Hi, I have been dealing with depression, anxiety, and eating issues since I was in grade school, but I always maintained a normal body weight. I finally sought treatment for depression in college, and have been taking anti-depressants (effexor) for the past 3 years. It took a long time to find a medication that helped, and all of them reduced my appetite. Finally, I have been diagnosed with EDNOS this year after losing 32 lbs in 3 months by restricting and exercising excessively. I recently read that anorexia can be caused by high serotonin levels, and starving helps regulate this. But I also read that anti-depressants increase serotonin levels… Could the anti-depressants have caused my eating problems, in my body’s attempts to regulate itself?

Thanks for your help.

A. I cannot say with certainty whether antidepressants are the cause of your eating disorder. Having said that, it does not seem as though medication is to blame. You stated in your letter that you have lost 32 pounds in three months “by restricting and exercising excessively.” Medication may be a factor but diet restriction and excessive exercise are likely the reasons for your significant weight loss, and thus your eating disorder.

I would suggest discussing this matter with your prescribing physician. There may be more information about your situation that was not provided in your letter that would lead to a different conclusion. It is important to explore all the possibilities as to why you have developed an eating disorder. Eating disorders are very serious. They have the highest mortality rate of all mental health disorders. Nothing is more important than assessing why the eating disorder has developed and receiving treatment. The sooner that you begin treatment, the sooner the eating disorder can be eliminated from your life. I wish you the best of luck. Please take care.

Dr. Kristina Randle

Every time my girlfriend and I have sex I just cant orgasm. and I don’t really mind but I care because she’s really really hurt and I often find her crying about it and I don’t want to hurt her. I am on Prozac, I don’t know if that affects anything at all.

A: I appreciate the fact that you are sensitive to your girlfriend and want to fix this. It sounds to me like you need to have a discussion with your medical doctor about this. Sometimes antidepressants like Prozac can have side effects, and sometimes the depression they are used to treat can be the culprit. In any case start I would start with a discussion with your physician.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

I dont know what to tell you really but saw your articles and needed to speak to you.

I have been WEIRD since I was a kid.

Never had a friend always been alone, only just got a woman at 50 an only then cos she is probably BPD. I was diagnosed a couple of years ago with paranoid personality disorder and being schizotypal. I am still not sure any of that is correct.

I definitely have paranoid tendencies and have never trusted anyone. That can be easily explained by bullying from a brother when young I feel and the hate from my mother and weakness of my father.

The problem I have is that when I am in new situations such as on holiday I see people that I think I know and I am convinced I know them and they know me yet my girlfriend tells me its impossible. This seems to be happening with increasing regularity along with olfactory sensations of death and decay.

I have seen psychiatrists and they just seem to despair of me…………………. I have always had suicidal feelings since I was a child but I take seroxat 40mg and that seems to keep me stable but I so desperately want to be free of tablets I dont know what to do.

A. One area of concern is your olfactory hallucinations, also known clinically as phantosmia. Phantosmia is a relatively uncommon symptom. According to Dr. Jeffrey Swanson of the Mayo Clinic, it is often associated with medical conditions such as head trauma, upper respiratory infections, temporal lobe seizures, epilepsy, sinusitis, brain tumors, Parkinson’s disease, migraines or strokes. Because phantosmia may be indicative of a physical condition, it is important to be evaluated by a physician. If you have not done so already, inform your treating psychiatrist about your olfactory symptoms. Your psychiatrist may refer you to an ear, nose and throat specialist.

It is difficult for me to comment about the situations (involving your girlfriend) in which you are convinced that you know someone and your girlfriend says that you don’t. I would need much more information about why she would say that you are incorrect when you are so convinced that you are. Either you are correct or she is correct. There is no in between.

Generally, comprehensive psychiatric treatments often involve both medication and psychosocial treatment but many utilize only one form of treatment with success. Since your goal is to eventually stop taking your psychiatric medication, I would recommend consulting a therapist. A therapist can assist you in developing psychosocial treatment responses to your symptoms. It would be unwise to simply stop your medication without having a plan to treat your symptoms. I hope that my answer helps. Please take care.

