Mental Health In Thailand.

[baboon]

I have not been feeling myself for the past few days.I an a 35 year old man with no paticular problems. I keep bursting into tears for seemingly no reason at all. For example I heard the phrase "lion man" on telly today which started me off. It is also happening in publc too, which you will understand is most embarassing. Should I visit a doctor or psychiatrist or what? I am very confused. What should I do? Please do not flame me on this one.

Edited October 14, 2006 by baboon

[John K]

Talk your problems over with a close friend first. Perhaps the two of you can find the cause. Mental health in Thailand is very limited. I on average am seeing 3 to 4 times more people for that than I ever did in the states. The ratio of mental health providers to people is way off. As a result psychiatrists don’t have time to sit down with you but just give you medication so you can have a whole little vanilla world for yourself. Medication was meant for short term but it is being used for long term.

If you can’t find comfort in a friend then the next step would be to seek professional help. Often just talking about things can make whatever burden you have seem less and more manageable.

[baboon]

Thanks, John. I should add I have been treated for this in the UK before, but this time it is back with a vengeance. If I decided not to see a doctor , go back on my old medication, could I pick it up from a Pharmacy or would I need a prescription?

[John K]

I would go to a pharmacy and just ask, because I truly don’t know about medication for mental health if it requires a doctors script or not, because I never bothered to ask. I know sedatives you cant get but you can get tranquilizers. The people Thai psychiatrists send me are already medicated and need the extra kick hypnotherapy gives. I tend to get their worst cases, mostly people who are suicidal. If they are that bad that they need medication I usually work as a team with a Thai psychiatrist.

[libya 115]

Such a difficult problem to address on a forum such as this. For example do you drink (alcohol)? Are you taking any medications now, regularly? Are you diabetic? Are you obese?

These are not foolish questions: but low blood sugar can cause a massive effect on the brain.

Do you feel anxious all the time, or at specific times?

Anxiety and Depression must be diagnosed (and treated) by specialist doctors. If symptoms persist, go directly to a good hospital and seek advice and help.

Meanwhile, avoid alcohol and try to relax.

What was your previous medication in the U.K. benzodiazapine or anti-depressant?

If you stopped taking them, how long ago? These are things you must tell your doctor when you see him/her in Thailand.

[unforgiven]

I have not been feeling myself for the past few days.I an a 35 year old man with no paticular problems. I keep bursting into tears for seemingly no reason at all. For example I heard the phrase "lion man" on telly today which started me off. It is also happening in publc too, which you will understand is most embarassing. Should I visit a doctor or psychiatrist or what? I am very confused. What should I do? Please do not flame me on this one.

sounds like your having some accute anxiety..........go to the pharmacy get some zaniax and go for a thai massage followed by a good meal and a good sleep,,,,,,,,,,,,,,,,it 'll pass

[Ijustwannateach]

Thailand is really not the best country to fall apart in... I think it requires above average stability just to maintain your bearings here. No big surprise if you've had trouble in the past if it crops up again here.

Seem to recall a mate of mine back in my college days who had a problem that sounded similar to yours- would be stable and ok for months at a time, and then go on public crying jags. Something about repressed emotions, I think. He went to a number of counsellors before he found one that could work with him, and seemed to adjust himself pretty well after that.

Good luck, and please do seek some kind of qualified help- this really isn't a good place to lose it.

"Steven"

[womble]

I have not been feeling myself for the past few days.I an a 35 year old man with no paticular problems. I keep bursting into tears for seemingly no reason at all. For example I heard the phrase "lion man" on telly today which started me off. It is also happening in publc too, which you will understand is most embarassing. Should I visit a doctor or psychiatrist or what? I am very confused. What should I do? Please do not flame me on this one.

sounds like your having some accute anxiety..........go to the pharmacy get some zaniax and go for a thai massage followed by a good meal and a good sleep,,,,,,,,,,,,,,,,it 'll pass

I know you probobally meam well, but that is really crap advise. For starters self medicating with Zanax is a foolish thing to do if you have psychiatric problems.

Secondly it often takes a bit more than some food and a massage to sort things out. I'm sure he wouldn't be asking on here if it could be solved as simply as that.

