Needs Hope & Advice
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Q:  Needs Hope & Advice

Hello, I am 21, married and very happy but although i take Pamelour my anxiet/depression started acting up and this time I have major issues with death. Just the thought of it makes me freak. I am so scared that i am going to lose someone. I love my husband and my family so much it literally hurts inside. If I think about myself dieing I get tingely and I start to panic inside. I think about what will happen to me after i die, or how it would feel, i know you would be dead but we have amind now, why not then? I am so scared of this stuff and i need some input. I went through a phase where i worked out regularly and ate very healthy andi felt so good for all that time and then months after, then I was considering coming off of my medication and not before i knew it I was taking a higher dosage. Will working how really help me and give me a "mental high". I hope so, I just need to know if this is part of my anxiety/depression because I need some hope or explaination! . Please give me some advice, so I can  live the rest of my life happy and enjoying it, not scared of when it will end.

Thank You

Dear Amanda -- 
Sometimes this kind of fear responds very nicely to a kind of therapy called "CBT"; cognitive/behavioral therapy.  So that might be worth asking your doctor about (local therapists, i.e. not doctors but MSW or Ph.D. types who often are easier to get to see than doc's).  

Now obviously this is not a typical bipolar symptom, yet here you are on this website, so maybe you have a prior diagnosis of bipolar disorder or maybe you just have a hunch.  In any case, it's definitely worth discussing with your doctor whether there's any way the Pamelor might be causing a worsening of a bipolar disorder that is showing up with this obsessive thinking about death.  I've seen folks like you get a diagnosis of Obsessive-Compulsive Disorder, but you can read my little essay about why I'd be cautious with that diagnosis for this symptom (because it often means treatment with an antidepressant that could make bipolar disorder, if that's more like what you have, worse).

In either case -- treatment with psychotherapy, or further rigorous diagnostic evaluation and then treatment accordingly, your symptoms sound really rough and I think you're likely to see considerable benefit for those if you stay in treatment.  That's by way of saying that you should definitely not let this thinking start convincing you that death has some sort of special meaning or importance or necessary-ness for you.  

Will exercise help?  Probably, at least some, and in a few cases it might make a huge difference, but I would also make sure you're hooked up with a good therapist or psychiatrist during this phase.  

Dr. Phelps 

Published December, 2002


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