Dr. Kristina Randle

Hi. Not sure how to get out of this deep, dark hole I’m in. I want to cry all the time, and feel like a complete failure in all aspects of my life. I really want to give up and if I didn’t have my parents and a few others whom I believe love me, I would just want to check out. I hate life, I hate myself, and I just want all the pain to stop. I’ve tried some an anti depressant, but it made me feel even worse. I believe that I must be a really bad person, and must be just getting what I deserve. I can’t get out of this hole I’m in.

A. It is important that you seek professional help. You are not thinking accurately. Your judgment is being clouded by depression. Proof of this would be your self-critical, derogatory comments.

Antidepressant medication hasn’t helped yet but that doesn’t mean that a different one would not help. When it comes to finding the right psychiatric drug or combination of psychiatric drugs, “one and done” is usually not the norm. It often requires trying multiple drugs, or multiple combinations of drugs before feeling relief. In addition, many people begin taking a new medication and find that the first two or three weeks are particularly difficult. After the initial side effects diminish, only then do many individuals report feeling the positive psychological benefits of the medicine. Sometimes, you have to “wait it out” to gain the full benefit.

Getting “yourself out of this hole” will be difficult to do alone and that is why it is incumbent upon you to seek professional help. If not for yourself, then do it for those who love you, who undoubtedly don’t want you to continue suffering and who want you to feel better.

Writing this letter is a great first step. It is a recognition that help is needed. The next step is to make an appointment with a mental health professional or your primary care physician. The find help tab, at the top of this page, can assist you in locating a mental health professional in your community. I hope you are able to get the help that you deserve. Please take care.

Dr. Kristina Randle

I have a complicated history of childhood abuse and mental illness. I take antipsychotic medication and am diagnosed with Borderline PD with some contention as to whether my psychosis(?) is more psychological or biological. I don’t hallucinate, my problem is mainly surrounding delusions(?) I often experience persecution via ‘government’ agencies via a very complicated system of mind control. I get very angry about being targeted. One example is that they are currently they are repeatedly putting feathers into my mouth to try and choke me, to wind me up, but they engage in a whole myriad of techniques to torment me and exert their power over me. They also affect the way I am able to articulate my experiences, so it’s difficult verbalising them to a psychiatrist in person (though, admittedly, I am partially reluctant because I know people don’t believe me about these things). This has been going on for nine or 134 years, or all in this second. I feel very confused, like there is no boundary to reality. I find that, in my waking/daytime life, some content of experiences has the rather random quality of dreamscape, and so it’s difficult to know whether I am awake or asleep. Added to this I have begun to experience what is possibly hypnagogia which has quite bizarre content – the confusion being that it works its way into my waking life and I believe what has happened throughout times to come. Apolgies for not being very succinct; my question is whether, in this sort of case, struggling to distinguish dreams, or indeed, delusions from reality is normal in psychosis or whether it’s likely to be something else?

A. There is no need to apologize. The thoughts and ideas presented in your letter seem indicative of psychosis. Please keep in mind that I cannot know that with certainty because I am basing my opinion on a short letter with limited details.

You asked whether or not your specific symptoms (i.e. difficulty distinguishing dreams from reality) is a “normal” aspect of psychosis. Yes, the very definition of psychosis is having a break with reality. Many people describe their psychotic experiences as their having difficulty knowing what is real and what is not. That, however, does not rule out the possibility of another problem. Alternative explanations for your symptoms may include an undiagnosed medical condition or a sleep disorder.

You did not mention whether or not you are taking psychiatric medication. If not, you may want to consider it as an option. Antipsychotic medications can reduce or eliminate psychotic symptoms. Understandably, some individuals are reluctant to take psychiatric drugs but a low dose might considerably improve your symptoms.

I would recommend being evaluated by your treating clinician and/or a medical doctor. You may also want to inquire about a sleep study. Your symptoms require treatment and they should not be ignored. An evaluation can uncover what might be wrong. Please take care.

Dr. Kristina Randle

Whenever I have to leave my house I start to feel sick. My heartbeat speeds up and my throat gets tight. I constantly feel like I’m about to throw up and I gag a lot. It started off when I would go to visit my girlfriend in another city. But it’s gotten worse and now it’s pretty much whenever I leave my house for anything. It’s really severe when I have to do something important, like a job interview. I’m starting to cancel on people just to avoid throwing up.

