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By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Psychiatric medications are one of the most commonly prescribed classes of medication. Every year, up to 1 out of 5 adults will be prescribed medications for mood and often end up taking them for the long-term. Medications can be helpful when symptoms of anxiety or depression – the most common mental health issues – are acute and severe. However, long-term use is often not required, needed or even recommended. If we are taking medications for mood, and as symptoms improve, it’s wise to consider whether ongoing use is needed – particularly given the unpleasant side effects. Any changes to medications should always be discussed with your physician, but it can be helpful to go into these conversations armed with information.
What causes anxiety and depression? For most people, the emergence of anxiety or depression symptoms is the result of a complex interplay of multiple factors, which include:
The way we think about the world (our thoughts) and the way we cope with stress (our actions and behaviours) also play an important role in whether – and to what degree – we will manifest the emotional state of depression. Although there is little empirical support that anxiety or depression are exclusively caused by a biochemical imbalance, biochemistry does play a role. The efficacy data on the use of antidepressants and anti-anxiety medications are also very clear: they are most effective and recommended when symptoms are moderate to severe – primarily to assist with improving what is called the vegetative (or physiological) symptoms that accompany anxiety and depression – such as sleep or changes in appetite. When symptoms are less intense, non-pharmacological interventions such as cognitive behavioural therapy (CBT) are recommended. Contrary to popular belief, long-term, permanent use of psychiatric medications is not recommended or even needed – and can lead to other side effects and problems. In fact, an extended duration of time during which mood is consistently stable, combined with significant changes in psychosocial circumstances and external stressors is often an indication that psychiatric medication use can be reduced, if not eliminated altogether. Safely reducing or eliminating medications If you feel that you are ready to reduce or eliminate the psychiatric medications that you are taking, here are three things to keep in mind before making any decisions on your own. Enlist the support of a mental health professional who can offer insights into the psychosocial factors that played a contributing or exacerbating role for you. They can also help build a relapse prevention plan – with a heavy focus on preventative strategies that can help you manage symptoms from a non-pharmacological perspective. Any reduction of medications should be done in close consultation with a physician so that the side effects of both the reduction in medication, as well as close monitoring of symptoms can be conducted. Then, if you decide that reducing the medication is the right next step for you, make sure to involve your partner or get the support of a close friend or family member. Having the support of another can help you to identify and manage any symptoms that emerge as a result of the tapering off process. Remember that not everyone is reliant on medications for their lifetime, but there is no shame if they are required. Editor’s Note: This post was originally published as part of a Globe and Mail “Ask the Psychologist” column authored by Dr. Samra, and has been edited and updated. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I recently had my second child – shouldn’t this be a happy time for a mother? But I feel lost. It’s like I’m not living my own life any more. Is that normal? What should I do? The answer: Having a baby can be one of the happiest moments in life … yet it is also high on the list of stressful life events. Most women experience myriad emotions after giving birth – excitement, happiness, elation and joy. In addition to the usual (expected) positive emotions, many women also experience low or sad mood, tearfulness, frustration or a sense of emptiness. These negative emotions are often a surprising reaction to what most feel should be a unilaterally happy event. This experience, however, is extremely common. As many as 75 per cent of moms will experience the “baby blues,” which in addition to low mood can also include a general feeling of flatness or emptiness. Unfortunately, however, many feel a sense of shame in terms of talking about their negative emotions. There are a number of factors that contribute to the baby blues. The delivery and postpartum process leads to significant hormonal changes. Progesterone levels – which play a role in mood, energy and libido, among other things – decrease dramatically to allow milk production to begin. There is a significant increase in adrenalin during delivery, and then a crash afterward. This, combined with the physical demands of birth and the associated sleep deprivation, understandably leads to a major impact on mood. In addition, there are substantive life changes that come along with the responsibility of caring for another human life. This can be compounded by already having one baby and can, not uncommonly, lead moms to feel overwhelmed and