Yousuf Raza – PsychBaithak QnA Session 3
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Yes, in the name of Allah and peace
be upon the Messenger of Allah and upon
his companions.
Peace be upon you.
How are you Azam?
Peace be upon you too.
Do you guys see me?
Give me signs of life people that you're
here and that you can hear me.
Okay, so today we're going to be addressing
some of the questions that have been coming
in.
Our apologies for not being able to have
our session last week.
Okay, there you go.
Azam is back.
Azam, welcome back.
Peace be upon you.
Peace be upon you too.
Where did you go?
I don't know.
Okay, you're back.
I'm lost.
You are lost?
Maybe you need a session.
Yes.
Okay, so where do we stand?
Do you have any questions to answer today?
Yes, Dr. Yousuf, we have a Q&A
today.
So, we'll be discussing that.
Okay, so let's start.
Let me ask you the first question.
Is there any connection between vitamin D deficiency
and depression?
Can you tell us about the systemic causes
of depression?
I was thinking that when a professor asks
a student a question like this in the
end.
Yes, vitamin D deficiency can mimic depression.
Just like many other metabolic causes.
I'm using mimic.
It can mimic and cause.
So, there is a controversy there.
But yes, vitamin D deficiency can cause that.
It should be dealt with as soon as
possible.
Apart from depression, it can cause a lot
of other things also.
So, vitamin D deficiency.
Now, it's winter in Pakistan.
So, we're sitting in the sun.
So, that helps.
Other than vitamin D, the second part of
the question is systemic causes.
So, there are a lot of systemic causes.
There can be neurological causes.
There can be metabolic causes.
There can be anemia.
Anemia can also mimic depression.
So, there are a lot more.
So, hypothyroidism is one very important.
There can be dementia in old age.
There can be any long-standing infection.
There are a lot of medicines.
So, it is a very broad question.
There can be a lot of things.
I don't think everything is different.
But yes, there are many metabolic causes.
There can be depression due to systemic causes.
There you go.
So, there are a lot of biological causes.
There are systemic causes.
In which depression and other symptoms like depression
can occur.
Also, if someone is experiencing depressive symptoms due
to psychological, psychosocial, existential, or spiritual reasons.
So, that can lead towards a lifestyle.
In which we superimpose biological depression on it.
For example, due to depression, nutritional, loss of
appetite, inadequate intake.
If that lasts for long enough, vitamin D
deficiency, anemia.
All of that will also come along as
well.
And then there is also a lot of
diabetes, hypertension.
They also have a long-standing impact or
influence.
You will have depressive symptomatology implicated.
Okay.
Exactly.
And just like in existential, spiritual, or psychological
issues.
If we give biological treatment.
It may be beneficial.
But it may cause more harm.
Or it may not work as well.
Same goes for the biological causes of depression.
If you think that it is due to
hypothyroidism.
And if you treat the relationships that you
have.
The amount of thyroxine will be fulfilled.
Then it won't be like that.
If we put a hypothyroid on a chair
and start.
Sir, please tell us about your childhood.
Something must have happened in your childhood.
That was going to be messed up.
On the part of the psychiatrist or the
psychologist.
If that is the direction to take it.
Also, there is also.
In every speciality.
There are some.
Diagnostic categories.
Which have a lot of overlap.
With stress and lifestyle.
So for example, we have PCOS in gynecology.
We have IBS in gastroenterology.
And then there will be.
There are neurological conditions as well.
In which the treatment.
Includes stress management.
But typically, the practitioners.
Medical specialists, gastroenterologists.
Would not be adequately.
Emphasizing as to how important.
The treatment of stresses.
Or the management of stresses in those conditions.
Yusuf, I just saw a patient.
Today.
He went to a neurologist.
And the neurologist.
Wrote on his prescription.
Stress positive, stress positive.
And he was given a vitamin D.
And also an estrogram.
So now the medical practitioners.
The neurologists.
They have a very common practice.
Whatever the problem is.
Along with that.
You prescribe an antidepressant.
Because they say.
If there is no harm in it.
Then it is beneficial.
So let it go.
And this is actually.
A pretty good prescription.
If they have given only vitamin D.
And isotelopram.