I have some financial problems and I’m trying to get my life together and move on to real adulthood. My mom has been helping me out but she doesn’t work so I hate asking her for help. I haven’t told my family about my anxiety/feeling sick because I know they’d think that I could control it if I wanted to. I feel like I don’t have anyone to turn to. I have friends that I know would help me but I can’t bring myself to ask them because I’d feel like such a loser for not being able to make it on my own. I’ve been at home for a year and I’ve been trying to find a job for a year but with no luck.

I used to be really religious while I was in college but now that I’ve graduated, I’ve lost most of my faith. Now I’m just angry and feel abandoned. I feel like I’ve messed my life up and I don’t know what to do. How can I get rid of this sick feeling? Is it something I can do on my own? I feel like I should be able to, after all there are a lot of people with worse problems than me.

A: What you are describing may be social phobia. Social phobia is a persistent and irrational fear of situations that may involve scrutiny or judgment by others. You’re discouraged about your ability to find a job. Apparently, you’ve been rejected a few times. It makes sense that you would be reluctant to put yourself out there where you might be rejected — again. Unfortunately, the only way to find a job (or someone to love, by the way) is to put yourself out there many, many times, knowing that the chances of being rejected are pretty good. The economy stinks. Lots of young people are having trouble finding work. It’s easy to take it personally when not finding a job may well be because the competition is so stiff.

My advice? Volunteer! If you can’t make money, start building your resume in other ways. Look for something related to your field and volunteer a good hunk of time every week. You’ll be putting yourself into the work you trained for. You’ll be making contacts. And you’ll be deconditioning yourself from your fears. Also — be willing to take a part-time job if that’s what you can find. Some work is better than no work. It’s at least a little money. It does help your resume. And employers are more likely to hire someone who is already in the workforce.

Still anxious? You may need a little short term treatment to settle yourself down. Consider seeing a mental health professional for an evaluation. An anti-anxiety medication will keep you from throwing up. Some cognitive-behavioral therapy will help you relearn how to master your anxiety without medication.

I wish you well.
Dr. Marie

I am a twenty three year old college student who has recently transferred to a different school were I live on campus. I currently have a therapist and take medication for a psychotic disorder. I know I’ve always been a bit different, but after moving to a new place I feel more like a freak then I have ever before. I feel so different from everyone at school. I hear voices in my head and often prefer talking to them and living in my own little world then having the normal college experience. I hate parties and prefer to be alone. I dont really enjoy being in reality and find whats going on in my head to be more interesting then the world around me. My question is, is this normal? or should I be concerned?

A. Yes, you should be concerned. It is not normal or healthy to be continually experiencing symptoms of psychosis. You are withdrawing from others and your symptoms do not seem to be well controlled. It is difficult to know whether your symptoms are making it difficult for you to interact with others or if you lack the desire to interact with others, and that isolation is exacerbating your symptoms. In either case, there is a problem.

You should report your symptoms to your prescribing physician and to your therapist immediately. Your physician might need to adjust your medication. The medication adjustment might help to eliminate the voices. Once your symptoms are under control, you may regain the desire to interact with others.

If it is difficult to meet with your prescribing physician or therapist while away at college, consult the mental health professionals on campus. In addition, inquire about whether any specific help is available to students with serious mental illnesses. Many campuses have specialized support groups or assistance for this population. I wish you well. Please take care.

Dr. Kristina Randle

Im medicated for auditory hallucinations but I have troubling thoughts about committing murder and continuing to drugs. I was diagnosed with severe depression and possible schizophrenia (my doctors aren’t sure). I was prescribed Citalopram (30 mg) for the depression and Abilify (1 mg) for my auditory hallucinations that frequently told me to harm or kill people.

Even though I haven’t heard any voices recently, I’ve been having this empty feeling, boughts of paranoia and frequent murderous thoughts. I alsmost feel like im being told to kill just like with the voices. I frequently use Marijuana and LSD….and I’m using these drugs to help make this go away.

This is starting to bother and scare me, and I really want to know what’s going on. What’s wrong with me?

A. There are several concerning aspects about your situation. The main concern is that you are having “murderous thoughts.” It is a sign that your symptoms are not well controlled.

My second major concern is your frequent use of marijuana and LSD. Both are hallucinogenic drugs. The drugs may be preventing your psychiatric drugs from working properly. In addition, the marijuana and LSD, in all likelihood, are exacerbating your symptoms. Self-medicating with illegal drugs is always a bad idea. It is dangerous and it can lead to disastrous outcomes.

