Ask the Doctor FAQs: Stress / Mental Health

FAQs: Stress / Mental Health

How do I cope with high levels of job frustration, given that I have a strong need for achievement? I don't mean having to do great things. I just must feel that I have done something at the end of each day. I am a computer programmer.
It's a great feeling to know that you have accomplished something significant with your day. But your question suggests that there is something about the pursuit of that good feeling that is troubling you.
Let me ask you a simple-minded question: Why do you suppose it is that you feel a need to have accomplished something "significant" with your day? What is it about accomplishing things that is so important? It's a question we should all ask ourselves from time to time, because in answering it we are apt to discover a number of assumptions about life, about ourselves, and about what society is asking of us (or what we think it is asking of us).
Like you, most of us have a desire to get somewhere in life, to accomplish something notable, or memorable, or lasting. To be recognized for the hard work and frustration, the times when we work alone, with no one patting us on the back telling us what a great job we are doing. Traditional Western culture, and certain other cultures of the world, place a high value on accomplishment: The man or woman who builds a bridge, publishes novels, receives promotions, or makes a lot of money, will be admired, respected, and envied. They will have a sort of power over others, and inside we may compare ourselves to the outer standards set by these accomplishments.
But I would argue that we value ourselves too highly for what we do, and not enough for who we are. Instead of human beings, we are human do-ers. The person who enjoys periods of quiet contemplation, who leads by listening to others, who is humble and aware of their small place in the universe, is not flashy, and not ambitious in the traditional way, may not get the promotion and may not get written up in the newspapers. But at the end of the day, that person may feel more content, more satisfied that their life has meaning even in the absence -- or because of the absence -- of anything measurable that they have accomplished.
In other words, most of us are deeply inculcated with the value of doing things and of being active. Our identities and self-worth are closely linked to what we do. Strangely, however, there never seems to be enough accomplished to provide the deepest, most heartfelt sense of satisfaction or contentment that most people yearn for. Consider the most successful people you know. Ask yourself if they are happier, or more content, than you are. Looking beyond physical comforts, are they, because of their accomplishments, better people? Are they better sons, or daughters, or parents? Are they more loving, or caring than you are? Have the paths to their accomplishments harmed or helped others along the way? Would you want to trade your life for theirs? If the answer is yes, then you have found someone who is a real master. Yet, too often, very many people who are widely recognized -- even loved -- for their accomplishments remain unsatisfied, restless, frustrated -- ultimately even bitter, angry or exhausted.
This is not to say that accomplishments, both large and small, are not of great value to oneself or to others. Rather, it is the over-emphasis of accomplishment that can become a problem.
Do your work well. Work hard, work mindfully, and with devotion. Then, at the end of the day, walk away. Let your work lie where you leave it. It is only work, and there is the rest of life to experience, with measures of success and contentment that are very different from what transpired at your job that day.
-- R. Jandl, 11/5/96, Category: stress and mental health

An office friend asked me to find out about a condition she has been recently diagnosed with: she has been told she is dysthymic, which she believes is a category of depression having to do with the thymus gland. Is it hereditary? What are effective treatments? What else can you tell her about it?
You are right that "dysthymic disorder" is a type of depression. However, it has nothing to do with the thymus gland which sits beneath the breast bone. The thymus gland ensures the maturation of a sub-group of lymphocytes, or immune cells, called T cells.
Dysthymic disorder is the name given to a type of low-grade, chronic depression that often starts in adolescence or early adult life. The symptoms are the same as other types of depression, and include low self-esteem, and feeling sad, anxious, irritable, guilty or hopeless. There may also be a loss of interest in outside activities, in the greater world, or in having sex. It does not appear to be hereditary.
What helps to distinguish dysthymic disorder from other types of depression is that the feelings seem to be life-long. They may appear to be simply a part of the person's character. Patterns of negative thinking are common, leading to a sense that things always go wrong, and that you have little power to change your outlook on life. The person may also have long-standing difficulties with relationships, may lack a sense of identity, and may harbor feelings of emptiness. Manipulative behavior may also be seen.
Just for contrast, it may help to describe what other depressions are about. A person with a "major depression" will experience the same feelings as those mentioned above, but will also have more physical problems such as poor sleep, poor appetite, weight loss, markedly decreased energy or ambition, even slowed movements, or thoughts of suicide. These symptoms are much less common in dysthymia. "Bipolar disorder" -- yet another type of depression -- is characterized by periods of mania (high energy, expansive mood, over-involvement in activities, lack of appreciation for negative consequences of actions) that alternate with periods of depression. Still other types of depression occur seasonally in association with a lack of sunlight exposure ("seasonal affective disorder"), or are temporarily experienced in response to a major life stress.
It sounds as though your friend is seeing a psychotherapist. This is the treatment usually recommended, and although there is not likely to be a "quick fix," it would be a good idea to continue with this. Anti-depressant medications are sometimes used, at least to treat the physical symptoms mentioned above.
Depression really feels awful. The support of family and friends for a loved one experiencing depression is always welcome.
-- R. Jandl, 10/21/96, Category: stress and mental health