[sobe]

go to the pharmacy get some zaniax

http://www.benzo.org.uk/

[Sheryl]

What was the medication you received for this problem in the past? How long were you on it, and when did you stop taking it relative to when this problem re-occurred?

Do you know what your diagnosis was when you had this problem before?

When you had this problem before, was there a thorough physical examination and neurological tests to rule out a physical cause?

Any history of pyschiatric problems in your family?

These answers will help me understand your problem a bit better.

it does sound like it may be a serious one so I would urge you NOT to self medicate and not to ignore it or just chat with some friends etc. You need competent medical or pyschiatric help. If you can answer the questions above I may be able to advise further.

[baboon]

First, thanks for your replies.

Secondly, to answer a few questions;

I used to take Sertralene which I found quite helpful. As I have not had suicidal tendancies, a need to self harm or hurt others the Doctor told me it was simply a common or garden depression brought about by a sensetive personality and the winter weather [cold and dark all the time in UK.]

True enough I think as during the Summer I felt right as rain and could stop using the medication.

My family has no history of psychiatric disorders.

I do not feel anxious all the time, only at random intervals. For example as I write this I feel pretty good [getting things off your chest with people who care is always a boost] but I cannot predict what will happen in the next 5 minutes.

I do drink quite heavily, but during the day my favourate tipple is iced water. I do not drink spirits, only beer and do not need a quick slug of something to get me started in the morning.

I last stopped using medication in January 2005.

Thanking you in advance for your opinions.

[Tywais]

I don't know how long you have been in Thailand but there is another factor that can not be taken lightly especially if already vulnerable and that is culture shock. It effects different people in different ways. Some it has nearly zero effects and others serious depression can occur. It can creep up on you and may take 6 months to two years before it is symptomatic. Experience has shown that severe, immobilizing depression can surface many months after the initial settlement.

[John K]

It almost sounds like seasonal depression. Have you tried light therapy?

[sriracha john]

In light of your previous diagnosis and medication regimen, I would strongly urge you to seek professional help by inquiring at the better hospitals in your area as to the availability of English-speaking physicians/psychiatrists.

It's far too serious an issue to get "pointers", no matter how well intended they may be, from Net posters.

Sort it out with a professional.

....and I wish you all the best of luck in overcoming your difficulties.

[Pattayatony]

First, thanks for your replies.

Secondly, to answer a few questions;

I used to take Sertralene which I found quite helpful. As I have not had suicidal tendancies, a need to self harm or hurt others the Doctor told me it was simply a common or garden depression brought about by a sensetive personality and the winter weather [cold and dark all the time in UK.]

True enough I think as during the Summer I felt right as rain and could stop using the medication.

My family has no history of psychiatric disorders.

I do not feel anxious all the time, only at random intervals. For example as I write this I feel pretty good [getting things off your chest with people who care is always a boost] but I cannot predict what will happen in the next 5 minutes.

I do drink quite heavily, but during the day my favourate tipple is iced water. I do not drink spirits, only beer and do not need a quick slug of something to get me started in the morning.

I last stopped using medication in January 2005.

Thanking you in advance for your opinions.

Your Medication before was working OK was it? Sertralene is the same drug as Paxil, Zoloft, Aropax, these are all from the same family of drugs which help to ajust a chemical inbalance in your brain. This is not somthing to play around with or to self medicate with. For the best advice go and see a qualified Doctor. These Drugs are available in Thailand but not across the counter. I have suffered with the same problem and was on Aropax for a number of years. While you may have to wait to see a specialest go for long walks get some exersise and try and find a friend to talk to or someone that will understand your problem. The Doctor you saw in the UK should have warned not to drink alcohol while taking this medicane this is very important!!! A lot of these drugs come under different names in different countrys, I know that Paxil and Zoloft are available in Thailand. All of these drugs are known as "Selective serotonin reuptake inhibitors" and are very expensive in Thailand. I hope that helps if you need any further help you can PM me.

Good Luck Tony

[Dakhar]

To the OP

Sorry, I don't have the time to read the thread.

So what I may say may have already been said.

Watch your meds. if you are on any. Google them and look for side effects.

I was on Ambien for a while, and that stuff, even taken in extremely small dosses will make me emotional etc.

Watch your meds, and that is advice for everyone.

