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Mind Health for All Ages: Aug 14

Publish date: 29/08/2014

Lily asked:

I feel like I have been quite clumsy over the past year or so (roughly since starting taking Quetiapine) and have fallen over quite a few times.  Could this be related to the Quetiapine I have been taking for Biposlar Disorder?

Dr Mark Winwood answered:

Hi Lily

It is quite common to feel slightly light-headed when standing and you might also feel a little bit dizzy.  This drug can also cause you to feel fatigued.

Falling-over is not a common side-effect - I would recommend visiting your prescribing doctor to discuss this.

All the best

Anonymous374 asked:

I believe my partner is suffering from a form of depression. His behaviour has changed over recent weeks, becoming very secretive. I have recently discovered it has been drinking and hiding this from me and visiting chat rooms. He believes everyone is judging him, he has no self worth etc, despite being very popular with a lot of good friends. He will not get any professional help or visit our GP. I have contacted the GP to explain the situation with which has been noted on his records should he attend the surgery. What practical things can i do to support him through this time?

Dr Mark Winwood answered:

It can be very difficult trying to support someone who is experiencing depression.  However a few things that might help are:

  1. Be there. - It sounds like you are doing this already - but do not underestimate how important it is for you to listen and just be present.
  2. Try a small gesture.  Cook your partners favorite meal, send voice mails and texts and keep him involved with what is going on for you.  Depression can make people feel isolated - this might help.
  3. Don’t judge or criticize. What you say can have a powerful impact on your loved one. Try and avoid saying statements such as: “You just need to see things as half full, not half empty” These words imply that your partner has a choice and it may make him feel like he is failing.  They’re not only insensitive but can isolate your loved one even more.
  4. Avoid the tough-love approach.  Some people  think that being tough on their loved one will undo their depression or inspire positive behavioral changes - this approach is often unhelpful.
  5. Don’t minimise or trivialise their depression.
  6. Avoid offering advice. It  seems natural to share advice with your loved one. Whenever someone we care about is having a tough time, we yearn to fix their heartache.  A better approach is collaborative - such as 'what can we do to sort this out'
  7. Be patient - it can take a while, even in treatment for depression to lift.
  8. REALLY IMPORTANT - Look after yourself - make sure you have someone you can talk to

All the best

Anonymous377 asked:

Is there any support for employees wanting to try CBT to cure such things as anxiety or confidence issues?

Dr Mark Winwood answered:

Dear 377

If you have access to an EAP or Employee Assistance Programme this would be an excellent starting point for you to discuss any issues you have relating to anxiety or confidence.  CBT may be an excellent approach for you but there may be others that are more suitable and by discussing your concerns with a trained therapist this can be explored.

You GP may also have access to CBT therapists via the IAPT (Improving Access to Psychological Therapies) service that has been adopted by the NHS.

If you want to access CBT in a self-help environment I would recommend the web-site 'Living Life to the Full' which offers an on-line CBT programme that you might find useful.

I hope this is helpful

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AXA PPP healthcare asked:

We've had a message on Facebook from someone who wants to remain anonymous:

My teenage daughter has become incredibly distant in the last 6 months and I'm getting worried about how much time she is spending on her own in her room. She has friends but very rarely goes out to see them.

The other day I knocked on her door when I walked in she was sitting in the dark by herself. I asked her what she was doing and she wouldn't tell me and shouted at me to leave her alone.

I remember what my life was like when I was 15 and I didn't want to talk to my parents either! But I'm really concerned.

How do I get her to talk about it?