My husband was diagnosed with pancreatic cancer in March, 1995. Chemo hasn't helped and lately he has been suffering from severe edema all over (face, legs, & abdomen) and has had a fever (100-102) on and off for the last month. He is constantly tired and his appetite has decreased. Oh yeah, the cancer has metatastized to the liver and I fear, to other surrounding tissues. My question...is this common, and if so, what other signs of disease progression can I look for? He has basically given up, and I cannot get him to go to the doctor anymore. He says it's because we don't have health insurance, but I think he may want to die. Any answers, or semi-answers you may be able give me would be appreciated. Also do you know of any resources for assistance? Support groups on the net?
-- LH
No doubt this is a very difficult time for you and your husband, but your courage in asking questions, and talking about and sharing your experiences will help.
Pancreatic cancer has a well-earned and nasty reputation for spreading rapidly and not responding well to treatment. As you suspect, spread to the liver, to other areas of the abdomen, and elsewhere in the body such as the lungs, is common. The result may be significant pain, jaundice (a yellowing of the skin due to liver problems), and weight loss. Depression is often seen with cancer, and may require a great deal of emotional support. One of the most difficult aspects of caring for someone with cancer is the loss of appetite. It's more than simply not being hungry; there seems to be a strong aversion to all food, and sometimes eating induces nausea. It is a simple, natural, human instinct to want to feed someone who is ill. Even in the face of impending death, it would be a relief to see a loved one eat a favorite dish.
Cancer may be a cause of fever, although it is always important to rule out other causes (usually infections, but sometimes other things such as drugs). Edema (or swelling) by itself would not be considered a sign of pancreatic cancer, but may signal other problems involving the circulation, the kidneys or the heart.
Faced with all this uncertainty, what is one to do? For one thing, I think it is important to realize that even for someone who has decided they are ready to die, there are many ways of making that process less difficult, not only for themselves, but for family and friends, too. There are choices. A compassionate doctor will provide his or her services for free; or may help you to obtain some type of insurance coverage to help with the cost of tests or medications. Home nursing services, or Hospice services can be invaluable for monitoring problems and complications, with practical advice for personal body care, pain control, and emotional and spiritual support. A priest or rabbi may be of comfort; and most communities have support groups for people who have cancer, or who are family members of someone who has cancer.
Online, you may find the Cancer Patient Emotional Support Group or OncoChat helpful; on Usenet, try alt.support.cancer. All of these offer an opportunity to share your experiences and concerns, and to provide emotional support to others.
-- R. Jandl, 9/22/96, Category: stress & mental health

