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Dark Fantasies

Question:

A number of times a day I find myself fantasizing about being in a car accident or having a serious illness. Let me be clear…. I don’t want to die. However, for some reason I feel the need to be injured or hurt. I am currently taking meds. for OCD/ depression and don’t generally feel sad or depressed. I do get extremely restless and bored on weekends or vacation but not really depressed. I have a therapist who I’ve seen a couple of times. He is a nice enough person but I don’t think he can help me. I don’t know if a change in meds would help me either. SHould I be worried about these fantasies? Or is it okay to just ignore them. Tina

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Answer:

Indeed, these are dark fantasies and they should concern you in that they represent two things: 1). You do have depressing thoughts and feelings and 2). There is an obsessive quality to these thoughts. The boredom and restlessness on the weekends mean that you have too much leisure time to ruminate or engage in depressive thoughts about accidents and such unhappy thoughts. You report that you are not really depressed but I doubt that. You may not feel as depressed as you did before you started anti depressant medications but that does not mean that there is an absence of depression. In addition, I suspect that on the weekends, with too much free time, you begin to feel anxious. You need to structure your time, see people and get involved in social and athletic types of activities.

With regard to medication it is possible that you need an increase in your dosage or that you need to begin a new medication. After several years on one anti depressant it is common for it to lose its effectiveness. You need to discuss this with your psychiatrist.

Medication alone is not the answer to resolving depression. You report that you have seen your therapist a couple of times and he is nice. A therapist is not there to be "nice" but to help you recognize the stimuli that cause you to start to feel depression. That way you can start to learn new ways of coping with or avoiding those stimuli. This is one of the reasons I prefer cognitive-behavioral therapy. However, therapy and medication work well together and you need to be speaking with a therapist with whom you can develop a therapeutic relationship so that you can overcome these problems. Developing a therapeutic relationship means you should be seeing someone at least once per week, if not more. There is no magic pill so that even if you do change medications it will still be important for you to get into a serious and deep type of psychotherapy.

Best of Luck

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