I would strongly encourage you to immediately speak with your prescribing physician about your uncontrolled symptoms. I would also suggest going to the hospital if you feel that you cannot control your behavior or if your thoughts become overwhelming.

In addition, make your prescribing physician aware of your frequent use of marijuana and LSD. Many people might not want to reveal that type of information to their doctor; however, it is important that he or she is made aware of all relevant information. I hope that you are able to get the help that you desire. Please take care.

Dr. Kristina Randle

I have been taking 1 mg Xanax twice a day as needed for about 6 months for Anxiety that builds to Panic.It worked fine but did not last very long. I wanted to get off the Xanax because I have heard it is not good for you. I have no issues with dependency, just wanted to try something safer. My Dr. prescribed Klonopin 1 mg two times a day. The first couple of doses made me feel druged and then evened out. To my shock, after 3 days I had a full on panic attack. This has not happened in over 6 months. She told me to increase to 1 mg 3 times a day in addtion to xanax for breakthrough anxiety/panic. Now she wants to put me on Zoloft. I am concerned. I did not realize how serious my problem was until switching meds. I know it is bad considering the full panic attack after going so long without one and worse than ever. Do the meds seem appropriate. I want help. I need to run a business, take care of my Mother and children. I am the only one they have and can not fall apart. I just want to be safe and function. Do you have any advice?

A. You asked whether the medications that you are being prescribed are appropriate. They may or may not be but only your physician could realistically answer that question.

Generally, trying to find the right medication is a trial and error process. This seems to be the norm for many people. It often means trying a new medication, coming off another, and so forth. Unfortunately, it can be an unpleasant process but once the right medication is found, you can experience significant relief. It’s worth the effort.

My main suggestion is to consider therapy in addition to medication. Medication can relieve your symptoms but therapy can address the cause.

In addition, a therapist can also teach you helpful strategies for dealing with the onset period of your panic symptoms. Comprehensive behavioral treatments, for most mental health disorders, include both psychiatric medication and counseling. One without the other can lead to ineffective results. I hope this helps. Please take care.

Dr. Kristina Randle

I have been dealing with anxiety for probably 15 years. I have little or no depression associated with this. I have an extreme need to control things and fix things. I can’t stand things being wrong or not done. It helps me at work and school in some ways. I am always seen as the best employee. It got me promoted. I also study extremely hard and had an almost all A average until recently. However, it also inhibits me at work. I have only been at this company for less than a year. At the previous company I was with I was so worried I would be fired because I was not selling enough I would cry in the middle of work almost daily. I am almost always nauseous. I over analyze ever situation to the point that I am so stressed out over nothing that I have a panic attack. My husband is laid back so my obsessive worrying annoys him and causes fights. I can’t even go on a vacation without every step planned. I can’t just relax. The only thing that helps me is alcohol. I saw someone 10 years ago who gave me alprazolam and that actually worked. However they also gave me fluoxitine which made me suicidal as I’m not depressed. Then they told me I can’t have alprazolam as it is addictive. It took me 6 months to use the one bottle of medicine. What can help me. I can’t lose this job. I feel that I am losing my mind. I am overeating as well. I also feel that I am becoming an alcoholic and I have a mom who has alcohol and drug issues. I do not want this path.

A. I cannot say with certainty but some of your symptoms are consistent with obsessive-compulsive disorder (OCD). OCD is an anxiety disorder. It is characterized by the need or desire to compulsively engage in a behavior or a set of behaviors for the purpose of decreasing anxiety.

Your current solution to your anxiety problem is to drink alcohol. In a way, drinking can be likened to the compulsions you engage in to temporarily decrease your anxiety. Both drinking alcohol and engaging in compulsive behavior will temporarily decrease anxiety but neither are long-term or healthy solutions to your ongoing problem. In fact, both drinking alcohol and continuing to engage in your compulsions will ultimately exacerbate the problem.

The main problem with OCD is that generally, without treatment, it tends to become worse over time. The compulsive behaviors temporarily decrease anxiety but that doesn’t last. Anxiety avoided in the short run, only intensifies it in the long run.

