looking for advice on how to best support my spouse

[mrae]

Hi everyone,

I've been hanging around this forum for a little while - I registered a few months back when my common-law spouse was having a hard time and I was struggling with how best to support him. We had a tough fall and then in December things got better...now he's lying on the basement couch with a blanket over his head and can't bring himself to look at me or speak to me, so I'm desperate for some advice or words of comfort!

He always felt like he suffered from some form of depression (since his early teen years) - it usually would come on a little stronger in the fall/winter months, but he would just soldier through. In the summer months there is enough work to do in the yard, etc to distract him from his thoughts. But this fall everything came on so much stronger than before - he experiences inexplicable guilt (guilt towards me mostly - thoughts that I must be settling for him and he's ruining my life by being with me) and for a good month spent every evening on the couch, pulling the blanket over his head if I walked by and then crawling into bed about 8pm. He spoke of running away or moving out for a bit to "clear his head". He finally felt so low that he saw his GP who put him on Effexor (37.5mg); however, she didn't refer him to a therapist because "he isn't suicidal"...this made me pretty angry...I think he could benefit greatly from seeing a therapist! He thinks that talking to me and his mom is enough, but we're not professionals and don't have that third-party view of things.

Anyhow, after about a month on the Effexor I started noticing improvements in his mood - he was more interactive, more engaged in the world around him - and since mid-December he's seemed great! He still had those same feelings of guilt, but wasn't constantly ruminating on them so they weren't taking over his life. He was able to get out and enjoy the outdoors, get some exercise and fresh air...and was laughing and smiling again.

In my head I know that cycles are to be expected, but I guess I still wasn't ready for him to spiral back down so quickly. He's still taking his meds - I check the bottle every few days and often see or hear him take them in the morning - maybe I should just trust him to keep taking them, but I had a bad experience years back when my brother went off Paxil cold-turkey...that's another story in itself...so I am concerned with potential withdrawal effects.

I'm feeling a little lost tonight - knowing that I can't fix him, even though I desperately want to make things better for him. All I can do is be here to support him, I just don't know how to best do that! This fall when he was down I just kept on living around him...cleaning the house, making supper, doing dishes...moving around him on the couch until he chose to start a conversation. I guess I was silently trying to "tell" him that life didn't come to a complete halt when he wasn't feeling well. I would ask him a question, get a one-word answer, and then move on with whatever I was doing...I didn't push hard. I don't know if that's the best approach. I don't know if I should be more forward - ask him directly how he's feeling - I know all I'll get is an abrupt "fine", but at least I tried to open up a conversation?

Any words of wisdom would be greatly appreciated! I'm struggling most with just those little day-to-day interactions...and also don't know how to bring up the idea of therapy. The last time we discussed it he got angry and quite rudely told me it was probably the stupidest idea I've ever had!

[AJ]

Welcome to the forum Mrae. It is quite obvious that you care very much about how your spouse is doing, and how best you can help him. You said it best yourself,

All I can do is be here to support him

It sounds to me that you are there in every way you can be. You interact with him as much as he'll allow you to and you make sure life around him carries on, without excluding him.

I just kept on living around him...cleaning the house, making supper, doing dishes...moving around him on the couch until he chose to start a conversation.

Depression has a way of pulling people who suffer from it, into a very dark place. The first thing I do when I'm depressed is retreat from the world around me, and the people in my life.

My view of the world, and myself becomes very distorted. It is hard to have a conversation with someone who's depressed. It is hard to know when it is time to talk, to just sit quietly, to ask questions, or make suggestions. My advice to you would be to go with your gut instincts. You may not always get it right, but you will always be doing it from the right place.

[paul m]

Hello Mrae and welcome. The Moods Disorders of Ontario has an excellent fact sheet on helping someone with a mood disorder. It has a lot of points that I would make, but space here just doesn't permit. http://www.mooddisorders.on.ca/helping.html

In regards to his medication. Often we need to increase or alter our meds when one just isn't working. His obviously aren't working properly and 37.5 mg is a very low dose of effexor anyways. Sometimes an Antidepressant(A/D) will help us climb out of a hole, but if the strength is not strong enough then we can fall right back in. There is always the potential for a placebo effect where we believe the A/D will help us so we get a small lift, but in the long run it just doesn't work. In that case another type should be tried.