Dr Mark Winwood answered:

Hello 

Getting teenagers to talk openly about what's bothering them can be hard.  A few tips might be:

  1. Ask, don't judge.  Assume they have a reason for not wanting to talk show your daughter that you respect her intelligence, and are curious about the choice she has made. If you don’t pre-judge her behaviour , she is more likely to open up. 
  2. Ask, don’t assume or accuse. Don’t assume that you know what’s wrong. Try asking  "I’ve been worried about you. You don’t seem your usual self, and I wondered what's going on with you at the moment? Is there anything I can help with?". 
  3. Be clear you want to help - make sure she knows you are there to help through any difficulties regardless of what they are.
  4. Help her think for herself.  Help them think for themselves
    Teenagers hate being lectured or bombarded with solutions. Instead of trying to be the expert on their lives, try to help them think for themselves so that they can make good decisions.
  5. Don’t criticise everything. If she only ever hears nagging from you she will  stop listening. 
  6. If they get angry, try not to react. Teenagers often hit out at the people they most love and trust, not because they hate you, but because they feel confused. Don’t think that she means the bad things they she says ("I hate you!"). She may just feel confused, angry, upset, lost or hormonal, and she doesn't know how to express it. 
  7. Make her  feel safe
    Teenagers often worry that telling an adult will just make things worse. You need to be clear that you want to help her and won’t do anything she doesnt  want you to. This may be particularly important id she is being bullied.
  8. Avoid asking questions she won’t answer. Try and ask open questions - you get far more information and it will allow her to open up.

All the best

AXA PPP healthcare commented:

Thanks Mark, we'll pass this back to them on Facebook now!

AXA PPP healthcare asked:

We've had a twitter question:

What is the most effective drug for depression?

Dr Mark Winwood answered:

There are many different types of anti-depressant medication available - the effectiveness will depend on many factors including the type and severity of your symptoms, any other medication you are currently taking, any co-existing conditions, past medical history..... the list goes on I'm afraid!

A really good overview of types of medication that can be helpful to treat depression can be found by visiting this http://www.nhs.uk/conditions/Antidepressant-drugs/Pages/Introduction.aspx">Anti-depressant drugs site.

Please remember that medication is only one of the available treatments for depression - talking therapies such as CBT and counselling have great results.

I hope you have found this helpful

Anonymous215 asked:

My partner gets very stressed at work, but often brings that stress home with him and I find it very difficult to get him to de-stress and relax. He struggles to acknowledge that he's still stressed, but are there things I can do to help him wind down?

Dr Mark Winwood answered:

Hello 215

It can be hard to help someone who is feeling stressed.  Many of the suggestions I have already highlight in my answer to  374 could also apply here.

  1. Be there to listen - don't judge or assume.  Ask how he is doing and let him tell you when he feels able. Make sure he knows you are there for support.
  2. Do some exercise  - when he gets home from walk go for a walk or a jog, cycle or swim - exercise is great stress buster and really good for your overall wellbeing.
  3. Prepare healthy food - what we eat can really effect how we feel psychologically - plenty of green veg and minimal processed carbohydrates.
  4. Create a calm environment - especially at night - that is conducive to sleep and relaxation.  Try and remove technology for the bedroom and  avoid computers and smartphones prior to going to bed. Stress can really affect our ability to sleep.
  5. Plan enjoyable activities - cinema, socializing and time for doing the things you both enjoy

Suggest your husband calls the EAP if available or visit the GP if his symptoms do not resolve

All the best

Anonymous215 commented:

Thanks Mark. He's self employed so I think he feels the strain of working alone & not having anyone to share his work-related stresses with. I'll try and implement some of your ideas to see if I can help.

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AXA PPP healthcare asked:

Another question from Facebook:

My dad has been very depressed since my mother left him a year ago. 

I want to support him as much as I can to help him through this really tough time but my mother is pulling me in the other direction.

I keep telling her that I love her as much as I do my dad but she gets really annoyed when I visit or talk about him.

I just want to help him and keep her happy too. How do I tell her to let me help them both?

Dr Mark Winwood answered:

Dear Facebook user

It sounds that you feel split between your parents trying to help them both.  Seems that you need to become the 'parent' in this situation if you feel your mother does not want you to help your dad.

Suggestion:

Tell your mother the effect her annoyance of you seeing your father  is having on you and suggest an alternative more helpful response from her.  It may be that she feels she is lossing you and asking for her for help it might make her feel less threatened.

Good luck

AXA PPP healthcare commented:

We've had a reply from the person who posted this on Facebook:

Thank you for answering. I think you're right, it's time to talk to her about how I feel about it. So far I've kept my thoughts to myself.