[Sheryl]

In your clarifications you did not mention whether or not you had a thorough physical examination (including neurological tests) when this problem first occurred to rule out a physical problem.

It sounds like you have a mood disorder complicated by drinking (a person can be alcoholic even if you drink only beer and only in the evenings...and in any event alcohol is contraindicated for people with mood disorders). However, it is important that possible physical causes be ruled out through appropriate neurological tests. Don't want to scare you but what you describe can occur in brain tumors and also a number of systemic diseases.

You should see a qualified psychiatrist -- psychiatrist NOT psychologist, as you need an MD who can conduct the necessary tests to ascertain whether there is a physical disease causing or contributing to the problem and who can prescribe medications.

By the way contrary to what one poster said setraline (zoloft) IS available over the counter in Thailand. But I do not recommend that you self medicate. Speaking as a health professional, what you describe is potentially serious and could without proper management get a lot worse; you need to see a qualified professional to determine excactly what is going on and the best treatment for it.

I suggest you make an appointment with one of the more than 20 English-speaking psychiatrists on staff at Samitivej Hospital.

Good luck and feel free to PM me if you think I can be of help.

[Noel]

The OP clearly needs to seek professional medical help, and soon.

He appears to have problems that, with all the best will in the world, cannot safely be dealt with on a forum such as this.

Time to go home would be my best advice...

[baboon]

Thank you all for your help. I am feeling much better at the moment, but will definately taking your posts int serious consideration.

[John K]

In your clarifications you did not mention whether or not you had a thorough physical examination (including neurological tests) when this problem first occurred to rule out a physical problem.

It sounds like you have a mood disorder complicated by drinking (a person can be alcoholic even if you drink only beer and only in the evenings...and in any event alcohol is contraindicated for people with mood disorders). However, it is important that possible physical causes be ruled out through appropriate neurological tests. Don't want to scare you but what you describe can occur in brain tumors and also a number of systemic diseases.

You should see a qualified psychiatrist -- psychiatrist NOT psychologist, as you need an MD who can conduct the necessary tests to ascertain whether there is a physical disease causing or contributing to the problem and who can prescribe medications.

By the way contrary to what one poster said setraline (zoloft) IS available over the counter in Thailand. But I do not recommend that you self medicate. Speaking as a health professional, what you describe is potentially serious and could without proper management get a lot worse; you need to see a qualified professional to determine excactly what is going on and the best treatment for it.

I suggest you make an appointment with one of the more than 20 English-speaking psychiatrists on staff at Samitivej Hospital.

Good luck and feel free to PM me if you think I can be of help.

Sheryl, that is a great thought in a perfect world. I have been regularly told by clients is 10 minutes with a psychiatrist in Thailand is considered lucky. I doubt they would have time to do the extensive tests you suggest. There was an article in the Bangkok post just about a year ago saying that Thailand needs about 750 more psychiatrists. I forget the ratio but I think it was 1 for every 1000+ people in Thailand. The case load they have is staggering.

[tc101]

When my girlfriend stopped taking anti depressents she cried almost every day, for no reason at all, for about a month. Then she was fine.

[Sheryl]

Sheryl, that is a great thought in a perfect world. I have been regularly told by clients is 10 minutes with a psychiatrist in Thailand is considered lucky. I doubt they would have time to do the extensive tests you suggest. There was an article in the Bangkok post just about a year ago saying that Thailand needs about 750 more psychiatrists. I forget the ratio but I think it was 1 for every 1000+ people in Thailand. The case load they have is staggering.

What you describe is accurate with respect to the public health system & government hospitals. The better international private hospitals like Samitivej are an entirely different matter. They have an excellent psych division and ability to do a wide range of psychiatric diagnostic tests, and of course many neurologists on staff for neruo work up.

[GuestHouse]

A consideration when looking for help with mental or emotional health issues is 'Culture' there are significant differences between cultures in their aproach to these aspects of health.

I think if possible consider finding a specialist from your own culture and perhaps consider a trip home to get a consultation with your own doctore who has your full history.

One caution is 'dependency' not drug dependency, but help dependency. Practitioners of mental health in Thailand are not controlled in the same way as back home, given the vulnerability that arises I'd take especial care in selecting help.