I have been on many antidepressants and I take the pill for birth control. I am now on Serzone and have COMPLETELY lost ALL desire for sex. Help! Is it the serzone or me? I can't find any info on serzone since it is a new medicine.
Serzone (the generic name is nefazodone) is a new medication for the treatment of depression. Chemically, it has effects on the brain that are different from previously used antidepressants, which just means it is not quite in the same category as more familiar drugs such as Prozac or imipramine.
It turns out that the incidence of sexual problems appear to be less with Serzone than with other antidepressant medications. However, the drug has not been out for very long, and widespread use of a medication in the real world commonly leads to a clearer understanding of it's effectiveness, and the frequency and types of side-effects.
Of course, losing all interest in sex could also be a part of being depressed. Or, there may be other issues that could affect your interest, such as negative feelings about yourself, problems with a relationship, etc. Or, there could be other medications you are on causing these side-effects; and even some underlying hormonal problems to consider.
Nonetheless, if you have generally been someone who has been interested in sex, and your feelings now are very different since you started the Serzone, then the drug would seem to be suspect.
This is not a recommendation to change your treatment, of course. That's a discussion for you and your provider.
-- R. Jandl, 2/10/96, Category: Stress/Mental Health

I feel tired all the time, I have been checked for Mono, but don't have it. My hormones were adjusted the first of the year after coming off of Depo Provera. I am a college senior working part-time. I have felt this way for five months. I am on no medication. I am a 26 year old female. How can I know if I am depressed? It is just getting worse and is now affecting my grades. Please help. Thank you.
-- M.E.
You have asked a very common and very important question -- "why do I feel so tired all the time?" Well, there are many factors to think about. First of all, when someone young and otherwise healthy complains of fatigue, it is often related to lifestyle factors and stress (e.g., too much work, not enough sleep, not enough money, unhappy job/school, lousy social life, etc.). There are, of course, other possibilities. You mentioned depression, and that is certainly one of them. Significant fatigue, a loss of appetite, difficulty sleeping, a loss of interest or motivation in everyday life, a feeling of being very down or blue, and spontaneous crying spells, can all be signs of depression. If that sounds familiar, you should consider making an appointment with a mental health counselor or doctor for consultation.
Other possible causes of fatigue include medical problems such as hypothyroidism, a problem with drugs or alcohol, chronic fatigue syndrome, some viral infections, and others.
Most of us today are living very fast paced and busy lives. We see everyone else doing it too, so perhaps we don't feel it's such a big deal. But I know of very few people who do not complain of being either over-worked, or too stressed. It seems we live in a society that values us more for what we do than for who we are, and that is a powerful incentive that drives us to do more, work harder, and fill up our days with busyness.
If lifestyle and stress do turn out to be the problem, allow yourself to get the rest it needs (for example, you may need more sleep than you think). Try to work in some quiet time, or time doing activities you enjoy, and ask yourself if your lifestyle, or life situation, is extracting more energy from you than it is worth. Maybe the trade-offs are worth it, or maybe they're not. But the time spent in reflection can only help make that a more conscious and happier choice.
-- R. Jandl, 12/15/95, Category: mental health

What are the side effects of ECT ?
Electroconvulsive therapy (ECT), although it seems primitive, is actually an extremely effective and generally safe procedure for the treatment for a number of psychiatric syndromes including severe depression, mania, and some refractory psychotic states. The procedure involves the induction of a seizure via electrical stimulation of the brain.
The procedure is performed in a medically controlled environment while the patient is under anesthesia. In fact, ECT may be the safest form of treatment for certain patient populations, such as the medically compromised elderly. Like all medical procedures, ECT has some potential side effects and the significance of those varies from individual to individual. Cognitive change is the principal side effect of ECT and the one that causes the most concern for those receiving treatment. The cognitive change may include temporary confusion or memory impairment. The memory impairment may be either anterograde or retrograde. Anterograde memory impairment consists of the rapid forgetting of or difficulty in recalling newly learned facts. This form of memory impairment usually dissipates shortly following ECT and rarely persists for more than ten days. Retrograde memory impairment involves difficulty recalling events that occurred in the weeks prior to ECT. This may be more persistent and sometimes permanent. These cognitive changes seem to be dependent on a number of factors including electrode placement, the level of stimulus needed to induce seizures, the person's cognitive functioning prior to ECT, and the duration of confusion the person experiences after seizure has been induced. Since anesthetics are used in the procedure, the patient can develop side effects from those as well.
Like any other major medical procedure, it is imperative the patient asks their doctor for details about the procedure, the kind of anesthetic to be used, and the anticipated duration of treatment.
-- Howard Blue, M.D. 11/16/95; Category: Mental Health