You asked what can help you in this situation. I would recommend consulting a primary care physician. Report your symptoms and ask if he or she can refer you to a mental health professional who specializes in obsessive-compulsive disorder or anxiety disorders. Seeking treatment from a mental health professional is the most efficient solution to this problem.

Your were prescribed medication ten years ago. Much has changed since then in the types of medications available and the protocols for their use. Medication may be very effective in your situation.

There are many other effective treatments that exist for anxiety disorders. I hope my suggestions help you to find the right solution to your problem. Please take care.

Dr. Kristina Randle

I am sending this message hoping that you will be able to help, or at the very least offer advice about my brother’s condition. My brother was socially awkward from youth, and eventually became depressed at an early age when he was put in the “special classes” back in elementary school. His depression grew with him throughout high school. At approximately 16, he stopped going to classes and isolated himself from the world. He would not be in contact with anyone, gave up his friends, and eventually stopped communicating with his own family. At one point about 2 years later, we found him lying in a bathtub speechless in a state of catatonia. We later found out that he had developed catatonic schizophrenia. We had no choice but to hospitalize him so that he could eat, sleep, shower, and do activities that he was unable to do in his catatonic state. He was given high doses of ativan coupled with resperidal and celexa. (during junior and high school, he was prescribed antidepressants, but they were ineffective.) Unfortunately, these medications began to wear off, so we swtiched medicatons, trying different types of atypical antipsycotics, such as seroquel, invega, and even saphris. NOTHING worked. Some even caused dangerous side effects, such as an involuntary head jerk. So we returned to resperidal and lexapro. Unfortunately, about a year ago, he began to develop a very serious and uncontrollable case of talking to himself. This goes on throughout the day, and when he speaks to himself, it is as if he is in a trance. He is unresponsive, and usually angry. He also yells obscenities, sometimes yelling inappropriate things in public. We recently switched medications to Latuda, assuming that the resperidal was responsible for his speech problem, but it made his problem worse, so we switched back to risperidal. We don’t know what to do at this point because we cannot see him in this state, but at the same time, we fear that removing him from medication will cause him to fall back into a catatonic state. It is a very sad case because he was normal growing up. Unfortunately, his problem is growing with him and we can’t even find treatments. If you know of any specialist in the New York area who would be willing and able to treat him, please let us know. We would greatly appreciate it.
All the best.

A. I am sorry but I do not have any specific physician referrals for your brother. My general recommendation is to have him evaluated by multiple psychiatrists and neurologists. I am suggesting that you consider neurologists because of the nature of your brother’s symptoms.

Some of his symptoms may be characteristic of schizophrenia, including talking to himself, unresponsiveness and emotional instability. Others may not be characteristic of schizophrenia, including yelling obscenities and doing so in public. The latter symptoms may be more characteristic of Tourette syndrome. Tourette syndrome is a nervous system disorder that often begins in childhood between the ages of seven and 10 years old. It affects males at a higher rate than females. Characteristics of this syndrome include repetitive, involuntary movements and vocalizations, called tics. It is possible that your brother is experiencing tics and cannot control his behavior.

Alternatively, it may be that his involuntary symptoms are related to schizophrenia or they are side effects of his psychiatric medication. Having so little information makes it difficult to discern the cause. That is why it is important that he’s evaluated by multiple types of specialists. I would recommend speaking to his current prescribing physician about a referral or several referrals to highly trained specialists.

I would also recommend conducting Internet research regarding the best specialists in the New York area. You may want to start at the Columbia University Medical Center website which can be located here. Their psychiatry department offers a toll-free referral line. That may be a good place to start.

Another good resource may be The National Alliance For Mental Illness in New York. They too offer a helpline and Internet resources that may be of assistance to you. Their website is located here.

I am sorry that your brother and your family are experiencing such distress. It is difficult to watch a loved one suffer. It can be a helpless feeling. Your brother is fortunate to have a loving and caring family who are concerned about his well-being. I sincerely hope that you can find the proper help for your brother. Please take care. Best of luck to you and your family.

Dr. Kristina Randle

I moved back to my native country (Brazil) after about 10 years living in the United States. Life had lots of ups and downs in the US, both due to being an immigrant and due to being married very young to an immature and mentally unstable man. About 1 year before we actually moved back we started talking about leaving the US due to the economic crisis and also because my husband’s mental health was deteriorating. We both thought the move was the right thing to do as we’d be closer to family and friends, he’d have free healthcare, and also because of better economic prospects in Brazil.