Compared to what actually goes on there.
Some add benzodiazepines.
Some even give antipsychotics.
Some give a combination of tricyclic.
And SSRI.
And.
They are not even going to tell.
The person that they are interacting with.
What is this medicine for.
How many patients do we have.
And they don't even know.
That this medicine.
This is for tension.
This is for depression.
This is for sleep.
They don't know.
As far as they are concerned.
They have physical symptoms.
All of these.
These medicines have been given.
For those physical symptoms.
And Allah Allah.
If there is anything else.
Nobody has ever told them.
Nobody has ever told them.
Apparently the gastroenterologist.
Or the medical specialist.
They think antidepressants.
Will cure depression.
Just like antipyretics.
Will cure fever.
So that's unfortunate.
So what about hair fall.
Yusuf.
Yusuf.
Our psychiatrists.
Have a lot of hands in this.
Because neurologist sees.
That if this patient.
Goes to the psychiatrist.
He doesn't have to do anything else.
Exactly.
If I send him there.
He will pay my fees.
I will shift the patient.
I will take him myself.
Because the psychiatrist.
Doesn't have to do anything else.
When he sees this.
So.
Of course.
It is more legitimate.
It is more legitimate.
To give this.
Because the patient has come to him.
And if he will refer him somewhere else.
He will also go and pay the fees.
It will cost more money.
And the result is the same.
That he has to get antidepressants.
Nobody has to talk to him.
He will have to face a lot of
stigma.
That he is coming from the psychiatrist's office.
So that's the problem.
Exactly.
So as psychiatrists.
We are responsible for the ignorance of our
colleagues.
In other specialties.
Okay.
Can hair fall also be due to depression?
It can.
You are teasing him.
Okay.
Don't tease him.
So.
It is a common myth.
That due to stress.
The vision becomes weak.
Due to stress.
The hair starts falling.
The hair turns white.
Due to cold.
The hair turns white.
So.
But.
We don't have any evidence.
That.
Due to depression or stress.
The hair falls.
There are a lot of medicines.
That cause alopecia.
But.
Depression in itself.
It doesn't cause it.
This thing.
Can be thought of.
Because self-care.
Decreases.
His appetite.
So as a consequence.
All these things.
Can be thought of.
But depression in itself.
If all this is fine.
Then there is no evidence.
Okay.
Hubab is saying.
That your discussion is very technical.
Avoid jargon.
And try to explain.
And Rabia is asking.
If they can ask questions.
By all means.
Please do ask questions.
And once we are done.
With the questions that we shared.
We will turn to your questions.
So when you say.
That Rabia is asking.
Take the full name.
Rabia is asking.
Okay.
Okay.
Okay.
Ask the next question.
Is breathlessness.
Related to anxiety imaginary.
Or can people actually.
Stop breathing and die.
I didn't understand.
The first part of the question.
But the second part.
The second part.
The answer to that.
Is that.
We cannot die.
By stopping our own breath.
This cannot happen.
So even.
I remember.
On National Geographic.
The science of stupid.
In that program.
They also showed this thing.
I will hold my breath.
It doesn't stop.
So.
I think the first part of the question.
Was concerned.
I think the phrasing.
Would have been a little better.
When we say that.
Breathlessness is imaginary.
On one side.
And on the other side.
Is it so real that it can cause
death.
That is assuming.
It's one or the other.
Which is inside anxiety.
Especially if.
A panic attack situation.
Is being created.
In that.
The difficulty of breathing.
That is real.
That is not imaginary.
That is really.
A difficulty of breathing.
That the person.
Who is experiencing it.
Is suffering from.
That will not lead to.
Suffocation and death.
As such.
That.
Can't go to that level.
But it is definitely a difficulty of breathing.
There is nothing wrong with that.
That is not being faked.
That is not imaginary.
That is not being.
What to say.
They are not putting on a drama.
They are really experiencing it.
It is a real symptom of anxiety.
Anxiety.
There are a lot of physical symptoms.
Heart rate.
Increases.
Shortness of breath.
Sweating.
Cold clammy skin.
Gastrointestinal.
Symptoms.
Symptoms of asthma.
Symptoms are real.
Sympathetic.
