Advocating for a spouse who is ill. Advice, please.

My husband has been experiencing physical symptoms for a long time, and has seen an assortment of doctors since last fall. Out of respect for his privacy (as much as that’s possible, posting our personal life on a public message board) I won’t post the specifics, but after six months of treatment including several changes in medication there is no improvement.

Long (like years long) before there were any outwardly noticable physical symptoms I saw what I believe are signs of depression. There is history of depression in his family. I am far from the only one who has voiced this concern. He dismisses the notion as ridiculous. It seems he thinks that seeking treatment for depression would brand him as a failure or less of a man or something.

He is very much a people pleaser, and has elevated saying what his listener wants to hear to an art form. I suspect that his doctor is not getting the whole story from him, and that I’m not hearing everything the doctor says either. Lately he’s had another round of tests and should be getting some results soon and I invited myself to his next appointment.

Part of me wants to ask the doctor right in front of him if his symptoms could be persisting because in addition to her original diagnosis he might be depressed. Is that even possible? I’m afraid that if I do he will feel betrayed and really close himself off from me. I’m also afraid that if I don’t I’ll be failing him in a huge way.

I can’t promise I’ll do what you say but I would sure appreciate some other perspectives on this, especially from the point of view of the patient or the doctor in this scenario.

Well, you’ve provided no information, whatsoever, about the other symptoms that your husband is having (and fair enough) so it’s pretty tough to say if they could be related to depression or not. Mental illness can certainly exacerbate many problems, but it generally doesn’t cause them. (e.g. people don’t develop type 1 diabetes because they’re depressed, for instance).

So, as to if you should share your opinion of your husband’s mental health with is Dr - well, I guess you know how your husband is going to react. I do wonder why you think he’s depressed - clinical depression is a rather specific diagnosis - the patients behaviour/mood/affect needs to meet a certain set of criteria for a specific amount of time before they will be diagnosed as depressed. Do you have any background in that type of assessment that leads you to believe what you do?

Alternatively, depending on symptoms, they could be causing a lower mood - chronic pain, for instance could make a person appear depressed even if they weren’t. Hypothyroidism can cause many depression like symptoms but is not a mood disorder - it’s a disorder of a specific gland or glands.

Sooo, dunno really what to say as it all kind of depends on what else is going on, ya know?

What are his symptoms?

My father was being unsuccessfully treated for depression for six months or so before my mother called up his doctor and told him how he was behaving during the times when he wasn’t depressed. He was put on lithium for bipolar disorder immediately thereafter, and returned to his normal self.

The doctor isn’t going to want to tell you anything about your husband’s medical condition “offline,” but I think it is OK to call him and tell him what you’ve observed, or even write him a letter. It’s also fine to bring it up during the appointment, but it may piss off your husband royally.

Take an honest, daily diet + caloric inventory, try to reduce high fructose corn syryups. processed meats, and fatty foods. No soft drinks, no whole milk. Chocolate once per day, before bedtime, no candy.

Got Broccoli?, well, get some and eat that shit like you were a goat, raw with dill dip, and in a stir-fry featuring pre-boiled chicken and carrots and them white mushrooms you buy in the store.

Initiate an excersize program and begin a life-long comittment to it. And not just walking around the block, I’m talking doin’ shit that damn near kills you when you finish.

Got a dog? If not, think about it, the added responsibility may help focus the mind, and puppies are a cure for depression. That’s a given.

Think positive as a MF-er. And FORCE that bitch to think positive. Smoke some pot and watch America’s Famliest Videos and shit, you will laugh your asses off, and the chemicals released in your brain from laughing will help you. That’s Mayo Clinic.

Sometimes you just gotta say, look bitch, like sands through the hourglass, we are not long for this world, and someday YOU ME and everyone you know and everyone they know will all be dead and forgotton and shit. What we got is now! So let’s party!

Word

gwendee, you don’t give a whole lot of information, which is your prerogative, of course, but it makes commenting a bit of a minefield.

