Suicidal Thoughts and Emotional Struggles in Depression

Suicide-related issues and some trivial matters?

Hello, doctor.
I am a patient with severe depression and have recently been suspected of having hypomania.
I have been undergoing medication treatment for five years and have completed one course of rTMS, but my condition remains uncontrolled.
I initially thought that academic pressure was the main issue, but even during my recent leave of absence, I still feel this way.
I am afraid to tell my doctor about my suicidal plans; I have been gathering various methods for a long time (which they know about), and I have almost purchased all the items I need for suicide.
The disappearance of these items around me only adds to my pain.
Additionally, I have been making plans with others over the past three to four months, some of which did not materialize, and there was one instance where I was not prepared.
If all goes as planned, we should be going through with it this weekend.
I hope to die, but I am worried about being hospitalized, so I am hesitant to share this with my doctor or the emergency staff.
Moreover, I have realized that my feelings towards my primary doctor are quite troubling.
I am extremely afraid of his anger or unhappiness and constantly worry about being abandoned.
I fear that if he is unwilling to help me anymore, I will have to hide things from him.
Recently, there was an issue with my emails to him, which caused my records and correspondence to not reach him, leading to extreme anxiety on my part.
I believe these records are helpful for my condition and would make our sessions more focused.
When I am unable to express myself, he has allowed me to communicate with him slowly, but he seems unhurried.
Without his consent, I went to his office and found him before my appointment, which seemed to upset him.
I know this is not appropriate, but I do not know how else to handle it.
My feelings for him have become more intense; at one point, I envied his children and wife, but then I thought that being in that position must be exhausting.
I want to collect images of him in various outfits (he agreed to let me take photos, but he has been reluctant recently).
I want to feel important to him and hope that our relationship is not just professional.
The most serious issue is that I have some sexual fantasies about him, but I truly do not want to change doctors.
I try very hard to control my feelings in front of him, but they seem to be escalating, and I cannot control myself; I just do not tell him.
Lastly, I have some minor concerns: sometimes I inexplicably vomit a little without knowing the reason, and yesterday when I received a muscle injection of lorazepam, it was extremely painful—much worse than the pain from other sedatives I have received in the past.
I ended up bleeding from my shoulder down to my upper arm.
What could this situation be? Thank you, doctor.

eunice, 20~29 year old female. Ask Date: 2023/12/14

Dr. Wu Enliang reply Psychiatry

If a patient's condition becomes unstable due to transference towards their physician or therapist, it may be necessary to consider changing providers.
If injections are causing severe pain, it is recommended to administer the injection deeper, and the medication should be shaken well before administration.
Dr.
Wu Enliang.

Reply Date: 2023/12/14

More Info

It sounds like you are going through an incredibly difficult time, and I want to acknowledge the pain and confusion you are experiencing. Dealing with severe depression, especially when compounded by suicidal thoughts and emotional struggles, can feel overwhelming. It's important to understand that you are not alone in this, and there are ways to cope and find support.

Firstly, your feelings of hopelessness and the thoughts of suicide are serious and should not be taken lightly. It’s crucial to communicate openly with your healthcare provider about your suicidal thoughts and plans. While it may feel daunting, sharing this information can lead to the necessary interventions that can help keep you safe. Mental health professionals are trained to handle these situations with care and confidentiality, and their primary goal is to support you in your recovery.

You mentioned that you have been on medication for five years and have undergone rTMS (repetitive Transcranial Magnetic Stimulation) therapy. It’s not uncommon for individuals with severe depression to experience fluctuations in their mental health despite ongoing treatment. Sometimes, it may take time to find the right combination of therapies that work for you. If you feel that your current treatment is not effective, it’s important to discuss this with your doctor. They may consider adjusting your medication or exploring other therapeutic options.

Your feelings of attachment to your psychiatrist and the fear of abandonment are also significant. It’s not unusual for patients to develop strong emotional connections with their therapists, especially when they are vulnerable. However, it’s essential to maintain a professional boundary in this relationship. If you feel that your feelings are becoming overwhelming, it may be beneficial to bring this up in your sessions. A good therapist will help you navigate these feelings and ensure that your treatment remains focused on your well-being.

Regarding the physical symptoms you mentioned, such as nausea and pain during injections, these could be related to anxiety or stress. It’s not uncommon for individuals with mental health issues to experience physical symptoms as well. However, if the pain during injections is unusually severe or if you have concerns about your physical health, it’s important to address these with your healthcare provider. They can evaluate whether there are any underlying issues that need to be addressed.

In the meantime, consider reaching out to a trusted friend or family member about how you’re feeling. Sometimes, sharing your thoughts with someone who cares can provide relief and support. Additionally, if you ever feel that you are in immediate danger or are considering acting on your suicidal thoughts, please seek emergency help right away. Hotlines and crisis centers can provide immediate support and guidance.

Lastly, remember that recovery is a journey. It’s okay to have setbacks, and it’s important to be gentle with yourself during this process. Engaging in self-care practices, such as mindfulness, journaling, or creative outlets, can also help manage your emotions and provide a sense of relief.
You deserve support and understanding, and there are people and resources available to help you through this challenging time. Please take care of yourself and reach out for help when you need it.

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