Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Antidepressant

“Antidepressant Medication”  The occurrence of a work-related injury can result in pain, financial devastation and destruction of family.  To relegate this upheaval to a dosage of the proper medication suggests that the patient cannot learn to solve the problems which have arisen. 

I ask the patient “was your father ever depressed?”  The patient replies “Never! My father was a strong man.” 

To the patient, not only is depression a weakness, but it is characterized by someone who does little, cries often and is a burden to the family. 

We have become lost in the definitions of the depressive disorders and, concurrently, begun to believe that they are biological events, quite unlikely to be tied to an injury.  The depressive disorders, in some quarters, are seen as a brain chemistry imbalance that is righted by one or more antidepressant medications. 

The average irritable and impatient individual, who has problems with sleep and appetite, and who is forgetful, joyless and has problems with decision-making is simply “mean spirited” or “just plain grouchy.” 

Unless they have tearfully retreated to a darkened room and refuse to arise, they are not depressed in the minds of their family. 

The patient, in turn, simply does “not feel well and has no energy,” and regardless of socioeconomic background, the patient also sees depression as an unwanted diagnosis.  And if the patient must accept a diagnosis of depressive disorder, he then reassures himself that he is the victim of bad chemistry, must simply take antidepressant medication and will never be required to address the issues that led to (and are amplified by) the depression. 

So once we remove the psychological as a causation for depression, we are left with a patient taking a medication that may have untoward side effects, a medication with which he will not consistently comply, and the problems that are amassing will continue to grow.  

There are, of course, competing schools of thought:

a. All depression is due to a brain that is no longer chemically efficient

b. Most depression has its roots in a series of losses and disappointments which have now altered brain chemistry. 

Thus, we see a disconnect when a patient is referred to a provider solely for medication and another provider solely for psychotherapy.  

Complicating this further, the two clinicians may not collaborate and each defers to the other when the patient attempts to share the same data, biological or psychological, with the “wrong” provider: “you need to tell Dr. ____ about that” or “Dr. ______ is the one that handles those concerns.” 

Which brings me back to my response: To relegate this upheaval to a dosage of the proper medication suggests that the patient cannot learn to solve the problems which have arisen.

To Self Refer

Wellness

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