Depending on where you live therapy can be very hard or impossible to come by unless you can afford to pay for it yourself. That's not your docs fault, that's just the way it is these days. I certainly agree that a proper specialist would benefit many, but there is severe shortage of docs for that right now.

What you can do is call or google your local hospital and see what they offer the line of out treatment(you are not admitted to the hospital). Often called out patients. Sometimes they have a variety of programs that may be of benefit for your spouse including some forms of therapy. Or google mental health programs for your area.

It's very tough to discuss a persons mental state when they are in a black funk. Unfortunately when everything is going well, we don't always want to talk about it then either because things are going well and we don't want to upset everything. But that is the best time. In the meantime I would at least try and talk to him about his meds and either getting the doc to increase them or change them.

Please feel free to ask more questions here as it is impossible to answer everything in one session. Good Luck and Take Care. paul m

[Stormy Weather]

Hi mrae,
I'm glad your here.
I totally agree with what AJ said so well

My advice to you would be to go with your gut instincts. You may not always get it right, but you will always be doing it from the right place.

I too completely withdraw and my thoughts as AJ described become really distorted, so what you describe is quite typical, but I know that doesn't make any easier for you.

Would he be willing to go back to the doctor? I'm wondering if the med and/or dosage doesn't need a change. It would be great if he could get referred to a pdoc as they are the experts with the meds.

[uni]

Hello and welcome mrae. Quite honestly, I think you are doing almost all you can. All I will add is: become as educated as possible about the illness, and don't give up even if/when your spouse seems to. Look after yourself above all; without that you are no good to either one of you. I wish you both well.

[mrae]

Thanks everyone...I really appreciate all your words of support, as well as your insight. Sometimes it's hard for me to understand what's going on within him...I have never personally dealt with those feelings and so I can't relate. This is nothing new to me, having grown up with a younger brother that battled with depression most of his life. But it is hard to see this tough, strong, "man's man" so completely lost, practically begging me to leave thinking that if I walk away, all his guilty feelings towards me will just vanish.

AJ - Your acknowledgement that I might not always get it right is true...I needed to hear that. I'm on eggshells when he's in this state and worried that anything I say might put him into a deeper funk. But I can't always worry about that - yes, I need to respect his feelings and the mood he's in, but he also needs to hear some of my thoughts, feelings and can't be lead to believe this doesn't affect me too.

paul m - I spent a lot of time reading up on effexor at the beginning, but took a look at crazy meds and the health canada website last night (following a link in another post) - it was a little eye opening...the info packet from the drug store says that there is no withdrawal effects...and that's not what I read last night! He has been back to his GP a few times for monitoring/refills since he started the meds. I think he is going back soon for a physical, but he tends to hide his doc visits from me...I find out about them after, not before. As for the therapy, his work provides some health coverage, and they also have a short-term employee support program that he could take advantage of in the meantime. Maybe now that he's feeling down again he might be interested in talking about it again. It's sad that one has to feel so bad before they take steps to feel better.

Stormy Weather - I've wondered the same thing about a pdoc...his GP isn't an expert in this field. Sometimes I also wonder, based on his behaviours, whether it's just depression or if he also experiences some level of hypomania. I think it would be beneficial to be seen by a pdoc, and not just automatically medicate as if it's depression only.

Uni - I've been reading a lot online...I've been looking for good resources on depression - trying to understand how it feels, how to support a loved one, etc. If anyone has some suggestions, I'm all ears!

Thanks again for all your well wishes.

[A.E.V.]

welcome to the forum mrae!

[paul m]

Hello Mrae. Effexor doesn't have withdrawal effects like heroin does(it doesn't produce cravings for the drug) and that is how the drug companies get around saying that it doesn't have withdrawal effects.

Having said, SSRI discontinuation syndrome can be very nasty indeed and one that people should be warned about more often.

However if it works it can be a god send. The following are some facts that you may want to keep in mind. When trying an antidepressant(A/D) there is a 50% chance that it will fail. When we try another A/D the odds are the same 50% failure rate and so on. So it can take a while to get the right A/D.

A/D's are also known to quite working for no known reason. A person may get a lift from the med initially and then in a couple of mths or even years later it may just quite working.

The best none medication form of treatment is through Cognitive Behavioural Therapy (CBT) and it also has about a 50% chance of working, but almost everyone who takes a CBT course gains some benefit. A good course is expensive, but his work benefits may pay part of it or the local mental health group or hospital may offer a course.

