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Dr. Steve
Dr. Steve, Psychologist
Category: Mental Health
Satisfied Customers: 370
Experience:  19 years conducting therapy; book author; newspaper columnist; former co-host of radio show
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MY HUSBAND OF 47 YEARS HAS BEEN FIGHTING DEPRESSION FOR YEARS.

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MY HUSBAND OF 47 YEARS HAS BEEN FIGHTING DEPRESSION FOR YEARS. HE ALSO DEALS WITH CHRONIC BACK PAIN FROM AN ACCIDENT IN HIS TWENTY. HE WAS ON NARCOTIC FOR YEARS. IN JANUARY OF 2009 IN WENT TO UNI AND DETOX AND IS NOW ON SUBOXENE. THIS PAST YEAR HIS DEPRESSION HAS GOTTEN WORST. HE AGAIN WENT TO UNI AT THE U OF U IN UTAH AND HAD ELECTRIC SHOCK TREATMENT WHICH ALMOST WAS THE DEATH OF HIM. IT TOOK MONTHS FOR HIM TO EVEN START TO FEEL AGAIN. HE IS NOW ON CYMBALTA AND GABAPENTIN. ALSO HE IS GOING FOR TALK THERAPY. AT THIS TIME ALL HE WANTS TO DO IS SLEEP, SLEEP AND SLEEP. HE HAS NO DESIRE TO DO ANYTHING. WHAT DO WE DO NOW.

Hi Lynn:

 

Okay, a couple things are going on here. First, both the Suboxone and the Gabapentin are going to cause drowsiness, so he may be fighting a battle against his medication. The Cymbalta should give a bit of a boost, but the Suboxone in particular is pretty heavy. If he only recently began the Cymbalta, then give it a few weeks to take root before going back the the physician to have the dosage examined.

 

Second, the Suboxone is affecting the pleasure centers of the brain, and essentially "coating" the receptor sites up there. The botXXXXX XXXXXne (I know it gets confusing) is that he will experience a decrease in general "happiness' while on the Suboxone. Drug addiction treatment may be necessary (hopefully, the talk therapy is incorporating this aspect) to address some of the issues of being hooked onto the opiates. If he is not an addict and does not have addiction in his family tree, then he may be able to wean off of the Suboxone and live free of the pain killers. If he has the genetic machinery for addiction present in his brain, then longer-term talk therapy and maybe a 12-step support group may be warranted.

 

Otherwise, the gabapentin may not be a long-term medication, depending upon how and why it is being prescribed. I would urge you to speak to the physician about the "Plan" regarding medical management so that you understand not only where the medication regimens are headed, but also what effects to expect.

 

And if shock therapy set him back, stay away from that form of treatment. Typically, that avenue is explored only when other medication treatments have failed. If he is just now on Cymbalta, then there may be options worth exploring.

 

If you are satisfied with the response, please click "Accept." That is the only way I receive credit for my answer. Thanks-

Dr. Steve

Customer: replied 6 years ago.
i need more information about what david is to do about his pain. he is truly in constant pain from his accident and his surgeries. between the pain and the depression he is at the end of his rope. and so am i as his wife. the thing we have going for us is we not only love each other after 47 years of marriage, we still like each other.

Hello again, Lynn:

 

One key element in the process is that the brain will actually create pain to motivate the person to get more of the pain killers. It is what makes detoxing off of the opiates so problematic - a neurological exam should be sought to determine if the pain is coming from an actual injury or if it is the addiction screaming out for more of the drug. I know that answer hits upon the very thing which frightens your husband the most, but that is why I recommended a substance abuse program for him. Getting in with an addiction medicine specialist (a physician who specializes in issues your husband is experiencing) will be beneficial in that he can be offered a different perspective. Many pain clinics simply keep writing prescriptions for the pain medication rather than at least considering the question of withdrawal symptoms (i.e., making the person feel more pain to drive them back to the pills). Ultimately, I would like to see your husband off of the meds if at all possible... but that is why a neuro exam would be beneficial. It would be hard for any of us (including your husband) to know for sure the extent of the injury.

 

If this step has already been taken, then allow the Cymbalta to take seat. His physician may want to up the dosage if there is some progress, but again, the Suboxone in particular is going to make the process tricky. If I could once again put in a plug for an addiction medicine specialist, they are in the best position to understand the interactions between the drugs we are talking about, and also to help manage the depression which is ALWAYS present when one is detoxing or going thorough treatment.

 

If you are satisfied with the response, please hit "Accept." This is the only way I receive credit for my answer. Thanks-

Dr. Steve

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