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Spiraling into Depression?

Q. I am 23 years old and just lost my father on 11/7. He had cancer but died of side effects from the chemo so it was a little bit of a shock. I am, of course, very upset. In addition to this change in my life, I got married in May, started a new job in September and go to grad school at night.

I feel that I am getting worse, emotionally, instead of getting better with time. I have a hard time getting out of bed each morning but I do it because I have to pay my mortgage. I have become fairly anti-social, eating lunch at my desk because I have a hard time making conversation and on the weekends I don't go out. How long do I go on like this before taking the anti-depressants my physician offered to prescribe?

A. I'm sorry to hear of your loss. Many of us who have lost a parent under similar circumstances will appreciate how difficult this is. On top of all the other huge changes in your life, it's not surprising that you are feeling very upset. You clearly have taken on a great deal of responsibility in a very short period of time. But you and your physician have raised another question: is treatment for depression warranted?

There are some important issues to clarify before making a decision about treatment. First, it's certainly possible that your reactions are part of a normal grieving process, since it's only been a couple of months since your father's death, which occurred under somewhat unexpected circumstances. You may not have been able to say all the things you needed to say to your father before he died--and may not have completed your own mourning process.

But I am concerned that you seem to be getting worse emotionally. This suggests that something may be interfering with the normal process of grieving, or that you may have developed a major depressive episode [MDE] in the context of all your other stressors. Finding it hard to get out of bed in the morning and withdrawing socially are consistent with MDE, but not necessarily diagnostic of it.

In order to make a confident diagnosis, a thorough physical and mental health evaluation are necessary. Your family physician has apparently offered to prescribe antidepressants--but what has he or she actually diagnosed and recommended? Since some family physicians are more comfortable than others in the diagnosis and treatment of depression, you may want to consider asking your doctor for a consultation with a psychiatrist.

The psychiatrist might then furnish your doctor with recommendations regarding the need for medication and/or psychotherapy. If, in addition to what you have described, you are experiencing a significant change in your sleep and/or appetite; feel much less energy than usual; no longer experience pleasure in most activities; feel hopeless most of the time or like not going on with life; have trouble concentrating; and have trouble functioning at work, even though you are able to drag yourself to the office--all this would point more strongly in the direction of MDE.

Not all patients with MDE require medication. Some may find psychotherapy alone sufficient--particularly cognitive-behavioral therapy (CBT). However, for more severe depression, the most effective approach is probably a combination of antidepressant treatment and psychotherapy. (I almost never recommend medication alone!).

The fact that you have raised the question of how long do I go on like this suggests to me that you are looking for effective treatment. I'd recommend pursuing this today with your family doctor--ideally, working in consultation with a mental health professional. I hope you feel better soon--and, with appropriate help, there is good reason to believe this will be the case!

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April 2003

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