Q & A / Depression

1) Hejsan! Vilken bra sida:)..

Jag undrar vad det kan vara för fel om man är trött hela tiden. Jag är inte trött så jag somnar, men är trött generellt och har får pressa mig själv till att orka prata med folk ibland. Jag jobbar med människor och på grund av tröttheten blir jag väldigt disträ och klarar inte att konsentrera mig och det fungerar inte när man skall lyssna på någon annans problem. Jag vet att det inte beror på sömn för jag sover som regel 8-9 timmar varje natt. Någon annan sa också att det kan bero på att man har för lite B12 i kroppen. Vad kan det vara annars?? Tusen tack för svar:-)

/Pia

Answer:

Pia,

It is hard to tell why you are tired without a full evaluation, history and laboratory exams. The causes of tiredness or daytime fatigue are numerous. Some medical examples which I see frequently include anemia (low red blood cell count), hypothyroidism, sleep apnea, etc. The list of possible problems is very long. Vitamin deficiencies are on the list but are actually very rare in developed countries as long as someone has proper metabolism. For example, B12 deficiencies can be a result of decrease absorption in the gut.


I would not go spending my money on a bunch of vitamins now though. You should first see a general doctor for a medical work up. Following this, one could consider psychiatric causes of fatigue such as depression. There are also unknown or idiopathic causes such as chronic fatigue syndrome; these illnesses are thought to have a psychosomatic and medical component. There are many treatments out there for chronic fatigue but an accurate diagnosis of the problem should first be made. Go see your doctor and talk with him/her about your symptoms; blog back when you get some answers…..Dr. L

 

 

2)

Hej!Jag har en fåga till er Och jag vill gärna vara anonym.

Det enda jag vill här i livet är att vara lycklig. Och det går inte. Visst måste livet ha sina motgångar. Men mitt problem är att jag snöar in på vissa saker att oroa mig för. Och så kan jag inte sluta tänka på det.

Sen är jag lycklig ett tag tills jag hittar ett nytt problem att snö in på. Jag vill leva i nuet.....Läse i mia törnbloms bok och det är så klockrent - om du oroar dig för famtiden och har ångest för det som hänt så pissar du på nuet. Något i den stilen va det. Min man som är en väldigt förstående man brukar fråga mig om jag inte bara kan va lycklig???


Som i sommras gifte vi oss, då tror jag att något dålig måste hända för jag är typ glad.....Vaför kan jag inte bara ta dagen so den kommer oh vara lykligt. Det är ju supersvårt att vara lycklig.
Sen städar jag som en tog och jag vet att det är ångest dämpade.....

MVH miss C


Answer:

 

Hi miss C,

There are two forms of anxiety or stress. The first is what I call signal anxiety. It is there to warn us of appropriate danger, get us motivated to do the right thing, and keep us living and playing well with others. For example, if I am running late for work tomorrow morning, I should be worried---That way I will hurry and I will be apologetic to my boss in an appropriate manner---And, I will take future precautions that it not happen again.


The second kind of worry is pathologic worry or anxiety. This is what you are suffering from. Pathologic anxiety is worrying for the sake of worrying. Chronic anxiety results in very high rates of depression. There are medications to help with anxiety and they are pretty effective (60-70% response rate). These meds are called selective serotonin receptor inhibitors or SSRI’s. They are very safe in general and here in the U.S. it is given out like candy so many people are on them.


People with your form of anxiety were previously described as neurotic by Freud and others. This type of anxiety if very responsive to psychotherapy. And I would think that is the first best step; Access a good therapist that is not weird and that you feel comfortable with. Preferably one who specializes in Cognitive behavioral therapy (called KBT in Sweden), interpersonal therapy or psychodynamic psychotherapy. These are all good types of psychotherapy for the condition you describe. Freud said the goal of therapy is to learn to live and to love. A therapist could aid you in your quest….Dr. L

 

3)

Hej, först och främst. Vilken bra idé att skapa en blogg som verkligen kan hjälpa andra människor! Sen speciellt intressant då jag har en fråga som "plågat" mig sen sommaren 2006.

