Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for June 25th, 2010

Family Anxiety

Posted by Dr. Vollmer on June 25, 2010

     Seventy-year old Eric, retired engineer, married for forty-five years, four children, two biological, two adopted, one biological grandson, is referred to me by his primary care physician five years ago. He complains of irritability, impatience, and overwhelming anxiety with regards to his ninety-two year old mother who is in a nursing home. He comes in with his wife who Eric says can “say how I am feeling a lot better than I can.” Susan, his wife, appears to really enjoy talking about Eric. Their loving relationship is quite touching. Susan describes the family history of anxiety. Eric’s mother was an alcoholic, but since she had her stroke five years ago, she has not been drinking. Eric’s brother Eugene committed suicide ten years ago. Susan says that Eugene was always anxious and “he never seemed comfortable in his skin.” Their biological children and their biological grandchild suffer from “terrible anxiety.” All three of them take selective serotonin reuptake inhibitors (SSRIs). Their two adopted children are doing well; they have never been on psychotropic medication.

     Although Eric has never been treated for his anxiety in the past, he has suffered with it for many years. The tipping point, according to Susan, was that Eric’s mother began to deteriorate and this exacerbated Eric’s baseline state of tension. After a very pleasant interchange between myself, Susan and Eric, I gave Eric Zoloft 25 mg and told him that I needed to follow-up with him in one week. A week later, Eric felt “like a new person.” I then saw him two weeks after that, and he maintained his stance that he was a “new person.” Now, I see him once every three months, the medication remains the same, and he continues to remind me how much the Zoloft helps him enjoy his life. He says he is more patient, and “little things just don’t bother me as much. ”

    Eric, the poster child for SSRIs, seems to show the biological basis of anxiety in that the anxiety  runs in his family, he  responds to medication, and his anxiety gets worse under stress. Over the years, his mother passed away; his life has become simpler. He is enjoying his retirement. He enjoys his wife. He enjoys his kids and his grandchild. He appreciates the Zoloft such that as far as he is concerned he is quite content to keep taking it as long as he lives. He has no side effects. Eric does not see any reason to go to psychotherapy, but he tells me how much he enjoys coming to see me, with his wife, every three months. He appreciates having me “look in” on his life.

    Many people in Eric’s situation would be reluctant to take medication, as it might make them feel “weak”. Eric might have felt this way, but he has seen how this class of medication helped his children and his grandson. Further, Eugene’s suicide made him realize how black life can get, so for Eric, if the Zoloft can make the “sun shine” then that is a “blessing.” Eric then tells me a story about his  ten-year old  grandson, Craig. Craig got up in front of his fifth grade class to talk  about how much Prozac helped him cope with his life. Eric then said matter-of-factly, “I guess this problem is in our genes. Thank goodness there is treatment.” I agree.

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