Nervous system.
Nervous system.
Fight or flight.
Emergency.
Urgent situations.
That has become.
Active in anxiety.
All of those.
Symptoms are a consequence of that.
They are not fake.
They are real.
But yes.
They do not lead to death.
Or.
A person cannot kill themselves that way.
Next question.
If one feels anxiety.
About certain things.
Which do turn out to be true.
And a cause of worry.
Should that person.
Use medicines.
To suppress their anxiety.
First of all.
The medicine they took.
Laxotinil.
Or any other.
Benzodiazepine.
Which we call.
Anxiolytics.
This is never.
Long term.
Advisable.
Even if it is advised.
They are only for.
Short term management.
Also for.
Emergency management.
But even in emergency management.
The oral medicines.
Will not.
Calm down.
Within seconds.
It takes some time.
At least a few minutes.
The first part of the question.
I forgot.
If that does.
Turn out to be true.
That is a reality.
The anxiety is based.
In the real.
Cause for concern or worry.
Then should that be treated.
With medications.
Or for example.
So.
Generally.
Psychiatrist.
Cause.
Cause.
Severity.
Overall.
Anxiety.
Symptoms.
Symptoms are so.
Spear.
Daily life activities.
Really.
So yes.
Medicines can be.
They can.
Symptoms.
Avoid.
But even then.
Even in moderate.
Intensity.
Anxiety moderate.
Job interview.
Psychotherapy.
The job interview.
Job interview.
Job interview.
So it.
Varies from.
Okay situation.
Or a psychiatrist.
The more important thing.
to look is, what is the severity, then
what is the cause and even if we
once in a particular situation, its severity, even
the way it is hampering, its performance, we
give it medication to control it, it should
come with the adequate information that this should
not become a habit, that if you have
a series of job interviews in a month
or two months and then before every single
one of them, you are going to start
taking a benzodiazepine or any kind of anxiety
medication, then its addictive potential, becoming addicted to
it, its possibility is real and that has
to be taken into consideration and its best
to manage this, not by your own consultation,
with someone's advice, okay, as much as I
believe you just mentioned, you just responded to
Kashaf Saleem's question with respect to benzodiazepines, emergency,
for those of you who are listening, benzodiazepines,
which are usually sleeping pills, Alp, Alprazolam, Xanax,
etc., that's their benzodiazepines, they are being asked
about them, that emergency Ghaliban, she's a doctor,
can they be given to treat a panic
attack in an emergency, and if they can
be given, then which one?
So, they can definitely be given, and I
won't tell you which one is on-air.
Okay, so Kashaf, you can message Azam to
find out, already our questioners, whether people know
the name of any other benzodiazepines, and if
you were to really say that in all
the classes of psychiatry, the most misused, abused,
which class is it, then that's benzodiazepines, as
Azam said earlier, they should only be used
with prescription, and even on prescription for a
short term only, we should not make a
habit of prescribing or taking them so frequently.
Alright, that's fine.
Do people with drug-related psychosis ever recover
completely?
How to address those who have little to
no insight?
So, the first question is, among psychosis, one
of, the psychosis which probably has the best
recovery rate, which has the highest chances of
recovery, is drug-induced psychosis, because as soon
as the drug is washed out of your
system, and its long-term effects are over,
the person starts to recover, and even the
short-acting drugs, which cause psychosis, like heroin,
cannabis, or the hallucinogens, even without any treatment,
as soon as the drug is washed out
of the system, they improve.
So, we are not talking about addiction here,
we are just talking about the psychotic symptoms.
For those of you who are not aware,
what is psychotic symptom?
What is psychotic symptom?
It means that people lose contact with reality,
and they are making either very tall, unbelievable,
unrealistic claims about themselves, about others, or hearing
voices, etc.
These are the symptoms we call psychosis.
And the second part of the question was,
how to engage with someone who has psychosis?
For those who have little to no insight,
how do we deal with them?
So, if there is no insight, and we
are only talking about psychotic patients, if there
is no insight, and generally, it is not
only psychotic patients, the chances are very low
that they engage with you in any meaningful
discussion.
Because if there is no insight, it signifies
that the odd beliefs or delusions are very
well organized.