Jag har sedan jag var barn, runt sju år, haft återkommande depressioner och försökte när jag var tolv år ta mitt liv första gången. Periodvis mår jag skrämmande bra, utåt sett är jag lycklig. Men hösten 2005 då en vän till min bror tog livet av sig (17 år gammal) raserades mitt liv totalt. Jag mådde redan dåligt men blev efter begravningen helt "blockad", slutade äta och gick ner 13 kilo på lite mer än två månader. Ett par månader senare försökte jag ta mitt liv, överlevde som ni märker och sen gick det väl sådär. Jag började dricka mycket sprit, lekte med killars känslor bara för att själv må bättre. Sommaren 2006 träffade jag för första gången en psykolog via min kompis som ville ha in mig direkt.


Jag vägrade och flyttade hundra mil hemifrån. Jag träffade då min nv sambo och sedan dess har jag sällan varit ledsen, mått jättebra. Men är livrädd att det tar slut då han är min livlina. Psykologen menade på att jag kunde bli ännu sämre ifall jag drabbades av en ny depression då det bara blivit värre med åren. Men jag är livrädd att skaffa hjälp! jag tror stenhårt på självterapi.. Kan hon ha haft rätt? att om jag t ex blir ensam igen, kan det då leda till att min depression återkommer och att det kan bli värre än det varit? Jag är livrädd, jag har snart en universitetsutbildning och mängder av vänner.. men vet ju att en depression kan förstöra så mycket. Sen, funkar självterapi mot självmordstankar?

Långt, och kanske luddigt.. Ha det bra


Answer:

 

Your case is such that I do not wish to give advice. I do wish to give some background or psychoeducational stuff to help you. Suicidal thoughts occur in many people who suffer depression. A past history of depression during childhood and suicidal thinking with suicide attempt does make one high risk for relapse. While the past does not predict the future, it is the most predictive tool we in behavioral health have. Even though it sounds you are happy and doing well now, someone with your history should know all the developing signs of a reemerging depression. Read my earlier blog that way you have an idea of what depression looks like if it did ever start to come back.

 

Also, self therapy is a dangerous game because it has been shown that depression plays tricks on the brain’s ability to understand events in an appropriate context. Depression is like seeing the world through a kaleidoscope where only negative thoughts, images are allowed through. Better to build a relationship with someone who can be trusted and who has unconditional positive regard for you. Sometimes people can find this in their parents, less often friends. It is usually a mistake to depend on this in a partner.

 

One can always find positive regard in the right therapist. Unconditional positive regard is a basic service that we are paid to provide. If depression returns, it would be helpful to already have someone in place whom you can trust to help you see the world as it is, not the depressed version….Dr. L

 


Q & A/ Barnuppfostran

Hur kan jag hjälpa mitt barn att utveckla en god självkänsla?

Min dotter fyller snart 8 år. Tack på förhand ;)

A:
Development (and maintenance ) of self esteem starts from a very young age and continues on into adulthood. By the time a child is latency age (5-9) much of the groundwork has already been laid down by parents and peers become increasingly more involved in one's self esteem.

Most adolescents have many struggles with self-esteem as they begin to obtain the cognitive ability to become more introspective and developmentally prepare for life on their own. It is very helpful for parents to understand child development in order to better assess their child's abilities and balance the parental need to be both supportive (nurturing) and demanding (increasing responsibility and accomplishments).

When discussing "self esteem" I think it helps to define two separate aspects. 1) self esteem 2) confidence. Many use these terms interchangeably but they are not one in the same.

1. Self-esteem = one's own inner feelings about themselves, their abilities, their attributes and their worth. The ability to feel good about one's self. LOVE
In general, when a person feels they are loved, liked, and cared for by those around them (friends, family, even acqaintances) they will develop growing self-esteem. "I am worthwhile". On the other hand, when a person feels unloved or rejected they will have diminishing self-esteem. "My boyfriend left me for another girl and I feel so ugly."

