Brief Answer:
Please provide details

Detailed Answer:
Hello thanks for asking from Health Care Magic

You are seeing a counselor and have wished to kill yourself. You also crashed your car. I can understand your problem but you haven't mentioned what symptoms you are currently having. Wish to kill self can't be ignored as it may point towards severe underlying distress and depression. Cognitive therapy by a therapist helps in improvement from such symptoms but still your symptoms are persistent. As per my opinion this is the time to consult a psychiatrist for evaluation and treatment.

I would like to know something in follow up so that we can proceed further-

- For what symptoms you are seeing a therapist?
- Have you ever tried to self harm yourself?
- Whether there is some psychological support from family or some friend?
- How do your symptoms started and progressed?
- Any history of psychology trauma you have?
- Any positive thing that makes you happy?
- How do you spend your day? Like doing work or staying at home?
- Whether you have any symptoms of depression like feeling of hopelessness, worthlessness, helplessness?

Even if you have no symptoms out of these still provide me any other symptoms you are having.

Please provide me the details so that we can proceed further. Don't be distressed; just remember one thing that you have to pass a bad phase of life.

Thanks

Dr. Seikhoo Bishnoi
(Consultant Psychiatrist and Psychotherapist)

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Brief Answer:
MAJOR DEPRESSION

Detailed Answer:
Hello thanks for providing me details, I can understand your problem.

First of all just to summarize your clinical history

You have poor support from parents during childhood and you raised your brothers and sisters. History of self harm about 45 years back doesn't make significance in present situation but yes it can tell about your psychological trauma during childhood. The symptoms immediately precipitated after the death of your brother by suicide. You were closely attached to him and this was a major loss in terms of family. Most of individuals remain in grief for about 6 months after some significant loss. But you again got trauma because of break of a relationship. There is no psychological support and you have significant depression and you are not getting happy with anything. You spend your day in crying. You have hopelessness, worthlessness and helplessness. All these symptoms along with history of suicide in family are sufficient to make diagnosis of SEVERE DEPRESSIVE EPISODE.

You are seeing a therapist but your symptoms are persisting. Medicines are probably not working. I would suggest you to attend COGNITIVE BEHAVIOUR THERAPY (CBT) sessions. In CBT therapist and patient work together and find out faulty cognitive distortions, abnormal thought process and attitude towards life. In depressive patients due to depression there are many abnormal beliefs or distortions like for example “if an individual tries to talk to some family member on phone and the phone is not picked because of his busy schedule, the patient will make generalization from this event that no one likes him" or we can go with second example " if an individual fails to finish a work at office he might start thinking that he can't finish any work and he is worthless"

A normal individual may ignore such day to day things but individual with depression with psychological trauma will start thinking bad about him.

The role of CBT is to make individual realize about these abnormal thought processes and to apply new thought processes in real life. The therapy runs long and may take unto six months but have excellent results. You have to take help of a psychologist for that. Apart from this I would advise you to exercise daily, as this will help to release endorphins which lift up the mood. Progressive muscle relaxation exercises, Breathing Exercises help in keeping individual relaxed.

I would also advise you to continue to take anti-depressant medicines as they will help in correcting chemical abnormalities of depression. You have not mentioned drugs but if you want an opinion on the drugs you can mention them here in follow up question.

In life we suffer many traumas in our day to day routine and sometimes nothing is left to think but still we have to live so we need to pass bad phase of life. It is easy to say but really difficult to apply, still I would request you to please try to move past the bad phase of your life. When your depressive symptoms would improve your hopeless, worthless and helpless symptoms will go away. I will also advise you to follow following life style measures-

- Have diets rich in proteins and carbohydrates and low in fats.
- Omega 3 Fatty acid supplements and vitamin B12 supplements help to improve depressive symptoms.
- Sleep at least 7 hours a day and don't sleep excessively as excessive sleep also aggravates depression.
- If you face any difficulty then you can tell this to your counselor or you can write here.
- Avoid excess tea, coffee or alcohol.
- If you have severe anxiety on remembering your brother then you can take low dose benzodiazepines like Etizolam, Clonazepam etc. Consult your psychiatrist for prescription of these drugs.

Thanks, hope this helps you. If you want to clarify anything or have more doubts ask again.

Take Care

Dr. Seikhoo Bishnoi,
MD PSYCHIATRY

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