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Question
Posted by: Ob commer | 2010-06-17

Black patch.

Hi CS
I have had 3 cases of severe (suicidal) major depression - now in remission. I have been advised to stay on my antidepressants indefinitely. Unfortunately I have just been through a major trauma and have been diagnosed with PTSD. On the whole I feel absolutely fine but occasionally when I do not have much to do and the house goes quiet my mind gangs up on me. My psychologist is on holiday for a month (world cup escape!) and although I have been managing just fine, this afternoon I had a major wobble. I was feeling very tearful and anxious and the blackness just seems to swamp in - get very agitated and hypervigilant and often tend to " ob com"  (get very busy) in order to cope. My psychiatrist once referred to this as dysphoria. I managed to call someone so that I would not be alone. Are these sad (and anxious) black patches normal? PS I have not been diagnosed with any personality disorder (I specifically asked) and am apparently highly intelligent (if this means anything in the bigger picture). Your advice would be much appreciated.

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Our expert says:
Expert ImageCyberShrink

I'm wondering about the timing of events and diagnoses here. One does not diagnose PTSD right after any major trauma - because many of its symptoms are normal though uncomfortable immediately after a trauma, and fortunately in many cases the symptoms fade within the first weeks afterwards. The symptoms need to have been present for more than a moneth to qualify for this diagnosis.
A specified set of the typical symptoms arising and troublesome in the first month can be diagnosed as Acute Stress Disorder, andagain, fortunately this may resolve itself without needing elaborate treatment. The disturbance lasts at least 2 days, and up to 4 weeks.
So don' despair at some of the early weeks wobbles, which don't necessarily mean that worse problems are coming.
What you are calling "ob com" are common and often useful coping mechanisms - limiting your time spent alone, and especially alone and unoccupied, is wise. As my work some years back showed, along with that eventually of ohers, antidepressants can be very useful here, and we know this of the SSRI group - I'm not sure that some of the more recent SNRI and others have yet been shown to be as useful - but your psychiatrist should be able to advise you on that, and will have taken this into account in reviewing your chronic treatment with them for the depression

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Our users say:
Posted by: cybershrink | 2010-06-18

I'm wondering about the timing of events and diagnoses here. One does not diagnose PTSD right after any major trauma - because many of its symptoms are normal though uncomfortable immediately after a trauma, and fortunately in many cases the symptoms fade within the first weeks afterwards. The symptoms need to have been present for more than a moneth to qualify for this diagnosis.
A specified set of the typical symptoms arising and troublesome in the first month can be diagnosed as Acute Stress Disorder, andagain, fortunately this may resolve itself without needing elaborate treatment. The disturbance lasts at least 2 days, and up to 4 weeks.
So don' despair at some of the early weeks wobbles, which don't necessarily mean that worse problems are coming.
What you are calling "ob com" are common and often useful coping mechanisms - limiting your time spent alone, and especially alone and unoccupied, is wise. As my work some years back showed, along with that eventually of ohers, antidepressants can be very useful here, and we know this of the SSRI group - I'm not sure that some of the more recent SNRI and others have yet been shown to be as useful - but your psychiatrist should be able to advise you on that, and will have taken this into account in reviewing your chronic treatment with them for the depression

Reply to cybershrink
Posted by: DEPRO | 2010-06-17

From my experience (suffer from depression and am on permanent medication) PTSD made me afraid &  i went back onto AD''s. What you feel is normal for PTSD. I had a great psych, you have too much adrenaline and everything in your body. Exercise helps a lot (gets rid of the xs hormones that make you feel like that) also any relaxation techniques. Cant you find another therapist for now? Very nb in the early stages of PTSD to see someone!

Reply to DEPRO

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