Could depression be causing a physical illness? Highly unlikely. It’s not impossible that mental illness can manifest as physical symptoms but it’s uncommon and you MUST eliminate all physical causes before coming to that conclusion. You don’t want to misdiagnose, say, gluten intolerance as anxiety disorder or something.

Could depression exacerbate a physical illness? Well, it certainly won’t help.

HOWEVER - you say he’s been treated for six months with [no improvement. It would be VERY ODD for a person NOT to be upset or down or blue with that going on. In other words, his “depressive symptoms” may be a perfectly normal reaction to chronic illness or a difficult to treat medical problem. That does NOT make him depressed. Treating him as if depressed will not cure the problem. Curing the underlying illness will cure the problem. (If that can’t be cured then you have to talk about management, but that can be a very complicated affair).

Mentioning it to the doc in front of him? Guaranteed to piss him off. You might wish to discuss your concerns with the doctor privately. Of course, unless your husband has signed a waiver giving you access to his medical info and his doctor permission to speak to you about his medical condition the doc won’t discuss them with you, but you can certainly give the doc your observations. It could be very helpful.’

Finally, and I can NOT emphasize this enough - just because mental illness runs in his family does NOT mean he is mentally ill! It is part of the stigma of mental illness that those of us related to the mentally must go through life justifying perfectly normal behavior that goes unquestioned in other people.

rIs it possible he’s depressed? Yes. But neither you nor I are qualified to properly diagnose that. Something else entirely might be going on. If you’re concerned, please talk to your husband’s doctor privately.

Man, do you have to do that when people are looking for serious advice?

Oh dear. I composed a lengthy post that disappeared when the board decided I wasn’t logged in when I most assuredly was.

Thanks for your responses.

I can see that I wasn’t clear. I was trying to save a little face, but really more than that I want to help him and don’t know how. I called his doctor early on when I began to suspect that he was editing what he tells her. Part of that people pleasing I mentioned. She never did call me back, but asked him at his next appointment “Hey, why’d your wife call me?”

The initial physical diagnosis was of Type II Diabetes, but with changes in meds it still isn’t under any sort of control. He has other things going on, too.

He has had a number of long periods of what I’m thinking might be depression for as long as we’ve been together (over ten years). His mother’s a psychiatric nurse and has asked him herself to be screened for depression. He says that he doesn’t believe in psychiatry, and that he considers himself a basically happy guy, not depressed at all. Meanwhile he goes for days at a time without leaving the house or showering or shaving, sleeps in short bursts if at all, and is up most of the night.

Why I think it would be worth bringing up to his doctor is that when he’s in what I perceive as a lull he doesn’t test his blood sugar, or eats foods he ought not to. In February he cancelled a doctor’s appointment and it took weeks of gentle reminders that evolved into a week of pleading to get him to reschedule.

I know he’s not feeling like himself, and I understand that is a reasonable cause for blues or situational depression, but the lethargy, and withdrawl from family and friends started way before he ever mentioned feeling sick. It’s hard too, because when I try and talk to him about it (which is difficult for me to do. I want everyone to be happy with me at all times) he waves it away saying it’s just because of his uncontrolled blood sugar.

OP: you need to see his doctor without him there or knowing you are there, and explain your concerns. But if he has a chronic illness, of course he’ll be liable to depression - who wouldn’t be? If she’s not taking that into account in his treatment plan, move to another GP. Today.

This belongs in the “worst advice given on The Dope” thread. Dude, you don’t remotely have enough info to be this specific. Not that I could imagine a condition in which this and only this adivce would be “good”. IOW, in cases where you don’t know what you’re talking about, STFU.