I'm just afraid she'll just fly off the handle at me. Is there a way I can talk to her to keep her calm when talking about it? They both came of the relationship really badly but she's been keeping her feelings bottled unless I bring my dad up, so I'm reluctant to mention him very often!

Thank you again for your help.

Dr Mark Winwood answered:

Again - you need to be the parent here and  if she does get angry explain to her how that makes you feel.  The aim is for her to appreciate that her anger is misplaced it is not YOU she is angry with it may well be that she is more angry with herself (as well as your father!).

AXA PPP healthcare asked:

One from Twitter:

I just lost my job & I'm finding it hard to get a new one. I'm really demotivated sitting at home and think I'm depressed. How do I move on?

Dr Mark Winwood answered:

Felling low after a life event such as losing your job can kill motivation, energy, interest, and focus.  It can also make you feel depressed.

If you feel you might be depressed - first of all try and get some help - speak to a friend, family member or go to your GP.

A few tips to help get you motivated are:

  1. Lower your expectations.
    When you’re depressed, you’re not functioning at your usual 70-90%. Rather, you’re sitting somewhere closer to 20%. If you set the same expectations for yourself that you had when you weren’t feeling depressed (which is sometimes just getting dressed), you’re going to feel anxious and overwhelmed, and probably won’t do the task you expected from yourself (and thus will feel defeated and ashamed).
    Set SMALL AND SPECIFIC GOALS. 
  2. Practice self-compassion.
    Self-criticism is common in depression. If you beat yourself up for being so “unproductive” and “lazy,” You’re going to keep yourself feeling terrible. Try instead to use the same encouraging words you might use for a friend or loved one. 
  3. Recruit support, or ask for help.
    Some of us have trouble holding ourselves accountable at the best of times. With little motivation or energy, it’s that much harder. Confide in someone you trust, and ask for their help. Ask a friend to hold you to your commitment. Ask your partner to accompany to an exercise class. 
  4. Envision how you'll feel after the task.
    Getting in the shower, going for a walk, preparing a meal, or hanging out with a friend seems like a very ominous task if you focus on the effort involved. People who are depressed generally have low self-efficacy, which means they have low confidence in their ability to perform tasks. As such, they tend to feel overwhelmed and avoid such tasks. Lower expectations for yourself within the task, and envision how you (might) feel after the task rather than during. 
  5. Make the goal to do it, not to enjoy it.
    When you’re feeling depressed, it’s natural to lose interest in things that used to make you happy. Comedy is no longer funny, sports are no longer fun, spending time with friends is no longer engaging. Anxiety, depression, and self-loathing take over, leading to feelings of detachment and defeat. So, when doing something “fun” or “active,” do it with the goal to do it, not to enjoy it. 

All the best

Kryten asked:

Hi Mark

I'm interested in how babies cope with separation from their parents (for example when going to Nursery for the first time). My 6 month old daughter is about to go to Nursery and I wondered if there was anything I should know about how babies process that kind of information and what to look out for.

Dr Mark Winwood answered:

Hi Kryten

Separation anxiety is a normal emotional stage of development that starts when babies begin to understand that things and people exist even when they're not present – something called "object permanence."

Babies can show signs of separation anxiety as early as 6 or 7 months, but the most common age for most babies peaks between 10 to 18 months.

The best way to transition a baby into a nursery setting is preparation:

1. Practice at home leaving baby with you in the next room where she can't see you

2. Get her familiar - visit the nursery as many times as you can before having to leave her so try a trial at first. Limit the first morning or afternoon out to no more than an hour. As you and your baby become more familiar with the childcare setting, you can extend your outings.

3. Always say goodbye. Kiss and hug your baby when you leave and tell her where you're going and when you'll be back, but don't prolong your goodbyes. And resist the urge to sneak out the back door. Your baby will only become more upset if she thinks you've disappeared into thin air.

4. Let your baby get to know a new caregiver first. If you need to leave your child with someone she doesn't know, give her a chance to get to know his caregiver while you're still around.

All the best

Kryten commented:

Nice one, thanks Mark, very helpful!

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