Q & A
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
Psychiatry and Game Theory
Some theorists propose that the concept of “mental illness” as we know it is a false paradigm. One may view society as individuals playing within a collective game. Each of individual is trying to maximize their potential and gain with minimal effort or suffering. Some individuals understand and play the rules of the game better than others. Problems therefore arise.
"The struggle for definition is veritably the struggle for life itself. In the typical Western two men fight desperately for the possession of a gun that has been thrown to the ground: whoever reaches the weapon first shoots and lives; his adversary is shot and dies. In ordinary life, the struggle is not for guns but for words; whoever first defines the situation is the victor; his adversary, the victim. For example, in the family, husband and wife, mother and child do not get along; who defines whom as troublesome or mentally sick?...[the one] who first seizes the word imposes reality on the other; [the one] who defines thus dominates and lives; and [the one] who is defined is subjugated and may be killed."…Szasz
Mental health disorders are medical metaphors describing incidents when the individual’s desires or behaviors are in conflict with society or nature. Problems of living such as depression, anxiety, and even psychosis exist to be sure. However, it is false to liken them to traditional medical diseases that should be “treated” by a medical doctor. Psychiatrists are similar to “soul doctors”, the successors of priests or shamans, who deal with the spiritual “problems in living” that have troubled people forever.
While people behave and think in ways that are very disturbing, this does not mean they have a disease. Society’s definition of mental illness sometimes seems like a matter of semantics. Thomas Szasz, one of the leading psychiatrists of this view, wrote: "If you talk to God, you are praying; If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; If you talk to the dead, you are a schizophrenic."
Through various Mental Health Acts or laws, psychiatry has slowly become a social control system, which disguises itself under the claims of scientificity.
It should be noted that Szasz’s views have been rejected by the American Psychiatric Association (APA) and the psychiatric establishment. His views are often inappropriately lumped in with less astute psychiatry deniers such as the Scientologists. While I disagree with much of his views, there is something compelling about them especially for any psychiatrist who has ever worked in military, forensic or disability evaluations. Dr. Lacy
Veckans Q & A
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
Min Åsikt/ Vi mår sämre trots att vi har det bättre…
Vi har det bättre ställt materiellt, ekonomiskt och tekniskt än någonsin tidigare men det verkar som att människor mår allt sämre i själen. Alla de nya kommunikationsmedlen och all “ny” underhållning har varken gjort oss gladare eller lyckligare. Eller? Knepigaste av allt är att inte ens alla tidsbesparande maskiner har lyckats ta bort tidspress och stress, utan snarare tvärtom. Vi är mer stressade an någonsin och psykisk ohälsa är idag det näst största folkhälsoproblemet efter hjärt- och kärlsjukdomar. Alltfler upplever depression, ångest, oro och ängslan, och värst är det bland unga, där är ökningen som allra störst. Jag undrar om detta beror på att det inte finns tillräckligt med information om psykisk ohälsa 50 - 100 år tillbaka eller om vi faktiskt är olyckligare idag.
Man kan ju undra varför det ökade välståndet inte har lett till ett ökat välbefinnande.
Jag har mina egna funderingar över detta: I dagens samhälle har vi ökad valfrihet i jämförelse med hur det var för några sekler sedan, när man föddes in i ett yrke, en familj, en umgängeskrets och en ekonomisk klass. Idag har vi möjlighet att välja våra egna liv precis som vi själva vill, vilket gör att människor får ångest, oro och stress. Pressen blir hög på en att välja rätt och trampa upp rätt stig i livet.
Den ökade valfriheten leder till att man själv alltid blir utbytbar, vilket ger en stor känsla av vanmakt. Äktenskapspartners, vänner och anställda går alltid att byta ut, eftersom alternativen är oändliga och ingen är oersättlig.
Min åsikt ar att vi lever i ett samhälle där skillnaden mellan den falska förväntan som finns och verkligheten är stor vilket gör att många upplever besvikelse, depression och hopplöshet. Men vad kan vi göra at det? Jag tror att det är viktigt att vi saktar ner tempot för att hitta en meningsfull tillvaro och anpassa våra liv så att vänner, familj och relationer får en större plats.Vad tror ni?
Hoppas ni alla har en bra dag!
/Charlotte
What is the cause of psychiatric conditions such as depression, bipolar and schizophrenia?
The large majority of today's psychiatrists would answer the above question by describing the "Bio-psycho-social" model. This has been the mainstay of psychiatric education for the last 20 or so years. It is basically the view that psychiatric disorders have multifactorial causes generally falling into three domains: biologic, psychological, and social. For any specific individual there may be differing levels of importance placed on any of these domains. The "bio-psycho-social" model does not work so well when studying large samples of patients but this way of thinking about mental illness works fairly well to determine the etiology of a particular individual's psychiatric problem.
For example, a 19 year old male patient who recently left home to enter college presents with 3 months of depression including symptoms of difficulty with concentration, decreased interests, decreased energy and decreased appetite. The patient states that he grew up in a divorced family and was raised by his father from the age of 11. He states that he also recently has had a break up with his girlfriend with whom he has dated for the last 3 years. The patient thinks that she must have met someone new around the time he left for college. He feels a sense of rejection and low self esteem. He reports a distant relationship with his mother who he describes as "too busy dealing with her own problems". The patient's mother has a psychiatric history of anxiety and depression. In addition to the above, the patient is worried about his worsening grades in school and whether his father will continue to help financially to finish out the school year.
Biological: family history of depression/anxiety, late adolescent age, drug use?, medical causes of depression?