It is common for someone depressed to push their loved ones away. First we often don't feel worthy and second we often cannot perform in the bedroom and for a guy this can be enormously embarassing. Effexor also is known for causing problems with both the libido and the ability(actual the inability) to have an orgasm(called Anorgasmia). Take Care. paul m

[mrae]

Thanks paul m. I really do wonder if he needs an increase in his medication. He's very vocal about the fact that "the meds aren't doing anything" - every time he talks like this, I just say that, from my view I think they are helping to take the edge off of the symptoms. They don't take the thoughts away, but they help so that the thoughts don't take over his whole life. Although he did take the initiative to go to his GP, he resists the need to go back and look at changing the dosage, etc. I think he's not quite ready to accept that getting treatment, whether medication or therapy, will require effort on his part - it's not as easy as just taking the first pill the doctor gives you and walking away. I will keep encouraging him the way I have been and hopefully one of these days it might sink in that he needs to go further than he already has in his quest for treatment. I feel like I can't push too hard...he has a tendancy to dig his heels in! But maybe some gentle reinforcement will be beneficial...he eventually decided to go to his GP in the first place...I can only hope that he'll eventually take the next steps too!

[paul m]

Hello Mrae. I remember once that I barked my shin and I ended up putting bandages on and using peroxide to self treat it. It was sore , but tolerable and I just never seemed to heal completely. Finally after about 3mths my wife kicked me in my other shin and insisted that I see a doc. I quick dose of antibiotics and the pain was gone in a week.

Taking antidepressants(A/D's) can be a lot like that. Taking a small amount often takes the edge off, but never leaves us completely better.

Having said that I also understand how difficult it can be to get to the doctor in the first place. You are correct there is much more to getting better than just a pill. Everything from diet to sleeping habits can affect us, not to mention things like caffeine use (caffeine is a stimulant) and alcohol use (alcohol is a depressant and sometimes interferes with the action of the A/D). You are also correct, it has to be his decision. (although sometimes a subtle kick in the shins works too)

If you have more questions, please feel free to ask them, answer other people's questions or just plain vent as sometimes dealing with depression from any angle can be difficult and frustrating. Take care. paul m

[mrae]

Thanks paul m. I'm very glad to have worked up the courage to post...everyone here has been so helpful! I truly appreciate the fact that there are people out there willing to share their time, their experiences and their friendly advice with me.

I'll keep the "kick in the shins" comment in the back of my mind too.

[Re-O]

Hi Mrae,

I don't have much to add since you've been given some great advice and insight. I did want to welcome you to the forum though. Welcome!

[Atlantis]

Hi Mrae, sorry I am late in saying welcome. I am looking forward to hearing more from you.

[mrae]

Thanks for the warm welcomes Re-O and Atlantis! It's true, I have received some great advice from many great people!

Things are going OK at home - the dark mood is lifting a bit, although he's not too keen on discussing his feelings right now and I don't push him. I've always been here to listen and to provide feedback when he asks for it...but it's best when he comes to me, otherwise the end result isn't always so positive! But he has been more interactive in the last few days, so that gives me some hope that he's pulling through the lastest funk.

I've had many friends ask me how it is that I manage going through these up and downs...why I haven't just up and left - sometimes it's hard when the people who love you don't know what it's like to love someone who suffers from depression. I love him and I love me...and I sometimes struggle to make sure that both of these loves are reflected in how I live my day-to-day life - that I take care of myself as well as I take care of him and us. It's hard, but worth it!

[jennisk]

Hi Mrae! I was being treated for depression for years before being diagnosed with bipolar type II. (Effexor is what I took from the beginning. I still take it. With additional meds to stabilize my mood swings.) When I intially took the meds, I couldn't believe the difference it made. The fog in my brain began to clear and I found I could actually think! I believed that I did not need to go up to the next dose of 75mg. But, my family convinced me to try. I felt better again. One more increase to 150 mg got me to the point of 'normal' for over a year. I quit taking it after a year because I was better, and I wanted to have another child. I went down very gradually with physicians supervision and the withdrawl was manageable. 37.5mg of effexor is usually considered a starting dose, especially if you are still seeing symptoms. As far the doctor, how would you feel about phoning him yourself or making an appointment to see his doctor by yourself?