General Psychiatry Q & A Page

Graydon G. Goss, MD



Suzanne, a 46-year-old writes:

"I have a 31 year old brother who has been diagnosed with severe depression and anxiety. He is on medication for both. On three occasions he has taken to much medication and was taken to the hospital and was Baker Acted. This last time scared him and he agreed to go into a treatment facility.

Prior to this he started experimenting with drugs at about age 16, I think only pot. He was also addicted to cocaine but got off on his own about a year ago, then he started taking xanax and became addicted to this also. He got off the xanax then was started using over the counter medication (unisom, nyquil).

He said he only takes the pills so he does not feel depressed anxious, even though he is on medication for this.

The treatment facility he is going to go into treats drug abuse. He said he does not need treatment for this, but for the depression. I would think the depression goes along with the drug abuse. I also think with his history of drug abuse, is the cause of his depression. I just want to make sure we are on the right track for the best treatment for him.

Thanks for any help you can give us, we are desperate.


Dr. Goss responds:

Your brother needs to get off everything. With supervision. Now! A physician with experience in substance abuse and psychopharmacological treatment of anxiety and depressive disorders should oversee.

If he remains severely depressed after doing so he’ll need treatment for that – which will entail non-addictive prescription antidepressants, therapy or (better) both.

Anything he self-prescribes over the counter will make any pre-existing problem worse. Anti-anxiety drugs make depression (and rebound anxiety ) worse and quick fixes mood elevators (like cocaine or speed ) make anxiety AND depression worse.

Your brother has a drug problem and should avoid self-treatment like the plague. He may have other problems, too. His self-treatment is probably seriously counterproductive to whatever he's being prescribed.

You are right - drug abuse can create depression and anxiety. It can also complicate psychiatric disorders that have arisen by other means. I won’t even try to diagnose the symptoms until obvious exacerbating behavior – like self-medication, stops first.

You sound like a great sister. Keep me posted!


Larry R, 39, of Redlands, CA writes:

Dear Dr. Goss,

I've been in therapy for about eight months with a psychologist. My problem is anxiety, especially in social situations. I don't feel like I'm making a lot of progress. I still get really nervous at parties and on dates with the result that I get tongue tied and really awkward. My therapist has spent most of our time together discussing my childhood, schooling, and I think we've traced the beginning of my problem to insecurity I felt when I first began school. Should this have helped by now?


Dr. Goss responds:

Dear Larry,

Discovering the "root" of a problem is often the dramatic solution to a problem in psychological thrillers, but in real life it seldom has much of an impact.

In your case, I doubt the revelation has any significance whatsoever. Do you really care when the problem started?

What is important is the mechanism that keeps your social phobia going. By mechanism, I mean the system of thoughts or actions which lead to a self-fulfilling prophesy. For example:

If your objective in going to a party is to impress other people, make them like you, or create some kind of impression, you have set out to have an effect on them. Your goal is fundamentally flawed because its success in contingent on factors beyond your control. If Ms. X at the party has just gotten her divorce papers in the mail, she may not be in the mood to like you at that moment. If your objective is to act "cool" when you're actually feeling terrified, your goal is dishonest.

Attempting goals that may be impossible or dishonest makes you feel uncomfortable. You therefore act nervously and people react to that. The experience is bad and makes you dread the next social event. The vicious cycle is set up and repeatedly reinforced. The problem gets entrenched and worsens with time.

Discovering when the problem started is irrelevant. What is important is determining the repetitive pattern and changing it.

For example, set up a new goal. Go to your next party with the goals of being honest about how you feel with as many people as possible. This goal has nothing to do with manipulating others and is totally honest and under your control. Walk up to strangers and say, for example, " Hi, I'm Larry. I don't think we've met. I don't know many people here very well so I guess I'm feeling a little uncomfortable. What's your name?"

See what happens. Nice people will appreciate your honesty and maybe even help you feel more comfortable. If they don't, try someone else, especially someone who also looks a little out of place.

In general, the hardest part of therapy isn't making diagnoses, it's making changes. Many therapists hesitate to make suggestions for change, (it's easier to keep rehashing the past). Ask for some creative ideas. If you don't get any, try another therapist.


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Copyright 1997 Graydon G. Goss, MD
Last revised: March 28, 2015.