lost. Most women find that their mood will lift within a few weeks as they get used to the baby and their new schedule, as hormone levels stabilize, and as mom and baby get into a routine. Talking about how you are feeling to those that are close to you can help. Joining a moms’ baby group in your community can provide you with additional support and may help you feel that what you are experiencing is normal. Ask those close to you for help in day-to-day things that feel overwhelming (housecleaning, grocery shopping, meal preparation). Build in short windows of time in which your partner or other trusted friend or family member can watch the baby while you get some time to yourself. Build in self-care activities, such as taking an uninterrupted bath, going for a walk or getting a massage. If you are persistently feeling low, flat or empty for more than a month, you may benefit from seeking professional assistance. About one of 10 women will develop clinical levels of depression that are important to treat early on. Ask yourself if you are feeling low or flat more often than not for weeks or longer. Do you have a loss of interest in usual activities and things that you would normally enjoy? Are you experiencing significant appetite changes, persistent anxiety or pervasive irritability? If so, speaking to your nurse, midwife, doula or family doctor is important. They may suggest a referral to a mental health professional, such as a psychologist or psychiatrist. If at any point you feel you are at risk to harm yourself or your baby, immediately seek help and call 911. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth
The question: I told a friend about a job I was applying for. The opportunity excited her, and she asked if she could apply too. I said okay, but I’m really ticked now and feel like I can’t trust her. Can our friendship be salvaged? The answer: Let me get this straight: You tell your friend about the job that you want; she directly approaches you and asks for your permission to apply; you say yes, but now you don’t trust her? I am confused! I’m unclear how or why this has created a trust issue – trust is broken when one deceives, misleads or betrays us. Unless I’m missing something, none of these instances apply to this situation. It sounds as though you are more upset with yourself than anything else, and that your frustration with the decisions you made (to tell your friend about the job, to say yes she could apply) is being projected on her. Ask yourself honestly whether the issue relates to anything your friend has done or said. I suspect the decision you are most upset about is, in the spur of the moment, replying “okay” when she asked about applying as well. Ask yourself why you said “okay” when you more likely meant to say “no,” so that you don’t do it again if you are ever in another similar situation. Are you a people-pleaser who easily succumbs to others’ requests? Do you hate disappointing your friends? Do you find it uncomfortable when someone is upset with you? Once you identify what the factors are, you will know how to move forward in an effective manner. Now, whether or not you can salvage your friendship – yes, of course you can. The best policy is honesty – you don’t want to move forward in your friendship with the elephant still in the room. Be proactive, short and to the point. Tell your friend there’s something that is bugging you, and take responsibility for your contribution. You could say something like: “I have to just put something out there about the job we both applied for. I know when you asked me about applying, I said ‘yes,’ but I realized after that I was actually super excited about the job and really wanted it. So I said ‘yes’ when I didn’t really mean it. That’s my fault, and I really respect that you asked if it was okay if you could apply. Anyway, I don’t want the job to get in the way of our friendship and I want to move on. I just wanted to let you know where I was at.” Then, do move on. For all of us, hindsight is always 20/20. Pay attention to the lessons you have learned about yourself. And above all, don’t let a job get in the way of a friendship that you value. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The Question:
My friend is convinced she has wrinkles and needs to get botox. She has absolutely no wrinkles that I can see (in fact, her skin is wonderful). I am concerned about her warped perception of her appearance. Why can’t she be happy with how she naturally looks? The Answer: A woman's relationship with her appearance is one of the most complicated relationships she will encounter in her lifetime. The relationship is mitigated by a number of factors, that includes a strong sense of self, confidence in other traits and attributes she possesses, and her overall sense of happiness. Our modern day society, however, is wreaking havoc on the self-image of even the most secure women, and I am seeing in increasing number of particularly younger, objectively attractive women in my practice who are consumed with undergoing procedures to further enhance how they look. I think this is an artifact of a number of factors. We live in the age of a technological revolution where we are literally bombarded with myriad images, on every medium and form, that set expectations for what society’s ostensible “standards” are for beauty. One would be hard