2. Confidence= the outward projection of behaviors, attitudes, appearances, and abilities. The ability to take on new challenges and appear capable to others. COMPETENCY
In general, when a person meets new challenges successfully they will develop growing confidence. "I always new that I could be famous". On the other hand, when a person is too anxious to bother taking new challenges or tries things too difficult resulting in failures they will have diminished confidence. "My mom never let me ride my bike outside the yard because she said it was too dangerous."

Parents should find ways to always remain fond of their children. Unconditional love (or the next best thing). Encourage relationships that enhance the love/adoration that is recieved. Discourage those that appear problematic or emotionally abusive.


Parents should struggle to find the right balance of pressing their child to "go for it" when there is a good chance for success and not be overly anxious about their child's ability/safety. At the same time, parents should avoid exaggerating pressure in areas the child is either unlikely to accomplish or has no desire or gain in accomplishing. With parental guidance and knowledge of a child's abilities, achievements and failures should appear more like a well balanced gungbräda. than an erratic one in which there is high risk of injury...Dr. Lacy

 

Charlotte:Jag tror barn behöver mycket stöd och kontakt med sina föräldrar för att utveckla en bra självkänsla. Detta genom att finnas dar med hjälp och stöd när det behövs, respektera barnets personliga integritet, erbjuda ditt barn tid tillsammans med dig varje dag, ( läsa en saga...) försök att förstå varför barnet känner olika känslor, och visa att du förstår, ge ditt barn friheten att utveckla en känsla av att han/hon kan klara av vad som helst bara viljan finns där, och uppskatta barnets uttryck för skapande tänkande och personlig problemlösning. Lycka till

Q & A

Kan man orsaka sin egen depression?

Svar:
Den är mkt svår att besvara eftersom personer har olika stor känslighet och benägenhet att utveckla depression.

Depression är ju en sjukdom med många orsaker, både fysiska och psykiska. Men vi vet att det är vanligt att man blir deprimerad av långvarig alkoholförbrukning. Likaså av vissa mediciner. En del personer är känsliga för ljusbrist och kan bli deprimerade under höst och vinter. Långvarig stress kan också utlösa depression hos vissa personer.

Du kan minska risken att bli deprimerad om man har sådan benägenhet, genom bra kost, regelbunden motion, gärna promenader när det är som ljusast på dagen. Tank pa att vara måttlig med alkohol och ta reda på om den medicin man får har depression som biverkan.


Läs har om Ansvarsfriskrivning / Disclaimer

Veckans Q & A

Hej, jag har en bror som är manodepressiv men han vill inte ta sin medicin och om man frågar honom om detta blir han föbannad. Han säger att han inte behöver den. Jag har på bästa sätt försökt förlara att han bör ta sin medicin men han vill inte lyssna.

Har ni något råd till hur jag kan förklara bättre så han förstår.

A:
Manic depression, otherwise known as bipolar disorder, is a chronic life long condition marked by periods of euphoric highs and depressive lows. Roughly half of bipolar patients have lack of insight and do not realize they are ill. Poor compliance with treatment is common. Patients often feel a natural high during the manic phase and it is very difficult to convince them that they need a med to bring them down to reality. Generally, patients have better insight into the depressive phase of the illness and are willing to take meds to improve their depression.

I view the issue of compliance in bipolar much like that of drug or alcohol addiction. There is little that can be done until the bipolar patient proves to themselves that they have the disorder. This process can take years and usually occurs as a result of much personal damage. Like alcoholism, family members often learn to avoid the bipolar patient in order to escape the cycle of problems brought by untreated bipolar. As an example, over 90% of those married with bipolar undergo divorce. Sorry to be pessimistic but this is a very hard area for a family memer to improve. Here are some recommendations:

1. Try to be helpful and loving when your family member needs support but do not go way out of your way to help someone who must make a decision to help themselves.
2. Avoid offering finances to help. If helping this way pay for product directly.
3. Do not bother rationalizing with someone who is already manic; they must come down from mania before being rational.
4. Take advantage of the periods of normal mood (such as the period following mania) to help improve insight and maintain the relationship.
5. There is some data to suggest that the patient should build a long-term relationship with their psychiatrist and that family members should be invited into the treatment (if the bipolar patient is willing to let this happen). This way family members can report to the psychiatrist when the patient is beginning to cycle into depression or mania. Here is a link.
--Dr. Lacy

