Effexor for depression and to date have been unable to find any one that can offer a solution. Is there a medication that I can take for RLS while on Effexor and is Effexor the cause of my RLS, need some help please.

Dr. Stuart Shipko Says...:

Having practiced medicine now for over 35 years, I watched restless legs syndrome morph from an extremely rare phenomenon into something so common that the pharmaceutical companies advertise products for this direct to consumers.  The old restless legs syndrome involved substantial actual movement of the legs.  A description of the newer RLS from a direct to consumer advertisement describes it as "The unpleasant sensations that occur mostly in the legs have been described as “itching under the skin,” or a “tingling, creeping, crawling feeling.”  This advertisement describes more of a sensory restlessness than a movement disorder.  Not quite the same condition. With this expanded definition there is a tendency to misdiagnose the restlessness related to antidepressant induced akathisia as restless legs syndrome. 

There is no way to know whether or not the problem is the Effexor.  I suggest that you discuss this possibility with your doctor.  If it were to be a drug induced akathisia, then treatment would likely involve slowly tapering and stopping the antidepressant.  If you were to have a primary RLS, then there actually are medications that can be taken safely along with a serotonin based antidepressant like Effexor.