How do I get my wife to the doctor? (Depression and paranoia)

In My Humble Opinion
1

This is not a thread seeking medical advice, it is about how to get medical advice…and it’s long.

If you have had experience as a caregiver or patient, I would like your input.

My wife going through a tough time right now and I don’t know how to help her.
Background: age 36, diagnosed with Multiple Sclerosis 4 years ago when the twins were 2. Currently has neuropathy manifesting itself as severe pain in her left arm, left half of her face and left leg, difficulty walking due to her left leg dragging, serious headaches and almost constant nausea. Prognosis is not great, and she may also be experiencing an exacerbation now.

She is already on a raft of medications including Rebif (3x/week injection that stings like hell), Lyrica, Neurontin, and methadone (4 ml daily 5mg/ml solution). She was on Tegratol a couple of years ago which worked beautifully for her until the allergic reaction forced her off it.

She has been diagnosed as depressed previously and is on meds for that but has been under stress recently and is getting worse. Our son (6) has trouble hearing and we are trying to get that seen to, and our daughter (6) has started having absence siezures (petit mal epilepsy). Our daughter is supposed to start at an epilepsy clinic in August (9 months after we started noticing, and 7 months after confirmation of diagnosis). Her spells are becoming more frequent and this is stressing her more.

I try to support her and listen and help out wherever and whenever I can.

Our neighbour recently cut down a stand of trees along our property line which has contibuted greatly to her stress. She loved the trees there and the chain link fence now there has robbed a lot of our percieved privacy. It has somehow reinforced her perception that everything is my fault and I am unable to support her in anything.

She knows that she is depressed (with good reason in my opinion) and has had her neurologists provided prescriptions for it, but I don’t think she has realized that it is considerably worse in the last couple of months.

How do I get her to recognize this and ask the doctor for different treatment? She now thinks that everything I say is an attack or putting her down. I’m afraid that if I suggest that something is up, then I am just attacking her again.

Case in point: The tree-hating neighbour told us that they would be putting up shrubbery to better provide greenery. He started working on a bedding area near his patio instead of at the fence. She looked at it and saw a large bush that is growing up at his patio and freaked that he is putting shrubs way up there instead of the fence. I look and comment that the bush was already there. She FREAKS! How dare I defend him? I suppose I shouldn’t have made the observation.

I should also be out planting and improving the back yard. I am not moving as fast as I should. If it isn’t her way, then it is wrong. If I wait for her approval, the why can’t I think for myself. I’m between a rock and a hard place.

She has a (benign) family doctor, a couple neurologists, but no mental health professional. I know she is feeling out of control because of everything going on around her, but she seems to be determined to attempt control everything that she can and when she can’t, there is trouble.

I don’t know what to do…how do I get her the help she needs without seeming to be accusing her of being difficult or that everything bad that is happening is her fault?

2

Whew! Tough Questions but the good thing is you are not alone. If you don’t mind give your location and I will try and find a support group for you. This is a very difficult position you are in, but remember to be there as much as you can for your children and yourself. As you are no good to anyone if you start to go down hill.

3

You’re in a tremendously difficult place. My heart goes out to you and your wife.

You are probably right that she’s trying to exert control over what she can in order to compensate for everything she can’t control, and I admire you for recognizing that.

No matter how badly she is suffering, however, she does NOT have the right to treat you with disrespect. You are her spouse and you’re on her side (though she doesn’t seem to acknowledge that right now).

I think you may truly need to put aside your fears and well, go ahead and accuse her of being difficult. She IS being difficult. What she is suffering is not her fault, but it isn’t yours, either.

I think you need to lay out in no uncertain terms that you will not tolerate being treated as her whipping boy, and that you are willing to do whatever it takes to help her be physically comfortable and mentally/spiritually peaceful. She needs a mental health professional’s guidance, and I suspect therapy beyond medication. Draw your line in the sand and help her get it.

4

We’re just west of Toronto.

I am wary of broaching the subject with her at all, much less suggesting that her paranoia isn’t real and that other people agree. It’s one thing to say that she has a physical symptom that is worse, but to claim that her mental state is changed when she already feels persecuted worries me.

