Virginia NPP

Funny about that, I did the same thing. I said I would let myself smoke at 65 (this was when I was 35) well I am now 63 but doubt I will start again at 65. (To tell you the truth I am sure I would be addicted again with one cigarette ) I think this idea is worth a try.

It just amazes me that this continues to be a question or concern. It must have something to do with stigma. Is it because of this false idea that depression is a character flaw or weakness that one can get over if they are strong enough or try hard enough??? REAL (clinical) depression does NOT work this way! Will someone PLEASE help me understand what the concern is here???? I will say again: ANTIDEPRESSANTS (NOT Benzo's or alot of other drugs people mistakenly think are antidepressants) do not effect skills except to make them BETTER in depressed persons. They help with concentration, decision making, motivation etc etc etc. Sadly, many people do not take them due to this attitude / stigma especially medical people.(see the previous video on doctors and depression). They end up hurting themselves and not helping others. I sincerely hope that a care provider with depression is medicated when taking care of me.

Sounds like you did a great job, and I agree with the take care of yourself advice. These questions of course have no answers, and the parent is just speaking his agony out loud. Silence or a touch is a good response, or just a simple "This is a terrible tragedy, I'm so sorry". Sometimes parents need to see their children after they have died and should be offered the opportunity, even if it is extremely difficult. Virginia

My 2 Cents. Propranolol will slow your heart rate down regardless of the cause. It blocks the effects of epinephrine. It has been used for stage fright and by public speakers for many years. What happens is if you are anxious, your heart rate goes up and then you become even more anxious in response. It becomes a vicious cycle. The propanolol seems to break the cycle by slowing the heart rate. This research is so very early, it really can't tell us much at this point. It needs to contiue, and hopefully will because of all the soldiers returning from wars who are suffering. I personally agree PTSD is over diagnosed for the same reason I mentioned in an earlier post. Clinicians make the diagnosis based on there own ideas, and do not use the specific criteria in DSM. PTSD is a very real problem, over-diagnosing it just makes it less reliable, and leads to questioning of its' validity. This is what seems to be happening with Bipolar disorder also. PTSD is really a syndrome, so medication is prescribed for the particular symptoms that a client has. There is no medication for PTSD per se.

The research shows it takes four attempts before someone actually quits smoking! So if you don't make it, don't think of it as a failure, but rather as a step in the process! (Really ) Virginia

Hi All, Lots of my clients are doing well on Chantix in terms of quitting smoking. The way it is said to work is by both stimulating and blocking specific nicotinic receptors in the brain; it is thought that the stimulation of these receptors mimics the effects of nicotine and reduces cravings. A number of reports have indicated that Chantix induces suicidal feelings and aggressive and erratic behaviour. I haven't seen any of that, but lots of people feel irritable. Its hard to know if this is from the chantix or withdrawal from nicotine. Insomnia can be a problem with Chantix. Remember no drug is without side effects, nicotine however is a real killer. If you do use the Chantix don't ignore the support they offer along with it, it can help. Virginia

Superfly is correct MAOIs are RARELY used today. Tricyclic antidepressants are not used often either (lots of side effects and VERY lethal in overdose. I think we are again mixing up Clinical Depression (most often genetic, "chemical imbalance") with "run of the mill depression" which is really mood changes due to circumstances, grief, sadness loss, anger (other things) and is mainly psychologically/ emotionally based. This type of "depression" usually responds to time and counselling. (Now personality disorder is another entire subject that often is misdiagnosed as depression, especially by non-psych professionals) Virginia NPP

Melatonin seems to work well for many people. The long acting or time release is the better choice for a full nights sleep. Can someone please tell me how you can tell the date and time of posts, I just can't get it. :oops:

Wow lots of big words here (I had to look up anaclitic had not heard it in years For others not in the know it refers to emotional dependence) and Orthomolecular (Ortho Molecular Science, which prevents and treats disease by optimizing the body's natural substances)! Any way as you very well know we don't have the answers to many questions about depression. Actually the latest theory (and much of medicine is theory, not just psych) is that clinical depression is a combination of chemical imbalance ( most often caused by genetics, heredity) and a stressor which sets it off somehow. I never quite get why some people need to protest so hard about a physical basis for depression, do you think is something to do with a need to feel in control issue?? Virginia

Hi, Glad you found it helpful. For all, I try to answer Psych questions, I can't keep up on posts on the site so feel free to PM me if there is a question you think I may be able to help with. Virginia

