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Do Environmental Factors Hold A Person Back?

Question:

I have been struggling with depression/anxiety/personality traits/suicidal thoughts for almost a year I have been in counseling and now been prescribed paxil I am doing so much to try and get through this but nothing really makes me feel any better. My marriage has also been a strain with finances and work problems too. I feel like everything is to much and that I can’t fix any of it. I wonder if there is just to much stress around me maybe thats why I can’t get better. Do you think that these environmental factors would hold a person back so much that medication and therapy won’t work. How long should one stick with the therapy plan before stopping it if its not helping. I have a hard time with decisions rate now and trying to cope with all these daily stresses. Any advice please??

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  • Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
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Answer:

When you’re weighed down with depression, anxiety and stress, it can be hard to keep things in perspective, so what I’ll do here in trying to answer your question is to offer you some perspective. The first thing to keep in mind is that, as the Buddhists so aptly observed thousands of years ago, “life involves suffering”. I take this to mean that a certain amount of anxiety and depression is just normal in this life. What you personally are experiencing right now is probably more than the average person is experiencing, but there will never be a time in your life when you are free of the influence of anxiety and depression entirely. This observation is not meant to crush you; but rather to simply help you relax. You can’t fail at getting absolutely better if getting absolutely better is not a credible or possible goal (which it isn’t). So – what you want to shoot for is getting relatively better.

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p> People become susceptible to anxiety and depression disorders for two basic reasons. They may have a genetically-inherited susceptibility; a temperamental disposition to be emotionally unstable (personality psychologists call this trait “Neuroticism”). They also may become confronted with more stress then they can handle at a given time (too many demands or losses of loved things). If both things occur, then it’s a double whammy. So – yes, environmental factors such as difficulty in your marriage and work stress can certainly contribute to the development and maintainence of your depression and anxiety, but they’re not the whole story. Things like jobs and relationships are double-edged swords that cut both ways. They can add stress to your life, but without them you may be lonely and poor. My point here is that it we are not always better off without these things (sometimes we are, but not always); rather, we have to strike a balance with these sorts of things as best we can.

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p> The question about how long to stay with therapy is a great one. That depends on the nature of the therapy you are involved with. With regard to anti-depressant medications, you are supposed to see some result within about two months from the start of a prescription. You yourself may not notice the result, but family members or other people who see you from an outside perspective ought to by that amount of time. You should be more energetic and less fatigued, sleepy, etc., at the least. If this is not happening, you should talk to your doctor and have the prescription adjusted, either by upping the dosage, switching medications, or adding additional medications, depending on the doctor’s judgment. With regard to counseling, the time frame is more variable. Some forms of counseling offered are generic and don’t specifically try to target depressive symptoms. Such therapy is probably inappropriate to offer to a depressed person, but therapists who don’t know better offer it anyway. You might benefit from such therapy or you might not. If you don’t see results within a 3-4 months (for mild depression/anxiety) I’d say it isn’t necessarily going to be useful to you. The better forms of therapy for depression take the form of either “cognitive-behavioral”, or “interpersonal” therapy for depression. These are medium term (12-18 sessions duration) protocols specifically designed to help depressive people feel better. Again, you should see results in 3-4 months if things are going to work. These time-frames are for an otherwise healthy adult who becomes depressed or anxious; people who are dealing with substantial personality issues will take longer. Think of therapy like you might think of braces for your teeth. If your teeth are mostly straight – it won’t take long to straighten them further. However, if you start out with a complete snaggle-mouth, you’re going to need to see the doctor for a while (several years) before you get good results. Several years duration (an almost unheard of luxury these days) is the outside duration for a psychotherapy intended to correct a specific problem. Anything that goes on longer than that may be overkill.

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