I've got a friend who is having panic attacks (situationally bound, five per week) that don't seem to be mangling her overall functioning, but look to be a serious physical health risk as they invariable end in vomiting. She's lost about 30 lbs. over the last two months, but is built to stand it, and I can't get her to see a practitioner of any kind. What can I do from here?
Based upon the information provided in your question, it is difficult to determine exactly what condition your friend suffers from. Although "panic disorder" is a discrete entity, it may also occur in the context of other conditions. If she is truly experiencing panic attacks and rapidly losing weight, I would, indeed, advise her to be examined by an internist or general practitioner as soon as possible.
Sometimes, medical problems present with psychiatric/psychological symptoms. Also, anxiety symptoms, including those of panic, may occur in the context of other disorders such as depression and bulimia. Your friend needs a thorough medical assessment and further psychodiagnostic evaluation before one can know what treatment approach will be most effective.
Seeking help is a voluntary action. I would continue, as you are doing, to advise your friend to seek treatment. Unfortunately, there is little else you can do beyond giving advice and showing concern. If she begins to exhibit irrational , self-destructive, or threatening behavior, in most states, you can enlist the help of police services to get her to an emergency room for safe-keeping and diagnostic evaluation.
-- Howard Blue, M.D., 11/15/95; Category: Mental Health

What are the major side effects of Prozac?
Prozac belongs to a group of antidepressant drugs known as the SSRI's (selective seratonin reuptake inhibitors). Relative newcomers to the antidepressant pharmacopoeia, these agents have about the same effectiveness as previously available antidepressants but with significantly fewer and less troublesome side effects.
Although usually well tolerated, the most frequent side-effects include excess stimulation leading to symptoms such as insomnia, restlessness, anxiety, or tremor (this is bad for some people, but may counteract symptoms of depression in others). Weight loss is fairly common (but not more than a few pounds), as is decreased sexual desire or difficulty reaching orgasm. Other symptoms such as nausea or diarrhea are possible, and there are a host of other less common side-effects. Early on there were reports of increased suicidality, but more careful research showed this was not true. Except for very rare reactions, most side-effects are fully reversible upon discontinuation of the drug. However, due to the long length of time that Prozac stays in your system, it may take a few weeks or longer until these effects fully resolve. It is not a good idea to just stop the drug once you have been on it for awhile, due to the potential for sudden recurrence of your original symptoms.
-- C. Ebelke, 10/11/95

My roomate suddenly woke up the other night having a really hard time breathing and really scared me. Once she calmed down everything was fine again. She told me that she has a history of panic attacks. What are they? Is there anything I should do?
A panic attack is just that. Among its many possible symptoms, there is usually a sudden feeling of shortness of breath, palpitations, claustrophobia, chest tightness, numbness and tingling of the hands, toes, and mouth, and a profound sense of impending doom (like you feel you're suddenly going to die -- really; or that you are going crazy).
They can be very frightening. People often worry that they are having a heart attack, that they cannot get enough air, or some other serious problem. In fact, some of these other problems may have to be ruled out, although the history alone usually reveals the diagnosis. However, even untreated, they always pass on their own, and will not cause serious problems such as sudden death.
Most often people who experience panic attacks do so because of an inordinate amount of stress or worry. They also may run in families, although the reasons are not clear. And they are very common among young adults. Interestingly, panic attacks usually occur during quiet times such as watching TV, reading, or falling asleep.
For infrequent or mild attacks, just the reassurance of knowing it is nothing serious or life-threatening, and that you are not losing your mind, can bring an end to them. There are, however, relaxation and stress management therapies, psychotherapy, and medications, all of which can help.
If your roomate has never been evaluated by a health professional, she should do so. If they are truly panic attacks, and she has another one, just try to reassure her that everything will be all right, turn some lights on, and try to help her to relax. If she is hyperventilating, she can also be shown how to breate into a paper bag to keep from getting dizzy.
-- R. Jandl

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