Hi BVESBC, All the things you suggest will help with many problems. However Clinical Depression is hereditary ( think like a physical illness) and truly a chemical imbalance (I hate that phrase its so over used). It will not really respond to these lifestyle changes. I know I did psychotherapy for years with some of these patients, so frustrating for me and them. Another comment, when someone is truly having a major clinical depression they literally cannot do these things, they cannot force them selves to make changes or "pull themselves up by their bootstraps". It is not a matter of weakness of character or lack of trying. It is a DISEASE with a biochemical cause (may be worsened by many factors) But there are true brain changes in persons with depression. Major depression can and does result in psychosis (really !!!) and suicide. It is a horrible disease, worse then many physical illnesses. Again the real problem is misdiagnoses and overuse of SSRIs. They do not work with sadness, personality disorder (another whole story) anger, and lots of other things they are prescribed for. One of the reasons I think it is difficult for so many to accepting clinical depression as a disease is that we all like to believe we can use our mind to control our mood, other wise we feel out of control ! Oh Well, sorry but this can be true. Ok enough already, hope I have convinced some. Virginia Virginia Duffy PhD Psychiatric NP PM me for details on my website...changed by AK

Hello All, I have been in the mental health field for 30 years. I have been exclusively prescribing meds for the last 15 as a psych NP. Can I put my two cents in in relation to many previous comments? "Benzos" are benzodiazpines such as Ativan (lorazepam), Xanax (alprazalom), Klonopin (Clonozepam) Valium ( diazepam ) THESE ARE NOT ANTIDEPRESSANTS. These DO have significant effects on your ability to respond and should not be used by anyone in a position of decision making, heavy machinery or even driving. These are addictive and are routinely screened for in "Tox" screens. In my opinion they are way overused. Persons with clinical depression (serious depression with physical symptoms) are much more at risk for making poor decisions, irritability and generally poorer functioning then those with a well treated depression. Depression is NOT, the blues, grief, "tough times" or burnout!! Antidepressants will NOT help these life problems; persons with clinical depression have more difficulty with these stressors and sometimes these situations will reveal the underlying depression. The side effects of the SSRIs are minimal (sexual dysfunction can be a problem). They do not make you "spaced out" like the benzos can. The TCA have more side effects and are used pretty sparingly these days. These are helpful in LOW doses (much less then antidepressant dose) for neuropathy, headaches and some other pains. These drugs are not found in general "tox screens" . A specific test must be done for them. I can't tell you how many years I did Psychotherapy trying to help patients with a true clinical depression. It was supportive but didn't help in most cases for more then a brief time. When they were put on an antidepressant they were like new people in 4 weeks. I am not exaggerating here! The problem is that antidepressants (like so many other drugs) are overused on the wrong patients. They seem to be given to everyone with a complaint of "stress". On the other hand significant clinical depression is often MISSED ( these are often not the people going to the PCP complaining of depression) and these people are suffering. Medication will make them better at their job of being a paramedic, ems, nurse, doctor,etc. It is important that we all try to understand the difference between clinical depression and other syndromes. Don't let anybody kid you, sometimes this is not easy, ever for experienced people. The problem is that everybody thinks they can do it. Feel free to comment or ask questions. Best and thanks for all your good work. ( I had a heart attack last year the the EMS were terrific) Virginia

I think you are referring to Sigmund Freud's theory of reaction formation . This is when anxiety-producing or unacceptable emotions are replaced by their direct opposites. Actually, bad jokes" and "sick humor" are very good examples of this. They also are effective in relieving tension. This type of coping only becomes a problem when it is used most/all of the time. Flexible coping skills are the key to managing stress. Hope you don't mind the plug, but I just wrote something in my blog about coping mechanisms that might be of interest. Check it out. http://www.behavioralfirstaid.com/wordp Virginia

FFMedic 1911, I know it is hard to really see the good you are doing when you spend so much time on illogical rules and paperwork, politics and incompetence. I get pretty tired of this sometime to. Then I have a great experience with a client whom I am able to help and who is so thankful. Those are the times you need to try to focus on. I also have become very good at filling out form with the BS they want. I also sometimes battle the system (pick your battles) and occasionally actually win. Stand up for what you believe. Put the drink down, (ice cream works for Me) Virginia

There is lots of research supporting women as being more empathic then men. Of course you can challange the research (as some do) and we all know women who have very little empathy. Yes , I agree guilt is a common feeling in rescuers who have poor outcomes, however it is not the only response. Sometimes its the most obvious, and the easiest to admit to (because it is a universal feeling). However there are often more personal issues that get triggered by certain experiences. The healing takes place in recognition of how/why the incident effected you personally. (Sorry if this sounds like psychobabble) Stay well and practice self-empathy ( also took me years to learn) Virginia

"Surprisingly enough, women make great paramedics, great nurses, great doctors. We're inherently more empathetic than men. Unfortunately, that's often our career downfall" (I still haven't figured out the quote thing) This is not really suprising. It is the reason we need to take good care of ourselves and emotions so we can continue to do such a great job. What an honest and gutsey post! Take care of you. (by the way it took me years to figure out how to do this) Virginia

Ok gentlemen lets get that testosterone under control!!! How many of you actually have seen a baby that has been killed by his mother? Ashley I presume you are a female coming to the age of considering motherhood, its no wonder this is bothering you. Again I hope you will get some psychotherapy before even thinking of changing careers. Virginia