Unfortunately, since we arrived, about 18 months ago, my life has been pure hell. None of the prospects panned out, my higher ed degree is not recognized here as it was earned in the US, my husband cannot get a job, both of his parents died within 12 months of our arrival and now he’s in a heated battle with his half-brother for the inheritance. Needless to say, his mental health has become worse than ever, our financial situation is not good, and our quality of life has decreased immensely. We have moved from city to city over here and we’re now living with my parents in a tiny town in a rural area. I cannot adapt to my own country’s customs and traditions, I miss the life I had before, I get really angry for having come back, and I feel helpless and hopeless about the situation. It’d be really hard to go back to the US now that we are broke and would have no job or home to go back to.

Lots of people have been telling me I’m depressed and I need to see a psychiatrist. The town does not have one, though, so I went to a GP and complained about having sleep problems. He did not even ask me any follow up questions to diagnose depression or any other mental problem, but he right away whipped up a prescription for 20mg of Citalopram daily. I took the first pill yesterday morning and I felt extremely ill all day. I was advised to take the second pill today anyway, so I did, but I’m really nervous about it. I had tried taking Prozac about 6 months ago, which was also prescribed without any formal diagnosis by my former GP, but the side effects were so crippling that I stopped after 8 doses. Now Citalopram seems to be making me very sick as well. What if what I have is not clinical depression? Will the pills hurt? If what I have is an adjustment disorder, is this drug the best treatment option I have, considering the lack of resources in the town and my financial situation? I appreciate any help, Thank you!

A. In Brazil, at least where you are located in the country, you don’t have the same kind of access to psychiatric services that you would likely have in the United States. Unfortunately, your options are limited.

Keep in mind that when beginning a new medication, it’s not unusual to experience side effects. For many medications, those side effects will subside after the first few weeks.

It is difficult to know if the type of medication that the general practitioner (GP) prescribed is the correct one for you. Finding the right medication often involves trial and error. Unfortunately, for the patient, this often means taking medications that temporarily produce unpleasant side effects.

Considering the limited psychological resources available in Brazil, you have to work with who is available. I would encourage you to report your side effects to the GP. You could also ask the GP about what other mental health services are available in the country. Ask if he or she has specific names or contacts.

The World Health Organization reports that Brazil has Psychosocial Community Centers (CAPS). CAPS seem comparable to the community mental health centers that we have in the United States. Though the CAPS program reportedly targets severely mentally ill individuals, social service workers associated with those facilities may be able to assist you in locating less intensive outpatient services.

Finally, you may want to consider returning to the United States. I understand the difficulties associated with such a move but at this point it seems as though you have nothing to gain from remaining in Brazil. The move might be difficult but the job prospects may be better in the United States than in Brazil. As you mentioned, your degree is recognized in the United States but not in Brazil. It may be something to consider. Please take care.

Dr. Kristina Randle

My husband suffers with clinical depression for which he is receiving treatment. Every so often he withdraws totally not speaking, not getting involved with anything happening around him. He loves planning our holidays but when he is like this he loses interest in that as well. He just watches TV or plays games on computer, drinks two bottles of wine a day and pigs on chocolate. I can tell when it is about to start as he becomes easily agitated and tends to answer questions with ‘its up to you’ the smallest thing will make him just close down. Last time it happened it lasted for two weeks and in that time our two dogs had a serious fight and he would not do anything to help with the one who had been badly injured saying it was my fault for not controlling them.

He comes out of this with no warning but always seems really drained of energy afterwards, he says he feels very lonely when he is like this but can’t seem to do anything about it.

He has been married before and his first wife was abusive and physically hurt him. I hate to see him like this as his life seems to close down for these periods and he withdraws from everything he enjoys doing.

A: How very sad for you both. What you are describing certainly sounds like depression. But it also sounds like your husband may not be getting sufficient treatment. As you are in your late 50s, I’m guessing that your husband is about the same age. As we age, physiology changes. His medication may need adjustment accordingly. It may also be that he isn’t able to give his doctor an accurate report of how he behaves when he is in these episodes of withdrawal. He doesn’t see himself as you do.