So, there are more chances that if a
patient has no insight, he will respond to
the medicine better, and only then will his
odd beliefs be able to be shaken, and
his aggression, his paranoia will be reduced.
Because we are only talking about psychosis.
So, only then they will be able to
engage in any meaningful discussion.
Right, Yusuf?
Or is there anything else?
I think that's pretty much most of what
they are probably asking.
And one more thing that I think is
important in this is that, if there is
no insight, how do we give them the
medicine?
So, in consultation with a psychiatrist that you
have elaborately discussed the particular case with, ideally,
the psychiatrist should have seen the patient as
well.
It is important to see them once.
Without seeing them, there can be problems in
recommending the medicine.
So, I mean, some way or the other,
the psychiatrist needs to have had a conversation.
A lot of people who don't have insight,
who don't consider themselves sick.
What does it mean to have no insight?
That they don't think that they are unwell,
or they have anything wrong with them.
And they are making tall claims, and they
are creating a lot of chaos.
Then people from Behlab Hosla bring them.
They tell them something else and bring them.
And that gives the psychiatrist a chance to...
Usually, people say, I have to get my
checkup done, come with me.
When they come there, then the psychiatrist gets
a chance to speak to them.
Somebody that they respect, despite all of psychosis,
some basic morals or values or respect elements
still remain intact.
There are some people who cannot be denied.
So, people can be called upon to bring
them.
And then, once that has happened, then if
you listen to them and take the medicine,
that's ideal.
Otherwise, there are other ways of giving medication.
What those ways are, how do they work?
It is best that you speak to the
psychiatrist according to that particular situation.
How can it be done?
Should it be done?
Do you have to mix the medicine in
the food?
How is that going to work?
How is that going to be used?
That's going to be discussed in a one
-to-one session.
Okay?
Let's go.
Kashif is saying, regarding the specific benzodiazepine, I
won't tell you live, that there was a
recent situation in which the patient was deteriorating
and I gave a benzodiazepine IV.
And I wanted to confirm and know, doc,
in such situation.
Okay.
Let's go.
Kashif, again, it's probably a good idea, if
you're going to have to manage a lot
of ER cases, that you will understand how
to do it in one go.
So, Kashif, if you gave IV benzodiazepine, in
Pakistan, if you are in Pakistan, there are
only two benzodiazepines that are available, Dormicum and
Dizepam.
So, if you gave Dormicum, its half-life
is only a few minutes.
So, it won't affect the anxiety.
If you gave Dizepam, its half-life is
about 50-70 hours.
So, if you gave it for a very
long time, maybe, in an emergency case, I
don't want to tell you what to give,
because only you are not listening.
So, it shouldn't happen that after that, they
themselves start doing it.
So, I would not tell that, Kashif.
Going on for a longer period of time,
and that would require a diagnosis.
And obviously, we are not here to talk
about, or take a class of emergency psychiatry.
You can do that sometime.
So, Kashif, next time, when this happens, write
a call to psychiatry.
And whoever is PGRE or consulted, you can
ask them.
Okay, I don't think, Kashif, wherever you work,
this facility is not available.
Okay, next question.
At what point should you give up on
your therapist and move to another one or
quit therapy altogether?
How does one realize that the therapy is
not working for you?
Very good question.
So, I will answer this in two ways.
From patient's perspective, or from counselor's perspective.
So, from patient's perspective, if you feel that
you are...
So, first of all, you need to understand
what therapy is.
It's not like you go one day, and
they tell you a few things, and you
follow them the next day, and you start
getting better.
We see patients who get better after one
or two sessions, and we see patients who
get better after a lot of sessions.
So, I don't think I can give you
a satisfactory answer to this.
Because if I talk in a non-technical
way, a lot of times, the therapist is
not compatible with your problem, or not competent
enough to deal with your problem.
But a lot of times, it happens that
the patient has his own guard.
He doesn't open up so quickly.
He doesn't listen to the therapist.
So, it's possible that that's why there's a
delay in treatment.
So, from a patient's perspective, if you are
doing everything that the therapist is asking, and
still there's no improvement, so maybe it's time
to move on.
