Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

"Medication vs. Medicating"

Prescribing an anti-depressant does not guarantee that the patient will be adequately medicated.

Injured workers, like most patients, are as reluctant to take medication for depression, as they are to accept that they are depressed. It is easier for them to tie the symptoms of decreased energy and libido, joylessness, irritability and impatience to their physical injury.

However, unlike pain medication, antidepressants do not work within minutes…, hours…, or days. The initial response to antidepressants will seem to the patient as either very subtle or none at all. Their families may note that they are less forgetful, less brooding, less withdrawn and spending less time sleeping the day away. The patient may have better control of appetite and eating.

But pessimistic thoughts and a sense of a negative future may continue and even seem unchanged.

Adequate treatment of depression requires:

The right medication at the right dosage levels
Preparing the patient for the gradual signs of improvement
Establishing with the patient what are the most important symptoms to target and track
Educating and enlisting the family in compliance
Involving the patient in cognitive-behavioral psychotherapy, where they learn more adaptive means of dealing with thoughts and feelings
When it comes to medication, depression is a unique disorder. A patient may not respond to one antidepressant but may respond to another or a combination of medications. Dosage levels for both side effects and therapeutic response may differ among patients.

Side effects are arguably the most problematic. Some antidepressants result in dry mouth and over-sedation. Others briefly create headaches and stomach complaints, and still others can result in agitation. The two most common reasons for lack of compliance are these unpleasant side effects, combined with a delay of several weeks before they note any improvement in their depressive symptoms.

The use of antidepressants almost always requires active and consistent involvement with the patient as s/he begins to mobilize.

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