Sunday, May 30, 2021
Alexander Papp MD
Jack was a married man in his mid fifties. He came to see me due to chronic depression, feeling down and lacking motivation, unable to enjoy pleasurable things, for some 20 years. His last therapist had recommended that he see a psychiatrist. On the first appointment he was a bit skeptical about medications, but after decades of psychotherapy that led to no improvement, he was ready to try something different.
Since Paxil was new on the market, I chose it as his first medication. I gave him sample pills in the usual starting dose and told him to come back in four weeks.
The first follow-up visit was memorable. He told me that about 2 weeks into taking the medication, “a cloud just lifted off from above my head”. When I saw him 4 weeks later, he had no trace of depression left in his mood. He was enthusiastic about the improvement, he felt energetic, he was able to enjoy things, and he was looking forward to doing activities he had not done in years. “I can’t believe I wasted likely tens of thousands of dollars on psychotherapies in the past decades, and all it took was two weeks for this medication to make me feel better”, he said to me.
Impressed by my own good work, I prescribed him the next monthly amount and told him to come back in another four weeks.
The second follow-up visit was also memorable, but for a very different reason. Jack walked in looking crestfallen. He was still free of depression, but his marriage was now on the rocks, he was having arguments with his friends, and he had quit his job. When I asked him what happened, he said: “You know, doc, I had lived my past 20 years as a depressed person. I chose a depressing job, my friends were depressed people and my marriage was depressing. I was okay with that because I was depressed. But I can’t live with my wife any more, I can’t stand my friends and I hate my job. My life is in shambles and I don’t know what to do!”
I told him to make sure to resume seeing his therapist, and provided him with another 4 weeks’ worth of Paxil. Unfortunately, he never came back to see me, so I don’t know how he resolved this crisis in his life.
I feel better – now what? can happen with many conditions, that include anxiety, OCD, bipolar disorder besides depression. When there are stubborn symptoms, people have no choice but to build their lives around those symptoms, if they still want to function in life. That is how they make themselves do things, or avoid doing things.
I learned something very valuable from this event. It is important to counsel patients, who have chronic psychiatric problems, and tell them to prepare themselves for getting better. It is a good thing, that is what we want, but it may not be easy and they should be prepared for some unexpected developments. And that they better not stop seeing their therapists!