type 2 diabetic chiming in …

Actually depression has nothing to do with diabetes. What depression can do is make him sneak foods he is not supposed to eat, and miss taking meds at the right time or in the right way. It is commonly accepted that diabetics have essentially the same mourning process as Kubler-Ross describes - denial, anger, bargaining, depression and acceptance. People are upset by a permanent chronic disease process that can make them lose body parts, vision, kidneys and deny them the ability to eat whatever they want when they want … and believe me, diabetes is a major lifestyle shakeup. Yes your husband is depressed, and it has nothing to do with a brain chemical imbalance, it is part of his mourning process - not for a relative or friend, but for a lifestyle. 6 months is nothing in the life of a newly diagnosed diabetic. Hell - life is done in 3 month chunks - my endo tweaks something and tells me to come back in 3 months, as it takes time for the metabolism to adjust. Some things can be relatively instant - changing the diet can drop the blood glucose from 600 to 150 pretty immediately [think about it, I have a friend who got hauled to the hospital with a BG of 640, he had been in the habit of drinking 4 r 5 liters of sugar based sodas a day instead of water, and snacking on chips and candy while at work. He changed to diet soda, and dropped the candy and chips for raw veggies and within the week his Bg was a more reasonable 100-200 range. Then he fine tuned the rest with meds and exercise] Adding exercise can help control by forcing the body to metabolize instead. BP meds help protect the kidneys, and glucophage helps the body metabolize by tweaking the use fo insulin still produced by the pancreas.

Your husband may be sneaking snacks, or nondiet drinks in rebellion to losing his old food/drink abilities. He may be ‘forgetting’ to get his meds - if he is supposed to be injecting byetta or even insulin, the idea of having to spend the rest of your live stabbing yourself with needles is a huge issue. Hell, I resent having to shoot up and I know how big a difference it makes. I resent not being able to randomly sit there and grab a bag of chips, or a candy bar. I resent having to measure all my foods. I can’t just decide to eat that huge porterhouse steak with the huge baked potato and finish up with that slab of dulche de leche cheesecake. And I have been doing this since 1980. I do it because I have very clear memories of a friend of my parents getting shorter from the bottom as they amputated body parts starting with his toes. I know exactly what detrimental effects dabetes can have on a body, and I really do not want them to happen to me. I am very unusual as I still have toe hairs [indicating perfect circulation in my feets] and no peripheral neuropathy at all. 30 years of maintaining. Yes I resent my husband can eat whatever he wants, doesn’t have to check his feet for injuries, doesn’t have to shoot up, or test his blood multiple times a day … but I get over it and do what I have to.

Watch your husband, I will bet he is still resentful and doesn’t do various things he is supposed to be doing, or sneaking foods/drinks he isn’t supposed to be consuming. Once he works his way through the mourning process, he should improve. You need to work with him and his doctor to get him to actually get through the mourning process and start taking better care of himself. I doubt medicating for depression would help, because it isn’t a brain chemistry induced depression …

Actually, some of the psychiatric medications can cause diabetes as well as other endocrine and metabolic problems. Unfortunately, many of the doctors who prescribe these medications are unaware of this. The potential link between his medications and his diabetes should be discussed with his doctor.

He doesn’t currently have any medications that aren’t to treat the diabetes. Does this mean though, that were he to start taking an anti-depressant it might interfere with controlling the diabetes? So I’m back to damned if I do and damned if I don’t?

Not necessarily. There are a lot of anti-depressant medications out there, and a smart doctor will consider side effects and interactions. Meds can also be changed out if undesirable side effects pop up.

aruvqan, I appreciate all that you shared. It seems logical that there is a natural response to “You aren’t how you thought you were and have to change everything.” Why it concerns me is that he was having depressive symptoms for 6 or 7 years (that I’ve personally witnessed, possibly longer) before there were any diabetes indicators.

Since the doctor is inclined to expect the sort of reaction you described, and my husband is inclined to lie about or underplay his own condition and symptoms my concern is that if there is depression separate from the diabetes that it will go untreated, and that in turn will affect his ability to gain and maintain his blood sugar levels.

I absolutely understand that I am not qualified to diagnose depression. My hope is that I can involve someone who can without my husband becoming so resentful that he leaves me. What I don’t know how to do is get from here to there.

What about a marriage counselor? Suggest that this “new” diagnosis of diabetes on top of the existing symptoms is something you are having trouble dealing with and that adding an experienced third party to help the two of you communicate better would be a good thing.