But even then, from a therapist's perspective, even
then, I will give him this margin that
this might be the case that the patient
does everything that the therapist asks him to
do.
But the patient is not opening up.
He has his own stressors, his own issues,
where the real problem is.
So, I've seen someone who has openly told
me that I'm telling you all this, but
there are some issues that I can't tell
you.
So, if someone can't tell me those issues,
it might be the case that those are
the real issues.
And there are more chances that those are
the real issues.
So, in such cases, you can go to
the therapist and do whatever you want.
So, it is not going to work.
Fair.
So, that's on the perspective that you've done
what the therapist has asked you to do.
There's a lot of times that you develop
this tension.
As two human beings in a professional interaction,
a gap is created.
And as a part of a normal therapeutic
process, gaps do get created, but they should
become a part of the conversation.
They should become a part of the discussion
and tell us why it's happening, where it's
coming from, what is being done about it.
If your therapist is hesitant to talk about
that gap, that tension, the possibility of alternatives,
that would be a red flag.
That would be a red flag.
If you find them to be guarded, not
only patients are guarded, therapists can also be
guarded, that because of the failure of a
therapeutic process, insecurities are developing.
And they're not openly discussing, okay, why is
it?
There can be the client-related reasons for
why the process is not moving forward, therapist
-related reasons as to why the process is
not moving forward, or the problem, the illness,
or the issues.
They're of this nature that wherever you take
them, they're not going to move forward or
they're not going to be easily resolved.
So, there can be problems at all three
places.
I would recommend that that conversation be, that
conversation should take place.
If you have started harboring this thought that
I am not able to move forward from
here, I should consider something else, you should
have that conversation with the person that you
are, whoever is your therapist.
And see how they respond.
See how they respond.
And there's a lot of people that I've,
I've had sessions with, that Azam, I'm sure
you've had sessions with, and it doesn't always
work, right?
We don't connect.
We don't, we're not able to give the
help that they need.
Sometimes they require a kind of specialist training
or help, or specific issues that we're not
trained in, that we're not, we don't have
the requisite skill for or the training for.
So, you know, ideally, you know, I think
it's a good idea.
We've, we've hit a plateau.
There's, it's not moving forward.
Let's discuss other options with you.
Let's discuss what it is that we should
be doing differently.
And it's part of the process.
Yusuf, you talked about a red flag.
A red flag, which I would definitely like
to advise.
If a therapist, like, and if a psychiatrist
is, both of them, if they are interested
in prescribing, then listening to you, then you
should move on.
So if they are not interested in listening,
that's a red flag.
Okay.
So there's also the question here.
Why not quit therapy altogether?
I get therapist.
Is the problem, something that is amenable to
therapy?
I don't know what you say to that.
Yes.
A very obvious answer, which any psychiatrist will
give you, that frank psychosis, schizophrenia, and drug
-induced psychosis, and other diseases, engaging them in
therapy, from the therapist's point of view, is
a very big negligence, to keep them away
from medicine.
As far as the therapist is concerned, why
not quit therapy altogether?
Yes.
There is a possibility, that there are some
issues, in which the therapy, can cause more
damage to the problem.
I can think of certain issues, where a
particular type of therapy, can be harmful to
a particular problem.
Like, we know that, the obsessive-compulsive disorder,
for that, the introspective-oriented psychotherapies, the analysis,
makes it worse.
So, it happens.
But, therapy altogether, I cannot think of any
examples.
I think it's a good idea, it's a
good idea to understand, if a particular therapeutic
process, did not work, changing therapists, definitely recommend
it.
Provided that, red flags, openness to alternatives, how
that conversation is taken.
Other than that, you might want to consider,
maybe a different school of thought.
Maybe a therapeutic school, the modus operandi, or
the way the therapist operates.
Therapist-therapist, also varies, therapeutic school, depending on
the training, the orientation, the process.
I mean, we have a lot of options.
You might want to consider, if there's another
option.
And even then, if you are convinced, okay,
therapy is not for me, I've tried one,
two, three, different schools, all of that, you
should still have something else, that you're going
to go for.
If not this, then what?
Right?
Do you want to, I mean, do you
want to say that my problem has, no
solution whatsoever?
That possibility may be there as well.
