Shirah Vollmer MD

The Musings of Dr. Vollmer

Living With Depression

Posted by Dr. Vollmer on June 25, 2012

Neha, sixty-one, female, says “I can’t stand going home. I hate being there because my husband of forty years just sort of creeps around the house. The vibe is really bad. The feeling is so empty.” “Is this a new problem?” I ask, thinking that the chances are high that over such a long-term marriage, Neha has faced this issue before. “Well, for years, we were busy raising children and then our parents became ill, but now that we don’t have so much stress in our lives, I really feel the emptiness.” Neha explains in a narrative which conveys that the problem has always been there, but now it is unmasked because there are no pressing responsibilities on them. “What happens when you confront Jason, your husband,” I ask. “He gets a down look on his face and so he makes me feel like I just ruined his day, but on the other hand, I don’t know how things will get better unless we talk about it.” “Is he open to treatment,” I ask, wondering if psychotherapy and/or psychopharmacology would help. “Yes, he is open, but frankly, I don’t know how optimistic I am that it will help.” Neha tells me, with despair. “It must be so hard to live with him,” I say, bouncing a way for a moment from a practical recommendation to a sense of empathy for Neha. “Oh yes. I don’t know what to do,” Neha repeats her sense of hopelessness and fear that things will never get better. “Getting him into treatment might help,” I repeat, giving her the reminder that depression is a condition which is treatable and there is a way out of her current situation. Neha looks at me with skepticism, along with a willingness to discuss intervention with Jason. “I think we are going to have a tough evening.” Neha says, knowing that sometimes things have to get worse, before they get better. “Yes, change, of any sort, but particularly changing a mental state, is a daunting prospect. “I guess it has helped me,” Neha says, recalling the hard times she has had in her own life. “Yes, remember that, as you discuss it with him.” I say, relieved that Neha has connected her journey with that of her husband’s, thereby developing more patience with him.

2 Responses to “Living With Depression”

  1. Shelly said

    In today’s new medical model, which is a 20 minute psychopharmacological meeting to check medications only, how does psychotherapy fit into the treatment of depression? Would Jason have to see two professionals: a psychiatrist to prescribe medications (if they were called for), and then a therapist for talk therapy? I refer to the NY Times article of several months ago, the one to which you also wrote a comment to directly. Would this also require double the copayment? Thanks.

    • Shirah said

      Today’s new medical model is not suitable for all. The standard treatment for depression remains a combination of psychopharmacology and psychotherapy. Jason could see a psychiatrist/psychotherapist, but I agree that this is getting harder and harder to find and it is harder and harder to get insurance reimbursement, although it still exists. Yes, seeing two professionals requires double the copayments, but under such circumstances the psychiatrist is not seen very often (sigh!). Generally speaking, the more complicated situations warrant a psychiatrist to do both the psychotherapy and the psychopharmacology. Jason’s situation does sounds severe, so that would be my suggestion to Neha, but as you say, the practicality of seeing a psychiatrist may be a barrier. Thanks.

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