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Query

I am a 21-year-old student who was diagnosed with depression and borderline personality disorder when I was 17. I was given medication to treat my depression. But last year, I quit my medication without consulting my psychiatrist. I feel like I am doing fine and I am mentally stable. I fear that my psychiatrist will get angry with me if I tell her that I quit my medication. But at the same time, I also need an expert to tell me that I am indeed fine. What should I do?—A confused patient 

Answer by Kapil Sharma, Counseling Psychologist, Hudec Nepal

The first thing you need to understand is that your psychiatrist is there to help you, not judge you. Your doctor will not be angry at you. She is there to guide you. There are many cases of patients quitting medication without any consultation. Chances are your psychiatrist may have had the experience of cases like this before. 

You should also understand that the fear of her getting angry is an imaginary scenario that you have created in your mind. Again, know that your doctor is there to help you.

Second, every doctor wants their patients to be happy and healthy. It is the same in your case. You being better is the main goal, for both you and your doctor. If quitting medication has made you feel better, then your psychiatrist will definitely address that. 

But sometimes while we think we are doing fine, something inside us might be going wrong. So it is necessary for you to visit a professional and get a legitimate diagnosis. It is the only way to determine whether you are actually doing fine. 

Feeling good and being healthy are two different things. Sometimes when we feel good about our mental health, we might still not be healthy. That’s why professional diagnosis is essential.

In case the diagnosis is positive, then that’s great. But if it turns out to be negative, there is no need to panic as well. Sometimes we slip off and we pull ourselves back again. The doctor will give you necessary suggestions, will resume the required medication if you need it, and with a bit of time, you will regain your mental health. No matter what happens, your psychiatrist will always be on your side, as both of you have the same goal—your mental wellbeing. 

Coming back to your fear of angering your doctor, if you are unable to move on from this fear, you can always consult a new psychiatrist. You might feel the new psychiatrist does not know your history. That is alright. In some cases, a patient’s mental health history is not necessary. Also, you can always share your history with your new doctor. 

I still suggest you visit your psychiatrist to gain more clarity on what to do next. If you cannot, you can always go to a new one. 

Query

I am a 22-year-old student who struggles to maintain a healthy relationship, be it with friends, dates or family members. Even the smallest thing they do or say affects me and I start crying. I know this behavior is linked to my terrible experiences in the past. It would be of great help if I knew how to manage my emotions and get over my past trauma. I don’t want to hurt the people around me. —N.G.  

Answer by Krishangi, Counselor at Happy Minds 

Your past is what shapes you. So bad past experiences make you build walls around yourself as a defense against getting hurt again. Your past experiences probably trigger you in your current life situations, making you bitter to other people as well. This causes confusion among those people who are in your life right now. 

First, you have to understand why and what about your past is affecting your present. Take some time out for yourself every night to journal your feelings, write down the situations that have hurt you and how they affected you in the past and in the present. Once you become aware of those issues, your emotions will be clearer to you.  

When you become aware of what has hurt you and shaped you in a negative manner, you can slowly start working on bringing your wall and defenses down. You being guarded might have been helpful at one point, but it doesn’t serve any purpose now. If anything, it is only affecting your loved ones.  

You can start by breaking your wall one brick at a time. It is essential not to feel pressured in this process. You should know that you won’t be fine overnight. You might feel a lot of emotions, good and bad, while taking this step. Also know that being emotional is not a weakness; you can always use it as strength to overcome hurdles. Letting go of the negative past experiences can be a very difficult start, but everyday is a new day. 

Something very simple like talking to a friend, family member or a counselor about your thoughts might also help you process your emotions and see things with a different perspective. Bottling up your feelings can suffocate you from within, causing you to make rash or irrational decisions, which could push away your loved ones. I suggest that you share your thoughts and feelings. It will make you feel lighter.

Query

Sometimes I get sudden anxious fits, and lately this has been getting worse. When I remember that I have work to do and have no time to waste, I panic and remain frozen for hours. What should I do? -P.R. 

Answered by Dr Rishav Koirala, Psychiatrist and Researcher

From what you have mentioned in your question, it sounds like you are having episodes of anxiety that escalate into panic attacks, which explains you not being able to move from one place for hours. But this alone does not give the entire picture of the problem. It is necessary to consider various factors that can contribute to these episodes. 

It is essential to ask, “What other symptoms do you have?”, “When do you get these episodes?”, “How often does this occur?”, “What are the triggering factors?”, “What is your coping mechanism?” etc. 

Figuring all of this out will require an evaluation of your mental state and of other factors that might have contributed to these issues. 

We can give you a proper diagnosis only after we figure out answers to these questions through a rigorous evaluation. It is always important to find out the root cause. 

Once we have the diagnosis, we can proceed towards possible solutions, be it in the form of medication or psychological therapy. In the end, I would like to assure you that there is a solution for whatever you are going through right now.

For the time being, I suggest that you avoid caffeine and alcohol, and maintain a strict sleep cycle as well as a healthy lifestyle. Taking these steps may help you to an extent.

Query

“Recently, I have been burnt out and I cannot accomplish anything without feeling immensely tired or irritated. Any suggestions on how I manage?” -A struggling student 

Answer by Dristy Moktan, Psychosocial counselor at Happy Minds

Burnout occurs when we run out of physical, mental, or emotional energy. We feel like doing nothing, lack motivation, get tired, and develop a negative attitude towards ourselves and others. In most cases, it is due to overwork—you didn’t get enough rest. It happens to most of us when we are so occupied with our daily tasks that we often overlook the signs our body is trying to convey. As a result, we keep pushing ourselves to achieve our goals rather than give ourselves much-needed rest. 

To combat burnout, it is most important to take breaks. You must pay attention to your body cues. You must recognize what is causing your stress, and be sensible enough to remove yourself from that situation. If you're not used to taking breaks, start small. For instance, getting up from your desk to get a cup of water could help. This may not sound like a big deal, but it is. You must also remember to check in with yourself from time to time. Self-reflection is useful in determining how one feels physically and mentally. It could be as simple as asking yourself, "How am I feeling right now?"

Another way is to practice mindfulness. The idea is to be as emotionally aware as possible. Deep breathing practices can help you manage burnout. Taking mindful breaths allows us to focus on the present moment. It takes little effort and can be done at any time—and it works wonders if practiced on a daily basis.

We often hesitate to say ‘no’ and therefore tend to accumulate things to do for ourselves. You must put things on a pause if you are experiencing burnout. If you're comfortable, communicate what you're dealing with. If you can’t, keep in mind that it all comes down to balance. You must balance your professional and personal demands while maintaining your health and well-being. 

Similarly, making adjustments to your routine, such as setting and keeping boundaries, doing things you enjoy, getting adequate sleep, eating nutritious meals, working out and focusing on priorities, might also help.

If you have been feeling this way for long you should consider getting professional help. It can be really good to have a safe space to talk to someone you don’t know, is neutral, and is trained to provide clinical feedback.