This counselor might then be able to help determine whether the depression symptoms are serious enough to need treatment, and help your husband to understand that you want him to be well and happy and in partnership with you.

(I’m just thinking aloud here, if I’m totally off base, I hope someone will say so.)

Depression isn’t an on/off binary thing, more of a spectrum. It’s possible that your husband is closer to “depressed” on that scale than other people might be, meaning he is more likely to display symptoms due to a particular stimulus than someone else might.

That doesn’t mean medication for depression would help. Unless the problem is rooted in brain chemistry (sort of the brain’s equivalent of diabetes) medication won’t help and might harm.

So, now that you’ve said more I see where he has some symptoms of depression, but I agree, it could be adjusting to diabetes. My husband went through this a few years ago - he had an attack of pancreatitis, was taken to the hospital in agony, then woke up in intensive care to be told a lot of his pancreas had been destroyed and he had become diabetic overnight. It took something like a year and a half to two years to get his medication adjusted and for him to adjust to all the changes he had to make. In addition to disordered sleep, not wanting to leave the house, and so forth he had to deal with fainting spells from low blood sugar. Which meant he was also not allowed to drive for months until that was sorted out.

He does need to stop glossing over things with the doctor, though. For one thing, if she’s competent he’s not fooling her one bit. Second, he’s going to be a lot more bummed out if he doesn’t get the disease under control.

Of course, you can’t really FORCE him to do anything.

So - here’s a suggestion for YOU. Find a support group FOR YOU for spouses/relatives of people with diabetes or chronic illness. Because this is obviously bothering you a great deal and you need coping strategies. If he asks why you’re doing this then be up front with him - tell him that it’s because he neglects his health and himself, which is causing you distress, and you need to deal with that so you can take care of him. He isn’t the only one in your relationship trying to please everyone and keep everyone happy and tell people what they want to hear.

**AND THE AWARD FOR WORST ADVICE EVER ON SDMB GOES TO:

SUPER KAPOWZLER**

Crowd goes apeshit, “We are the Champions” begins to play, SK runs around room with hands in the air.

"For taking a simple premise as “Outward Symptoms of Depression” and suggesting such witchcraftery as "Good Diet, Exercise, Puppies and personal motivation/attitude adjustment"

What I meant was 20mg Paxil 3Xday. Tuck patient into bed, suggest 20-hour-per-day-sleep cycle, Feed fast food, junk food, and pure sugar. Avoid sunglight, Avoid fresh air, avoid mental and physical challenges. AVOID PUPPIES AT ALL COST they will cause a SEVERE REACTION. Reassure patient that this life is ONLY TEMPORARY and that in the next he will come back as Bon Jovi and be worshipped and loved and life will be a fucking cakewalk.

I lived at the corner of Paxil and Prosac for a good two years.

Askance, you can stop staring at my junk, it is getting embarassing.

It means you have to do your own research on each medication he takes, and be vigilant about watching his blood sugar numbers for trends that correlate with changes in psychiatric medications. Many doctors are unaware that certain psychiatric medications have this effect, so you have to be the one to stay on top of it.

Lithium use has been linked to type II diabetes. Some of the atypical antipsychotics are linked to problems with metabolism and diabetes (like Zyprexa). These are being used increasingly to treat depression. Paxil has been linked to changes in blood sugar in some users. The risk is higher with some medications than it is with others. If he starts a medication for depression, do your reading!

I have type 2 diabetes (courtesy of lithium) and I take psychiatric meds. But I have chosen a medication that does not seem to impact upon blood sugar levels.

This is the heart of the matter. You should be bringing up these actual symptoms, rather than attempting to diagnose depression, when you speak with the doctor. Just tell the doctor that in addition to whatever other symptoms your husband is experiencing, he is also experiencing these symptoms, and you want to know whether they are related to his diabetes (clearly the not testing and the eating habits are) and how they should be treated.

Telling the doctor about specific symptoms that you have observed is absolutely reasonable. How your husband might react is a separate issue, but there is nothing wrong with advocating for his health.

Take your act to one of your own threads. It doesn’t belong in this one.