My own personal observation on this matter is that when I was seriously physically ill in Thailand (and with that came a huge emotional burden) the Thai doctors I spoke to where unable to make any connection to me in terms of dealing with the emotional stress that came with my illness and hospitalization.

I was eventually medivacted to the UK and I can not describe the relief of being able to talk to doctors and nurses who understood from the same cultural view points the problems I was dealing with.

To conclude, I think it it was me, facing such a problem I'd be taking a trip home to get some help their, rather than patch the problem in Thailand.

Best of luck which ever choice you make.

[sleepyjohn]

Some good advice above.

As you are bursting into tears you almost undoubtedly have a bout of true depression. No doubt there are a few decent head doctors here but I would be very wary. There is a great tendency to overprescribe, and believe me there is no such thing as a pharmaceutical free lunch. In other words, if the drugs make you feel good, as benzos like Lorazepam can, you will have a reaction when you stop.

Consider this. It sounds as if your depression isn't severe. If the symptoms are similar to your last episode you might take the same dose of the same drug as last time, an SSRI, if you feel it helped. It would be reasonable to assume things should go well enough. If you're getting no sleep a tricyclic might suit better. These are well understood but have considerable side effects for a little while and the dose must be built up slowly, so it really needs to be administered by a doctor. All in all it might be best to work it out with a doctor but have some possibilities in mind before you go....such as the above. The doctors here seem to be very open to suggestion, will almost ask you what you want. Also have some rules. Such as NO BENZODIAZEPINES.

Your problem is almost definitely temporary. Understand this. Act accordingly.

Medicines alone will help but are no total answer. Your life needs to change. Given good conditions the mind and body will almost always help itself. A passive but excellent treatment. So how can you make the conditions better?

Take daily exercise in a disciplined way, as much as reasonable.

Enjoy the company of others, don't isolate yourself. Are you close to anyone here? If not, do something about it gradually.

Be occupied by all means, but give yourself time, never cram things in. Always look for little enjoyments in what you do. If you start to feel stress, do less.

Alcohol really needs to be given up in the long run if you are prone to depression. Don't be aghast at the thought of this, you will end up much happier after you adjust your lifestyle. If that's a problem consider AA for a while, if nothing else it fills your time instead of drinking, and you'll feel less isolated.

Are any of your ethical standards lacking? If they are, and we are all a bit guilty, you can never be truly happy. In this context consider Buddhism, which really is psychotherapy rather than religion.

When you are feeling a bit better consider meditation (NOT if there is any history of schizophrenia).

It is easy to feel isolated from the Thais all around you if one doesn't speak the language or one doesn't know good English speakers....is there anything you can do about that?

All these things will stand you in good stead to resist future bouts of illness. Don't rush. Take one baby step at a time. Accept a bit of pain. remember it's temporary. Take a deep breath, do your best to smile, and you will come out of this a stronger man.

Good Luck.

Edited October 18, 2006 by sleepyjohn

[John K]

A consideration when looking for help with mental or emotional health issues is 'Culture' there are significant differences between cultures in their aproach to these aspects of health.

Very good point, I see that a lot and I need to compensate for that when I see people from other cultures. You can also produce endorphins with physical activity. Your body does not know the difference from working out in a gym, jogging on the beach, or activities in a bed. So find the one you like and do it.

[Cooo]

Hi, I have been working at a famous health resort for he past 2 years and have had some success with this type of problem. I am willing to give you a free session and we can have a go at dealing with it. Contact me.

[bendix]

I've been feeling a bit sad lately as well.

Can i come too?

[britmaveric]

sriracha john - I have to agree with you mate. 1/3 of the population is on meds - seriously doubt that???

Edited October 20, 2006 by britmaveric

[Mr Jones]

Baboon,

Go see John K.

He will sort your problem out, and I promise it will never rear its ugly head again

Lez. DHP.

ask for mates rates.

[baboon]

Just a quick one. I am trying to sort myself out without using drugs by banning any negative media from my house, concentrating only on the positive as best as I can and forcing myself to get out there and socialise. I went as a voulenteer to an English camp 2 days ago. It was great- surrounded by happy kids and enthusiastic teachers. I do feel quite a bit better but am monitoring myself. Thanks for your opinions, especially Lazyjohn.