pressed to find a television show or film without a star that has either privately or – as is the current trend – publicly pronounced the cosmetic surgeries she has had. Gone is the shame and stigma with undergoing enhancement procedures. And, gone are the days where cosmetic surgeries were only for the very rich and famous. The last decade has witnessed an explosion of the range of available cosmetic procedures and clinics, and the drastic drop in costs has made many of these services accessible to the every-woman. Virtually all of us engage in some element of appearance enhancement – ranging from the clothes we wear, the grooming practices we engage in, and the makeup we put on. A decision to engage in something more significant (and arguably not benign in terms of long term health impacts) is a very personal decision. As a friend, your job is to support and not judge your friend for the very personal decision she is making; however, as a friend, it is also your job to (respectfully and kindly) express the concern you have to her. Start a dialogue with her about her reasoning for wanting to get botox. Most importantly, listen to her reasons, as that may give you an indication whether her decision is a temporary knee-jerk reaction to fleeting insecurity or unhappiness, or if it is a well-thought out, considered decision to engage in a procedure, fully understanding the potential risks. If the former, try to listen to support your friend as best as you can and ask her what you can do to help. Encourage her to defer the decision until she is in a better place emotionally. If the latter, focus on keeping your opinions to yourself, and maintaining the friendship. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
My common-law partner and I have both had previous marriages. I’ve always wanted to marry again, but he refuses to even speak about the possibility. He pulls away emotionally and physically each time I’ve asked. Why can’t he get over the past and start fresh with me? I’m ready to be a wife again. The answer: For all of us, what we value and want in life is shaped significantly by our past experiences. Our history makes us who we are and – right or wrong – has a bearing on the future decisions we make. There’s no area in which this applies more than in our relationships. Humans are, to the core, social beings. We want, need and thrive from our social connections. Family, friends and intimate relationships are all important, yet distinct elements in the social network that surrounds us. Of our varied connections, intimate relationships are perhaps the most complex, confusing and crazy-making. These are also the relationships that have the potential to bring us an immense happiness and joy. Unfortunately, today’s relationships are more complex (for a range of societal reasons) than the relationships of decades ago. People are much more likely to see divorce as an acceptable option to a failing relationship; both men and women are waiting longer to get married; women are willfully not having children; and many choose co-habitation in the absence of legally being married. I don’t see your biggest issue as being the difference in value you and your partner place on the legal institution of marriage. Many couples are able to come to a mutually acceptable decision to agree to disagree on important relationship points. The bigger issue is the manner in which the two of you are communicating – or not communicating – about these differences. You make the assumption that his disinterest with marriage is reflective of his inability to get over his past. There is a good chance that this is a faulty interpretation. Have you tried to ask him about his reasons for not wanting to get married? Perhaps his experience was that the legal entity of marriage offered no added value to his past relationship? Perhaps it added financial and logistical complexity that he does not want to deal with again in your current situation? Perhaps he perceived marriage as having a constraining, negative and destructive influence on his relationship? Conversely, does he understand (and have you been able to fully articulate) the reasons you want to get married again? Do you feel that marriage would offer you a commitment and stability that isn’t currently in your relationship? Ask yourself if there are things he can do or say that would provide you the key elements you think marriage would offer. It could be that the bigger issue is not the difference of opinions on marriage, but other fundamental difficulties in your relationship that need to be solved. I would encourage you to have an open conversation about your positions on marriage. You both need to truly understand each other’s perspectives and ensure you have the same long-term vision of your relationship for it to work. Remember that getting married is no guarantee that the relationship will be a fulfilling or lasting one – similarity and respect for your individual and joint values and goals are. Ultimately the issue of marriage may become a deal-breaker for one of you, but try to be open to the idea that you can both have what you want in a relationship in the absence of it. Who knows, open conversation may even result in one of you making a willful shift in your ideals. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. |
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