This week's Q & A / Psykisk ohälsa

Hej! Jag och min sambo funderar på att skaffa barn. Han har en bror som lever med diagnosen schizofreni och jag är mycket orolig att våra barn kommer att få denna sjukdom. Hur ärftligt är det? Ingen i min familj har haft några psykiska problem och inte heller i hans, förutom brodern!hoppas på svar

A: Schizophrenia like many other psychiatric conditions does have a genetic component. However, other factors outside of genetics also play a significant role in the development of the disorder. For instance, if two identical twins were separated at birth and one developed schizophrenia, the chances of the other developing the disorder would only be approximately 50%. If one parent of a child has schizophrenia the chances the child will develop the disorder is approximately 5-15%. In the case of one uncle with schizophrenia, I would expect the chances to be somewhere in the range of 1-4%. This is only slightly higher than the rate of schizophrenia in the general population (approximately 1%).
Another thing to remember is that very few people actually have no mental illness in their family. Many people in the general population have at least one close family member with bipolar, depression, alcoholism, etc. All of these disorders have a genetic component as well. There are so many possible medical complications out there to worry about when having a child. I dont think you should let this be one of them. -Dr. Lacy

This week's Q & A

Rädd att han är otrogen

Q: Hejsan! Vilken intressant blogg!
Jag har problem i relationen med min sambo sedan 5 år. Jag kollar honom hela tiden, vad han gör, hans meil och samtalslistor (är rädd att han är otrogen). Han säger att han inte orkar med min ogrundade misstänksamhet .

Vet inte om detta har att gjöra med att min pappa bedrog min mamma ständigt under deras 30-åriga äktenskap. Hoppas på råd och eventuell hjälp. TACK!
/Anna

A:
Hej Anna,

The modern era of cell phones and computer systems that hold carry information for long periods of time has led to many a relationship downfall. You are in a long term relationship, congratulations you and he have been doing something successful. Now we can discuss the differences between appropriate behavior in a long term relationship versus early on (<6months) in a relationship.
In marital therapy, I often liken the process of building a long-term relationship to that of a house. Trust is a core foundation of the house similar. It should be built and tested early in the relationship, well before there is love, before there is sex, and certainly before there is co-dependency. In most cases, it should take many hours spent together over months to build trust. Once trust is earned and given, it should not be questioned except in the most obvious situations of infidelity or other lying. As you are both working on the walls of the relationship (years 1-3), it is destructive to constantly go about testing the foundation. As my wife once said, "you have to trust the process".
Five years into a relationship, most healthy relationships have moved well beyond building. The roof has been placed on the house and you both have what you have created together. Of course, relationships forever may be tested and there is constant maintenance. Some times relationships are so severely tested that individuals must rebuild or even break up.
There are any number of reasons behind why you do the things you do but they will not unlock the secret behind creating a good relationship today. Yes, it could easily relate to your family experience. My guess is that on occasion you find things that are semi-concerning but easily explainable and never cause enough to actually break up. Your spying becomes like playing a gambling slot machine that you just can't get off of. You must realize that by constantly checking on your boyfriend you are constantly undermining your relationship! The belief and acceptance of this will likely allow you to stop yourself. And you must stop immediately, "cold turkey".
I will say from clinical experiences (and personal ones) if you go looking it is very normal to find things that you do not like that are essentially harmless. Looking into cell phones and emails is not unlike looking into another's diary. In any long term relationship, each individual presents a "front" or "side" of themselves to the other. This is an important part of love, romance, etc. That is not to say people lie in relationships. For example, I may talk and act like a different person around my wife versus my co-workers versus my patients versus my friends at the beach. This is normal and appropriate. An individual has many facets. You should have the trust to let your loved one be free to show all facets of his/her personality to the world.
Remind yourself that mistrust and jealousy actually lead people to be less faithful. By constantly mistrusting, you may create your own nightmare. Loved ones tend to carry out your predetermined expectations of their behavior. It is as if you are constantly reminding him "I date you, but you are untrustworthy". Eventually he may just make you right.
If you are unable to give the gift of basic trust, a thing that should have been earned in the first year, then it is time to live alone for a while and work on yourself. That way you may one day live in a happy home:))......Dr. Lacy