5

If her mental state has changed, ignoring it will not make it go away. She needs help, even if she doesn’t want to admit it. It will not do her, you, or your children any good for her to continue to take everything out on you. Sooner or later you will break under the strain.

Can you discuss this with her GP and see what he advises?

6

Thank you for your input and support.

Yes, I would like to discuss it with her. Having not dealt directly with someone in this state of mind, I don’t know how to bring it up. I’m hoping that someone who had already been through this will add to this.

In my mind, there are 2 ways to approach this, directly or through a professional. My fear with the latter is that it will support her theory that I am against her and going behind her back, while the former may seem confrontational to her.

I realize that I am the one who knows her best and how she may react, but I would like to have some idea of how people in this frame of mind view things.

7

She may not be in a frame of mind to do or say anything rationally. Probably not. She’s also probably very afraid. I would find a good therapist, LCSW maybe that specializes in major depression and talk to them one on one with just you. Then tell your wife how difficult a time you are having and that obviously you love her, but reassure her of that, and then broach the subjct of her coming with you to the therapist.

8

I would suggest looking at her medications with the help of her doctors. Sometimes side effects can affect mood - even causing paranoia. I hope this doesn’t cross into medical advice, but I’ve heard that more than once about neurontin. YMMV, of course.

If fact, suggesting her medications may need more oversight could be a way of saying that you don’t think it’s her, it’s her medications, and you believe there is a fix.

9

I don’t think there’s anything wrong with you making a call to the next doctor she needs to see. She’s being prescribed a whole lotta medicine. There’s even the possibility that one of her medications is aggravating the depression/paranoia. The doctor should be able to ask useful questions and refer her to a psychiatrist if necessary, and the psychiatrist should be able to make the recommendation for counseling, medication, etc. The doctor doesn’t need to mention that you called.

10

Good suggestions regarding the meds. Yes, she is on a lot of stuff, each to treat something different. I’ll see what appointment is next on the schedule, and see if I can at least have a note attached to the file.

I have to say that I’m not impressed with the way the doctors are handling her meds. She has 2 neurologists (one for MS, one at a pain clinic) and the GP. There doesn’t seem to be anyone who is willing to take the holistic viewpoint. We’re trying to find a new GP. This may be the ‘tactic’ that I need to present to her.

She’s talked about going back on the Tegretol again despite the allergy since it seems to be the one that made the most improvement in everything…(we know she can’t).

11

I agree with the suggestion of talking to her doctor(s), but you need to let her know that you’re going to do that. Otherwise, it will become more fuel for the paranoia – you’re going behind her back, etc. Maybe the fact that she’s reconsidering Tegretol could be the way to initiate the conversation.

My heart goes out to you both. Just dealing with depression by itself is complicated and difficult enough.

12

I’m so sorry you are going through this. I am caretaker for my husband. He has Bipolar type II. As an added bonus, he has a serious medical condition that restricts many treatment options.

At first, I couldn’t convince my husband to go to the doctor for a diagnosis of his mental health issues. He had gone to a psychiatrist previously and been diagnosed with clinical depression. Years of going to that doctor was wasted—because my husband was diagnosed incorrectly. Therefore, he assumed that his continuing depression was related to the health condition, not anything wrong with his brain. I made him an appointment with a counselor and as it got closer to appointment time, he became balky at going. So I went instead. It was the best decision I could have made. The counselor helped me find ways of dealing with my husband and convincing him he needed both a psychiatrist (for medication maintenance) and a counselor for talk therapy.

It took a while, but I convinced my husband that he had to go see someone about his depression. Which is when we found out he didn’t have the unipolar depression that he had been treated for on and off for 10 years. That’s when we finally figured out that he was bipolar and that many of the anti-depressants he had been taking over the years were contraindicated for bipolar.

I am still learning the best ways to deal with his problems. He had to quit working 18 months ago, and he is still not stable. He is going through a manic phase now that we can’t stop. His psychiatrist just mentioned the possibility of going inpatient and my husband is completely resistant.