I suggest that you talk to your husband about letting you come to his next appointment with his doctor so that you can add to the conversation about how he is doing if you think he is leaving things out or minimizing the effect of the depression on him and on his family.

I also hope your husband is in therapy. Often medicine alone isn’t enough to resolve depression. Cognitive-behavioral therapy has been found to be very effective in helping people manage a mood disorder. Ask his doctor for a referral to someone who specializes in helping adults who are suffering from depression.

You must care deeply for this man to withstand these periods of gloom. Unlike his first wife, you are seeking help instead of hurting him out of frustration. I hope your husband is able to accept your love and let you participate in his treatment.

I wish you well.
Dr. Marie

I’ve been on antidepressants since 1985. I’ve had a bunch of therapy over the years mostly in the mid to late 80′s. I believe I understand and have dealt with my childhood issues.

Every few years or so I have to switch meds because they stop working. As you probably know this can be a hellish experience. I’ve been off of Cymbalta for 20 days and was hoping that the worst was over… but I’m not sure. I’ve been on Nortrriptyline for about a month at a very low dose (25mg) because I don’t like certain side effects and will likely taper off of the 25mg. I’m hesitant to go forward with different meds because of when I have to switch again. My Psychiatrist is suggesting Zoloft based on the drugs I’ve already been on.

I’m kind of scared…I feel so agitated/angry/crazy at times. If you asked someone who knows me their first thoughts about me they would include something about how much I love animals. We’ve got 2 high energy dogs (herding breeds) that I take out daily to exercise (them and me). Usually we walk for an hour and I let them run in an open field at the end of the walk. Lately (the past week or a little more) I feel so irritated by them when we go for walks or for a car ride to the dog park that I am almost abusive to them. Yelling at them in the car just because they are panting too loud! What is wrong with me? Is this from the Nortriptyline? Or part of the problems coming off of the Cymbalta? Or is this some new depression thing? Whatever it is it is really awful and I wish someone could just put me out of my misery.

A. You are currently in the midst of a medication transition. You have described that experience as “hellish.” Many people would concur with that assessment. They too find it to be an unpleasant process. It is “hellish” largely because of the emotional dysregulation that often characterizes that experience. It is very likely contributing to your current feelings of agitation, irritability and your overall emotional instability.

You should consider returning to counseling. You tried counseling approximately 20 years ago yet the depression has remained.

Therapy could be advantageous for several reasons. One reason is that it might clarify whether you are currently having a depression episode or if your symptoms are associated with the transitional medication process. Secondly, a therapist could assist you in the development of relaxation techniques that might increase your emotional stability during this transitional period. Finally, therapy could help you to address your symptoms of major depression that have been your “ball and chain” for more than a quarter of a century. There are effective therapeutic modalities that can significantly minimize your depression or eliminate it from your life. Psychotherapeutic treatments have advanced a great deal since the 1980s.

I would encourage you to discuss your symptoms with your psychiatrist. He or she might prescribe a medication that can quell your agitation and irritable feelings while you are transitioning to a new set of medications. Also, I hope that you will consider counseling. A competent therapist can help to permanently remove depression from your life. I wish you the best. Please take care.

Dr. Kristina Randle
@DrKRandle

I am an 18 year old female living in Wisconsin. About 6 months ago I was diagnosed with depression and put on Celexa. I’ve found that ever since I started the medication I am unable to cry. When I am very sad or in a situation that crying is acceptable, (like in a funeral, etc.), it is impossible for me to even shed a tear. Crying used to help me feel better and it is extremely frustrating to have to deal with this. I was wondering if anyone had any feedback or tips on what to do? Any help is appreciated. Thank you very much.

A. A possible side effect of some psychiatric medications is emotional numbness, that is, the inability to have a “normal” range of emotions. Some have proclaimed emotional numbness to be a welcomed change, especially in the case of individuals struggling with severe depression or anxiety symptoms. Others find it limiting and abnormal.

My suggestion is to speak to your prescribing physician. It is important to report all possible medication side effects. Report your limited range of emotions. It may be a sign that you are on the wrong dose or taking the wrong medication. Your doctor may need to make adjustments. You might also want to consider trying a different medication. It is not uncommon for medications to need to be adjusted or changed. I hope this helps. Please take care.

Dr. Kristina Randle
@DrKRandle