Hi, I am a little late on this post but wanted to know how you are doing. Chantrix does have the best success rate, side effects to watch for are insomnia and depression. Just to let you know the research shows that most people make 4 serious attempts to quit before actually stopping. It part of the process. So know you will eventually succeed. Remember you are never home free, don't let yourself have just one any time. I am off cigarettes almost 25 years, still dream occasionally that I am smoking and some times think I would sell my soul for a marboro. My chronic SOB makes me hesitate thought. :evil: Maybe when I hit 70 y/oI will start again. Virginia

Hello EMTb Ashley, That is a horrible experience for a young person. It shakes your view of the world. I agree some professional help is a good idea. Occasional dreams are to be expected but 3 times a month is too often at 3 years later. Do you have any other symptoms (flashbacks, startle, irritability etc that might indicate PTSD or depression?) I do not think that visiting the grave at this late date will help you much. I hope you will consider talking to a mental health professional, there may be more going on. In general, aggressive treatment the earlier the better is what really helps with dealing with trauma and preventing long term effects. You can PM me if you want to talk some more, Good luck, Virginia

Hello All, I cannot speak to the legal aspects of this at all!! However, I have a few thoughts about how to talk with the family. I agree that giving information at the start and during the resuscitation attempt is helpful, instead of saying nothing till the end. Starting off will something like. "It is very serious, his heart is not beating, but we will do the absolute best we can" is a way to gently prepare the family. In the middle of it you might reiterate with something like, " We have not had any success but are still trying" When you call it, simply stopping and looking sincerely at the family and saying something like " I am very sorry, we did the best we could" is probably the best thing to say. Then be quiet and stand or sit with the family if you can. You can answer any questions that you feel able to. Hope this helps. Virginia

Hi Asysil2 leads. Well I guess we disagree. I have been in this field for almost 30 years and have worked with more therapists and psychiatrists that can be counted. I have also been involved with training of residents in psychiatry. Psychiatrist training in the art of talk therapy has historically been very scanty. (unless you were in a special program or pursued psychoanlytic training, which you don't have to be a psychiatrist to do). I also know there are psychiatrist who are good at therapy, but I believe this is the exception rather then the rule. In terms of standards I have seen many people who graduated from the same program with the same credentials who are worlds apart in their ablility to do psychotherapy. As I said, much of it depends on the individual. Any one else want to weigh in on this issue? Virginia

Hi, In terms of a mental health therapist my advice is to look at all disciplines, Nurses (Masters in Psych with certification), Psychologist (PhD Licensed), Social Workers (masters in clinical social work with Certification). Counselors, Family and Marriage Counselors, Grief Counselors and pastoral counselors can also be good choices. In my opinion, the thing that is most important is the individual not the discipline. This is of course not easy to figure out. Don't be afraid to ask people who have seen the person for opinions. You should realize Psychiatrists may not be the best choice. There are very few Psychiatrists who do talk therapy, they are (some exceptions of course) very medically oriented and are good to see if you need medications. They and Psychiatric NP are the only ones in the Mental Health field who can prescribe medications. This is confusing for many people as we have so many people who do "counseling". Make sure whoever you are considering is Licensed in the state (if license is available for that discipline) and certified by their own discipline. It is an important decision, check it out before you commit. Remember if you see someone and it doesn't feel right, look elsewhere. Trust your guts.

Hi CBEMT, First of all, I am sure you are not a horrible human being. I am not sure why you are shocked by this advice but let me say more. I think it was my reference to "child" that you responded to. Spending time with children you love (your own, friends, relatives) can be a way that helps you see a more innocent , less complicated way of being. The fact that the incident involved a dead baby is not a reason to avoid children (or babies). It is in fact perhaps a reason you shouldn't. (you know like getting back up on the horse that threw you). You certainly "will see them everywhere" after this incident anyway, and better to see and be with them in a loving situation where you can do something for them. I hope this helps, if not say more, and I will respond. Best. Virginia

jouleman I am so sorry you went through that, it sounds horrible. I agree with Dustdevil that CISD has been found to be useless and maybe worse. Talking to some one who understands is so much better. If you can find a good professional a few sessions would do wonders. Sometimes talking to peers is enough. I would have recommended that you turned off ACE and talked and cried together, I think that would have helped more. What you are feeling is understandable after such a horrific event. It is not an indication of burn out. If you are burnt out you usually become more jaded with few emotions except anger, frustration, and annoyance. I would give you your 5 points ( what ever that means) that Dustdevil took away back for honesty and bravery in your post. Do something special with someone you love, perhaps a child. And make sure you are not doing EMS work on your days off. Best, Virginia

Hi All, I think the last 2 posts are great and right on. This string is really a great place for people to express those difficult emotions. Sometimes being "thick skinned" is easier (in the short run) because it helps avoid the pain. In the long run however it can cause a lot of distress in all aspects of life., and it can cause burnout.