My advice is getting a counselor for yourself first. S/he can help you gain coping skills to deal with your wife and some ideas of ways to convince her to see a mental health practitioner. And to get the correct diagnosis upfront. Then, just like with the MS, treat the disease and its symptoms and remember that the things she does are caused by the disease and may not be an accurate reflection of how she feels about you. My tactic with mr.stretch is to assume that he doesn’t mean any of the shitty things he says—it’s the bipolar talking.

My email is in my profile—feel free to use it if you need a shoulder.

13

Well, I guess there is no easy answer and we’re in for a ride.

I’ll start talking to her about her meds and see if she is amenable to changing Rx’s. There are enough issues with meds that I should be able to discuss it with her without causing aggravation.

There is another MS Clinic in a hospital a half hour away from us. Apparently it has good treatment programs, and it is the same clinic that our daughter will be (eventually) attending. I suppose with all that I should be able to have her agree to review her meds and behaviours. I have attended a couple of appointments with her in the past (usually with a new doctor), so I will be able to discuss it in that forum at that time.

Would the neurologist treat depression patients, or is that typically left to the GP or psychiatrist?

14

Tell her that a medical librarian says:

Depression is common in people with MS and it’s nothing to freak out about. Could be a side effect of meds, stress-related, or MS-related.
Read:

http://www.nationalmssociety.org/site/PageServer?pagename=HOM_LIB_sourcebook_depression

http://www.mslifelines.com/understanding-ms/symptoms-of-ms/depression.jsp

(Not intended to diagnose or treat anything. YMMV. )

15

I would strongly suggest you get a psychiatrist involved in medication management and disagnosis. A neurologist isn’t going to want to deal with psych meds and my experience with GPs and psych meds is not so good.

Also, as Snowcarpet says, depression is common in MS patients–my aunt has MS and she definitely has a depression component that wasn’t there pre-diagnosis.

16

Thank you for the input. Good information from all.

At least I know what sort of approach I need to take. I’ll post an update later with the results.

17

I guess that’s my cue…

First off, I am not a doctor, psychotherapist, or whatever. All I am is a husband whose wife has been diagnosed with clinical depression, and I have been there, buddy; reading your post was like stepping back in time.

Currently my wife is not on any medication for her depression and we’re doing fine – some good days, some bad days, but on the whole a lot better than we were. Back when things were nasty, though… ugh.

If I could find the link, I’d post it. Googling doesn’t seem to do much good and I’ve gone through four computers since then, so I’m afraid we’re out of luck there. I found a website that had suggestions on how to deal with your spouses depression. It appeared to be legit and I’m not a very trusting person. Anyway.

The biggest single thing that made the difference was… I wrote my wife a letter.

The website suggested it as a way to communicate. See, talking requires a lot more emotional involvement. Body language, tone of voice, gestures, all of it go into a face-to-face conversation, and it’s more than likely that you’re a bit frustrated with all that’s going on (even if you don’t think you are). That comes through as an attack on the other person, they get defensive, and bam – talks break down.

A letter is about as neutral as you can get, though. It’s just words on a page. There’s no tone (if you’re careful), no emotional baggage, just your words.

I can’t suggest what you put in the letter, really. You need to express your concerns. You need to reassure her that you’re not attacking her, that this letter is not a prequel to divorce paperwork, that you’re not suggesting she’s loony, all of it. But how you do that? Geez, man, I dunno. It took me a week to figure out how to word mine.

In the end, it all worked out for us. My wife went on medication briefly, and is now able to manage without it again (though there are trouble signs in the air again… darnit :slight_smile: ). These days, when she’s getting too moody, I can pipe up with “Do I have to write you another letter?” and she realizes that It’s Happening Again and can take steps to fix it.

But really, the key thing is that she realizes that she CAN trust you, regardless of what her emotions are telling her at any given moment. And that’s HARD to prove.

18

Wow. Thank you. I think that makes sense. It can be difficult to discuss anything calmly sometimes…especially when she is in a confrontational mode. I’ll start writing stuff out and see if it is something worth presenting to her (when she is relaxed and in a good mood).

At this point she is finding it difficult to trust me, so, yes, this is the hard part…well, one of the hard parts…