Depression iv a: “when all that glitters is not gold”.

In this blog, I want if I may, to draw together several important and related points, concerning the diagnosis and treatment of depression. In order to achieve this end, I shall again draw upon actual experience within the clinical scene, this time involving a patient seeking help from her consultant oncologist for depression. The lady concerned had been successfully treated for ovarian cancer but was still attending the ovarian oncology review clinic at much less frequent, but nevertheless regular intervals. It so happened that at that time (and in fact for a number of years) I held regular psycho-oncology clinics within the outpatients department of the dedicated Oncology Centre which had call on my services.

One day toward the very end of the afternoon I was approached by one of the oncology consultants who was also rounding off his out-patient activities for the day. He told me that his patient (who he had momentarily left in his consulting room whilst popping in to see me) was pressing him to prescribe, or to ask her GP to prescribe antidepressant medication. He agreed that she certainly appeared to be depressed but would value another opinion on the matter. As I just happened at that moment to be between patients, I readily agreed and at his suggestion, we saw her together.

Angela – an extremely pleasant lady in her late forties – was married with a very supportive husband and family of two children. The eldest, a son, was a university student in his early 20s and the younger member, a daughter, presently in the sixth form at school. Angela’s mother, as well as a couple of sisters, were also on the scene and appeared to be very attentive and supportive. However, she had sadly lost her father by death some eight months previously. The three of us together briefly reviewed recent events and present concerns in her life.

As far as one could tell, Angela appeared to have coped well with her father’s death and had also seemingly provided her mother with a very adequate ‘shoulder to cry on’ on several occasions. Indeed, it really did, on the whole, seem that the family – bearing in mind such history of recent events – had managed courageously and successfully to erect and maintain mutually enabling networks of support and succour. Nevertheless, there was no doubt that Angela was now experiencing significantly more than the occasional bout of “low mood”. As she talked – more especially about the loss of her job at a local travel agent’s (which had been held in abeyance for some months following diagnosis, but which she had terminated around the time of her father’s death) – it became increasingly clear that this was something of a key factor in her overall decline in mood state.

There seemed no question about the presence and reality of several key symptoms of depression, e.g. bouts of sadness already referred to, loss of self worth, irritability, sleep disturbance, impaired ability to concentrate and – increasingly – feelings of self reproach and guilt. The latter two seemed to connect to an unavoidably reduced family income, which in turn was forcing certain economies in their present lifestyle affecting her youngish family. Angela’s own account of the line of reasoning underpinning her request for medication was as follows: ‘I am depressed and it seems reasonable to assume that an antidepressant should deal with my problem’. Unfortunately (and as we have already glimpsed in my previous blogs on depression) this argument is flawed in very particular ways, which, in my next blog, I shall endeavour to make explicit.

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