When Antidepressants aren’t the best option (3)

Antidepressants can make an enormous difference to the quality of life of sufferers of both depression and anxiety. But as we discussed in When Antidepressants aren’t the best option (1) and (2), there are cases when antidepressants should not be prescribed, or should be used in conjunction with other therapies. Let’s look at another case study.

Collette’s children have both left home and her husband, Bryan, sustained mild brain damage in a workplace accident and no longer works. A former nurse, Collette is responsible for the daily care of her husband plus her usual chores.

But because of Bryan’s head injury, he often becomes aggressive, forgetful, and says hurtful things to Collette which he cannot remember having said five minutes later. Not surprisingly, after five years of caring for him, often in the role of a caretaker/nurse, Collette is tired, stressed, and often at her wits end. However, the most difficult thing for Collette is that she feels she has “lost” her husband, as his personality has changed, made more poignant by the occasional heartrending glimpse of the old Bryan which make her realize how much she has lost.

Her two sons are busy with their own lives so Collette has little family support. Sometimes she visits a neighbor just or a break when she feels that she just can’t take anymore. Her doctor’s advice? “Try to let what he does go over your head and here’s a prescription for an antidepressant”.

Collette dutifully took the antidepressants. They helped a bit and so she kept taking them. But once she felt better, she tired of the side effects and weaned herself off the tablets. What happened next was entirely predictable. After about two months, feelings of anxiety, of being overwhelmed, of being incredibly sad, descended again. Reluctantly Collette went back to the doctor, who promptly announced she was depressed again and put her back on medication.

Collette continued this merry-go-round life for several years. She would take the medication, feel like she could cope, go off the medication, go downhill again. But did Collette have a chemical imbalance in her brain that was making her sick? No, she didn’t. She was reacting in a perfectly natural way to a very difficult situation. She was inwardly grieving for the loss of her husband, she was her husband’s sole carer, and she had no-one to talk to who really understood the situation. She felt isolated and frightened. The antidepressants helped, but did not address the real problem.

Fortunately, Collette got a new neighbor who was a Social Worker. She quickly recognized the dilemma Collette was in and organized for Collette to see a counselor. Taking about her grief, her guilt, and her depression helped Collette to feel better. Community care was organized so that Bryan could spend two half days at respite so Collette could spend time alone enjoying herself. Her family was brought in and asked to help out where possible and Collette joined a support group for people in her situation.

Bryan has not changed, but Collette has. She worked consistently in therapy to deal with her grief about her husband, and she also had to work through guilt at sending him away for two days so that she could recharge her batteries. Today Collette does not take antidepressants. She has learned to accept the situation and work with it. She copes much better with her husband, and she has a smile back on her face. The antidepressants she took did help her in their way; they allowed her a breathing space in which to exist. But they were no solution to her problem, only a band aid. Collette has now since developed her own coping skills and enjoys life again.

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