But, there must be some management, in some
speciality, in some way.
You would want that, you get an opinion
there, someone tells you from that.
If you're leaving this, and going towards something
else, what is that something else?
And have people with similar problems to yours,
responded to that something else, should be, questions
that you ask yourself.
Okay.
Let's go.
But, I don't think that we gave a
satisfactory answer.
Why should you?
we can come back to this, in our
next session.
In our next session.
I'm still thinking, that there is an example,
where, therapy in, in itself, can be harmful.
And that's why someone should leave therapy?
I don't think that's what they asked though.
What they asked was, when it's not working.
Harmful, the idea is that it's not, giving
the results, that should be sought.
Okay, we'll, we'll reconsider this, if anyone has
anything, to offer us on this, by all
means, please do.
And we can always come back to this.
Okay.
Signs or changes, for parents to look out
for, in their kids, to determine, if they
are being abused, or not.
So, for this, one thing is that, which
we did, a few weeks ago, we did
a full episode, with Dr. Ayesha Minhas.
You watch that episode, in that, Dr. Ayesha
Minhas, discussed this in great detail, and she
has a lot of experience, with such cases.
Briefly, if we talk briefly, so, if you
see your child, one, some very visible, psychological
changes, you see in that, that he starts
to be quiet, or he starts to be
irritable, he becomes distant, he starts to be
quiet.
So these, but, but,
but, but,
but, but,
but, but, but, but, but, but, but, but,
but, but, but, but, but, but, but, but,
but, But what will be important is, to
know, normal sexual development.
A lot of times, parents would underestimate how
much this age should know and normal sexual
curiosity increases with age so they should be
very clearly aware that corresponding to the age
of the child some sexual activities are normal
and they need to be perceived as such
and those parents should not think like when
they were this age what did they know
parents should think like what do kids know
these days because the world has changed a
lot so I think that's it okay so
thank you for that question we move right
along how many questions are left why can't
psychologists rebrand themselves as happy doctors they have
they certainly change our misguided world views and
bring ease in our lives so I think
this misguided view should change that therapists or
counsellors make us happy no they are not
supposed to make you happy they are only
supposed to better understand and in some way
alleviate your suffering or to use that suffering
or that anxiety in some productive ways they
are not supposed to but to make you
happy because this notion I think there can
be a time when we won't have any
tension and its inverse will only be happiness
so we Pakistanis we all know that peace
is only in the grave so we have
been told I mean that's something as a
myth and it is a myth and the
psychological problems that arise because of running after
it and I think Shiba Ansari is right
on the mark because they are not drug
dealers that to cause happiness or to discover
happiness we are going to them that's perhaps
one of the reasons that they are looking
to become more and more legitimate drug dealers
let me give you stuff that will make
you happy it is going to be short
lived or frustration of not being able to
achieve this utopian happiness the depression that will
create problems that is going to compound the
situation then you are going to be depressed
about being depressed the original reason for depression
is in its place then that's compounded it
is made worse by depression about depression so
this is messed up it doesn't mean that
there should be happiness yes happiness is a
part of your life but this notion that
there can be something that we are always
eating this is not possible this is not
possible at least before your death and regular
audience they have started to read your mind
because they are not drug dealers so yeah
that's saying something we are getting some conceptions
across so this in itself is a misguided
world view of course we all are looking
for happiness but when it becomes an ultimate
aim when it becomes a final goal that's
probably one of the red flags if you
are looking for therapy if your therapist is
promising you that kind of happiness then you
know that's something that I read something that
all the great pieces of literature that throughout
the world or even the scriptures they do
not idealize happiness they idealize satisfaction they idealize
a kind of inner peace they idealize a
kind of living for something they do not
this idealization of happiness 40-50 years 4
-5 decades exactly I think that's perhaps even
a misconstrual of Freud they took Freud to
a place where he did not go in
terms of placing that pleasure on the kind
of pedestal and then that wild goose chase
of trying to create that scenario and yes
there is no other possibility except stimulating your
brain directly with drugs and creating that state
so it is the past few decades if
you look at the past few decades the
movies and literature even now that people are
really really goggling over huge fans of the
themes struggle, suffering, tragedy heroism those are the
main themes that people are still inspired by,
