depression

[Guest guest]

Hi everyone. Have seen a new patient today suffering depression, which his GP

describes as moderately severe. The pt is a 46 year old man who suffered a

prolonged period of severe stress in his life in the late 90's. He had a

successful and interesting career which he really enjoyed, at that time, but

feels that the stressful situation and economic circumstances brought about the

" collapse of his career " . He had one bout of depression when he contemplated

suicide in 2001, but got a new job which he feels saved his life. He was

prescribed anti deps at that time, took them for one week only as they made him

feel so ill. Had some counselling which he feels helped - but the job was the

reall saviour. Now the depression has returned again and although he is still

working, feels there is nothing in his life that gives him happiness. He doesn't

want to be at home and works as much as he can to be away from his wife and

teenage children. He has been to the GP but is very reluctant to take the anti

deps prescribed due to his previous experience and because a close friend

committed suicide 2 years ago whilst on anti deps. He has no enthusiasm for

anything, he describes his energy as poor but recognises that he has a

physically and emotionally demanding job, does not socialise inside or outside

work, drinks too much (positive family history of alcoholism which he is very

aware of), he doesn't eat anything from breakfast until the evening altho what

he does eat is okay and he is interested in/likes shopping for food and cooking,

no palpitations, no anxiety. At the moment he says that he is not suicidal.

During the consultation he appeared emotionally very flat, he took a long time

to answer my questions. He feels that the depression has deepened in the last 2

weeks but doesn't know why. He started counselling last week. I discussed diet,

eating regularly, reducing alcohol, exercise, getting outside especially now its

sunny, EFA's. He had cancelled a follow-up with the GP due to work committments

but i emphasised the importance of making another appt with the GP and

discussing his decision to see me. We talked about the possible role of anti-dep

use in severe depression, even as a short term measure. I wrote down the points

we had discussed and he was quite willing to sign it. He says that he feels he

is just hanging on by his fingertips but that he won't/can't get any worse at

the moment because his eldest child is taking his GCSE's. This worried me as it

seems like he's set himself a timetable for the depression to get worse. He's

also dreading the family holiday at the end of July.

I am considering Hyp perf, Ginkgo, , Avena, Borago, Carduus.

I would welcome advice from anyone who has treated pts with more severe

depression.

Sue Salmon

Huddersfield

----------

No virus found in this outgoing message.

Checked by AVG Free Edition.

Version: 7.1.394 / Virus Database: 268.8.2/357 - Release Date: 06/06/2006