Det ar svårt for mig att veta om dina misstankar är helt ogrundade eller om din sambo faktiskt har varit otrogen tidigare (if so, borde du har lämnat honom tidigare) eller att du har hittat olämpliga mail, samtal mm. Om din misstänksamhet är helt ogrundad tycker jag att du ska gå och prata med ngn om dina tidigare problem och inte lägga dom på din sambo och er relation. Kom ihåg, din pappa och din sambo ar två helt olika individer. LYCKA TILL!
/ Charlotte


Ok att ta antidepressivamediciner livet ut?

Hej! Jag är tjej och snart 27 år. Hittade er blogg via google. Har av och till ätit antidepressivamediciner i snart 7 år. Är detta normalt? Ska jag räkna med att äta dessa mediciner livet ut? Jag är så trött på att vara trött. Vill må bra igen.

Ans:
Thank you for your blog. It is our first Question!!! Unfortunately, I can not answer the question "Am I normal" without meeting you socially. Who is normal really? We are all individuals. I can say that it is very common (and appropriate practice) for patients with recurring depression to be on antidepressants for many years. This may be appropriate for several reasons. First, Major Depressive Disorder is often a recurring condition that is life long. The natural course of the disorder is depressive periods lasting months to years followed by periods of "normal mood". This cycle may continue throughout one's life. Only the future can say whether this will be the case for you. Many patients also go into remission and never face another bout of depression even without meds. Second, today's antidepressants (SSRI's) are very safe in long term studies. Other than stigma, there is very, very little risk of long term side effects associated with today's antidepressant. In fact, antidepressants are safer to use long term than most over the counter medications. There is some evidence that they reduce the risk of heart disease as well. So, when you compare the benefits to the risks (the risk benefit ratio) long term use of antidepressants is much more beneficial than facing recurrent bouts of untreated depression. While the meds do not usually cause full symptom remittance, they do generally decrease severity and length of depressive episodes.

Current guidelines for antidepressant use in recurrent depression: 1) first depressive episode (unless severe with psychosis) treat for 6 months to one year and take off meds. 2) second depressive episode (unless severe with suicidal acts or psychosis) treat for 3 to 5 years. Some clinicians treat second depressive episode with antidepressants including lifelong maintenance antidepressants once symptoms improve 3) third depressive episode- recommendation for treatment followed by lifelong maintenance or prophylactic antidepressant treatment. I also like to attempt to slowly taper patients off of medication after every 2-3 years of stability if possible.

For many, the feeling of happiness is fleeting. The good news is that the natural course of depression is a waxing/waning condition that comes and goes with time. The average depressive episode (untreated) will last 6-18 months. In time, you will always find happiness again. -Dr. Lacy

____________________________________________________________________________________________

Först och främst, välkommen till oss!
Bra svar! Hoppas ovanstående hjälper dig. Måste bara säga att jag ar lite skeptiskt till sjukvårdens syn på antidepressiv medicinering, vilket verkar tas till vid alla typer av psykisk ohälsa. Jag säger inte att antidepressiv medicin är av ondo. Det ar jättebra att det finns för dom som verkligen behöver den. Jag anser att ett visst mått av sorger och kriser är normalt, något som drabbar oss alla, en svacka som vi kommer att gå ur stärkta; allt borde inte medicineras bort. Tror att det ar viktigt att försöka hitta ( och bota) orsaken till den psykiska ohälsan och låta hjärnans kemi arbeta i fred. Lycka till
- Charlotte
____________________________________________________________________________________________

Thank you Dr Lacy for your answer to my question. I feel better now knowing that taking medication for life is rather safe. hope I can stop and feel happy without it but if not I will continue using antidepressants. hope to get my energy back soon.

Tack för en underbar blogg!

P.S Charlotte, jag är en av dom som verkligen behöver medicin men jag tycker också att det är viktigt att bearbeta mina problem och inte bara ignorera orsaken till min depression. Tack!

RSS 2.0