they are still attracted by, they still find
some sort of an aesthetic appeal in that
says something that
says something success success success
economic success success success success success success success
success success
success success success success it is always like
this if you
say so so I think aside from happiness
becoming that you know that ideal which it's
a marketing pitch right, success and I think
we owe the life coaching industry for this
for raising this you know trying to show
everyone that everyone can be Bill Gates everyone
can be Steve Jobs and everyone as many
people as they are helping there is a
huge population that is now being subjected to
an inferiority complex on being a bigger chunk
of the population is being subjected to that,
what about them so it's real cause for
concern personality theories popularize motivation psychological ideals
we need to take a step back and
analyze where are we coming from possibilities consequences
are we really taking them into consideration ideals
ideals mental health are we willing to take
that into consideration what's happening we are seeing
6th, 7th class kids failing exams committing suicide
these are the consequences of this pursuit of
success if I'm a failure he was a
college dropout even then even then you can
be Steve Jobs okay Azam I think we've
exhausted our there is one more question specific
question I think we did answer some of
this before I went to a psychiatrist in
Pindu who gave me these medications for a
diagnosis of extreme depression Clomipramine 75mg Bromazepam 3mg
I've taken them over a year, I've become
addicted if I stop I get shivers from
anxiety and fear palpitations, I'm also pregnant what
do I do generally I would say extreme
depression is not a diagnosis if you are
saying this then okay, but if the psychiatrist
has written it himself then I'm doubting that
he's a psychiatrist and I'm saying this very
cautiously because there are famous psychiatrists in Islamabad
I know all of them so you don't
know this is coming from Islamabad this can
be coming from Lahore as well don't try
to bracket us Islamabad psychiatrists but apart from
that, generally speaking Benzodiazepine which you are taking
because of pregnancy as soon as possible you
should stop taking it Clomipramine which you are
taking there is no direct evidence that it
can be harmful so we have to wait
to stop taking it what are the risks
it can be stopped or we can continue
it and stop it after pregnancy because if
there is depression then child birth can cause
a recurrence so it is complicated from a
good psychiatrist who knows extreme depression you should
meet him and the case is complicated you
do need to see somebody who would ideally
try to manage you who can be tapered
off what will be the alternate how will
the depressive symptoms be treated how to taper
off so that the chance of symptoms this
class of medication should not have been given
for such a long time why did it
continue for a year when one of the
two medications should have been given but why
was it extended all the way to a
year if pregnancy was planned then why was
there no consultation done why was the medication
not altered at that time there is a
lot that has happened that does usually happen
but it shouldn't happen so the best we
can do is to let people know that
this is messed up and we need to
do our practice properly and please tell us
in the comments where are you getting clomipramine
from because I really want to know that
because it is short in the market and
it is a very good medicine it is
not for those who have depression I am
not asking about tell us where to get
it Azam wants to know where to get
it you can get it here thank you
so much for your questions one question that
was asked that I think we should take
before we end how reliable and lasting are
NLP interventions for treating anxiety or depression Azam
so I don't know about it I know
that in Pakistan if you want to do
fraud and if you want to charge people
excessively and your psychology and psychiatry does not
have good formal training and you have to
take a shortcut to becoming you know somebody
who can treat people through this then NLP
and hypnosis these are two certifications that you
will get online whose evidence base is very
weak very weak but here such people are
marketed that there is no better treatment than
this I do know that the people who
are trained in NLP and hypnosis know how
much psychology and therapy they know that is
later they know how to sell themselves and
they know how to market themselves you know
in ways that we can't even dream of
so be very cautious there may be some
benefit and efficacy in these interventions but for
now for now whatever we have in front
of us it doesn't paint a very good
picture of what these treatments represent or what
they have done or who the people that's
just unfortunate the way these things are being
done okay so I hope that answer feel
like tagging the master trainer there's a lot
of master trainers and they'll be coming on
radio and television and ironically they would even
have psychiatrists on their panels oh my god
so it is what it is it is
what it is good to go most of
the questions have been responded to to the
best of what we could manage thank you
for your questions people and with that I
think we are ready to sign off okay
challenging