Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Course of Care & Depression

Antidepressant medicaitons are effective_for their intended purpose.

Depression consists of two very different components:

a. The physical (neurovegetative symptoms) which include problems with sleeping, eating, irritability, concentration and decision making, etc.

b. The emotional aspects (from a recent journal article) which include _a return to normal functioning rather than solely a relief from symptoms_the three most frequently judged to be very important in determining remission included the presence of features of positive mental health such as optimism and self-confidence; a return to one’s usual, normal self; and a return to usual level of functioning

The latter (b) are most often not addressed. It is assumed that a patient in pain is depressed (or the patient complains of being depressed). He/she states that she is _down in the dumps_not sleeping very well_tired_grumpy_forgetful_eating habits have changed._

They are prescribed someone_s favorite antidepressant, and they may, indeed, sleep better, have a more normal eating pattern and be less irritable.

However, (as noted in this study) _patients indicated that the presence of positive features of mental health such as optimism, vigor, and self-confidence was a better indicator of remission than was the absence of the (physical) symptoms of depression.

Many patients will tell you that _oh, the medication helps somewhat, but it does not tell me how to solve all these problems._

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