Psychological: How does this person deal with a break up? Was he really rejected or is this just his perception? Does moving away from home and loss of a girlfriend unconsciously bring back prior losses. Maybe there is an increased sense of rejection because he blamed himself for his mom leaving. "I was just another of my mom's problems"
Social: What is his college like? Are people generally friendly or is it a difficult place to meet people? Does he have a roommate to talk with? Why does dad pressure him financially about grades? Would dad continue this negative pressure if he knew his son were depressed? Is the school too academically difficult? Would it be easier to go to a smaller school closer to home? what other environmental stressors are present? What if this patient suddenly won 5 million kronor and met a beautiful swedish girl; would his depressive symptoms suddenly disappear?
Now, you know the bio-psycho-social approach to understanding mental illness. There are many other theories or models out there (some of them pretty wack-o) to explain mental illness. This is currently the most broadly accepted. I hope to present some others throughout the coming week.
This week's Q & A / Psykisk ohälsa
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
Veckans ämne: Källan till psykisk ohälsa såsom depression, schizofreni och bipolär
Varje vecka kommer vi att diskutera och informera om ett nytt område inom psykisk ohälsa. Vi kommer att svara på frågor som rör ämnet men om ni har andra frågor kommer vi att svara på dom i ett separat inlägg. Den här veckan kommer vi att fokusera på ett väldigt brett ämne, “orsaken” till psykisk ohälsa. Vi hoppas på frågor och feedback från er. Om du har en ide till ett ämne, lämna gärna en kommentar och vi kommer göra vårt bästa för att informera om det som ni läsare tycker är intressant.
Psykisk ohälsa är som sagt ett brett begrepp som innefattar allt från psykisk sjukdom, allvarlig psykisk störning till att uppleva psykiska besvär som mer eller mindre stör det psykiska välbefinnandet och som påverkar ens dagliga liv. Många av oss lever med kronisk psykisk ohälsa men fa söker professionell vård.
Det finns många orsaker till psykisk ohälsa. Vi är olika sårbara för de påfrestningar och upplevelser vi möter under livet. Den individuella sårbarheten är till viss del genetiskt betingad. Man kan till exempel ärva dispositionen för att utveckla en depression men det är inte säkert att en depression bryter ut. Det hänger bland annat samman med vilka yttre villkor som gäller i ens liv.
Stor arbetsbörda med för lite egen kontroll kan innebära att den psykiska hälsan påverkas. Det är också negativt att ha för lite att göra och att inte känna sig uppskattad samt uppleva en bristande balans mellan prestation och belöning.
Svaret till vår fråga den här veckan är inget enkelt svar, utan man är tvungen att söka sig till flera olika förklaringar och tänkbara anledningar. Vi kommer att titta på några under veckans gång. Hoppas att ni alla har haft en fin helg!
Tack för alla frågor!
Verkligen jätteskoj att så många intressanta frågor redan har mailats in av er läsare. Det är med intresse jag läser alla kommentarer och email. Vi kan försäkra er om att vi kommer att besvara alla meddelanden vi fått så snart som möjligt. Vi har som mål att besvara alla frågor nästa vecka. I framtiden kommer vi försöka besvara alla frågor dagligen om det är ett rimligt antal. Annars kommer vi besvara dem så fort vi kan, men man bör kunna räkna med att få svar inom en vecka.
Privata frågor som man inte vill ta upp här får vi hävisa till [email protected]. Det finns inga "dumma" frågor.
Hoppas ni alla får en underbar helg!
/Charlotte
Lugn & Frid. Vill vara här just nu.
Sanningen om internet
Jätteroligt att bloggen fått så många läsare idag:) Tack vare min älskade vän Josefine. Tanken med den här bloggen är att vem som helst, både killar och tjejer, kan fråga oss i princip vad som helst om barnuppfostran, familjedrama, relationsproblem, pengaproblem, psykisk hälsa/ohälsa eller kanske bara dela med sig av sin egen historia. Vi har ju alla vara egenheter och "problem" och det kan vara skönt att kunna fråga en specialist inom området utan att behöva sitta ansikte mot ansikte med ngn.
Internet har ju verkligen förändrat vårt samhälle och vänt upp och ner på både kommunikations- och affärsmodeller. Det som från början var en obskyr universitetsuppfinning är i dag en lika stor förändring av samhället som industrialiseringen var på sin tid. Ja, mkt har hänt. Internet har blivit personligt och en stor del av vårt sociala liv. Vi lever "uppkopplade" liv och vi har ständig tillgång till världens mest omfattande och avancerade grupparbete och det ar också här som vi kan hjälpa varandra. När internet först kom var jag lite tveksam till allt nytt och det tog mig ngr år att inse att internet är en ny del i vad det innebär att vara människa och jag måste ta del att detta fenomen.
En sak är klar. Inget samtida fenomen är så genomgripande och så avgörande för vår tid i historien som internets uppkomst. Men jag tror att det vi hittills sett är bara början. Maila gärna in fragor!
Ha det bra så länge...
This week's Q & A
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
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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!
Nya rön om adhd
Läs mer
Olyckliga människor tittar mer på tv, enligt ny studie
I studien har man jämfört människors självupplevda lycka med hur de väljer att tillbringa sin tid. Människor som beskrev sig själva som olyckliga tittat ungefär 20 procent mer tv än människor som beskrev sig själva som lyckliga. De lite gladare tillbringade mer av sin tid med att läsa och med att umgås med vänner.
Enligt forskarna bakom studien är tv det enkla alternativet, eftersom man inte behöver planera, klä upp sig eller gå någonstans för att titta, och det gör en glad för stunden. En av forskarna beskriver tv-tittande som lite som ett beroende, eftersom det precis som andra beroendeframkallande aktiviteter gav en kortvarig lycka men att det i långa loppet ökade känslan av ångest och nedstämdhet. Vad tror ni?
