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Dr. D. Love
Dr. D. Love, Doctor
Category: Mental Health
Satisfied Customers: 18762
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am seeking guidance regarding my 49 year old brother who

Customer Question

Hi - I am seeking guidance regarding my 49 year old brother who was diagnosed with Chronic myeloid leukemia 10 years back - he has been thankfully in remission on medication. He went through major depressive episodes over the first few years after diagnosis of CML, going through stages of withdrawal, pessimism, and depression/was advised to seek psychological assistance but persistently declined. He has a supportive family and a few close friends, and after the first few years following diagnosis of CML, his mood and outlook to life had stabilized until the past 2 years - He has been the primary care giver of our 82 year old Mom whose health has been deteriorating with progressive dementia - and her deteriorating health is clearly impacting his psychological wellbeing. He is reluctant to seek a psychiatrist /psychotherapy - I would appreciate any advise regarding resources for online / skype therapy sessions and therapists who are willing to take on a client - financial responsibility is assured.
Many thanks!
Submitted: 1 year ago.
Category: Mental Health
Customer: replied 1 year ago.
To clarify- he was never diagnosed with "major depression" but had manifested symptoms of depression within the first two years of being diagnosed with CML (withdrawn, focused on death, reduced pleasure in life, irritable, lost sleep, anger issues etc.).
Expert:  Dr. D. Love replied 1 year ago.

Hello from JustAnswer.

It is very common for someone that is dealing with a major illness to also have depression. And the added stress of caring for an ailing mother could be a cause of depression, even in someone that is generally healthy.

There are online sites that offer varying amounts of therapy. Examples of such sites include talkspace,com,, and

Customer: replied 1 year ago.
Thanks- yes these sites are easily identifiable via web search -any guidance regarding which may serve better would be appreciated. Any suggestions regarding how to engage a reluctant individual in seeking therapy? Is there a role for empiric antidepressant therapy, and if so, which class of agents may be best for first line trial?
Expert:  Dr. D. Love replied 1 year ago.

There is no objective rating or review system to say which site is better. There is no single best way to get a reluctant person to seek care for a mental health problem. You can only encourage him to seek help, but the nature of the encouragement would need to adjust for the individual personality. It may help to get a greater number of family members and friends to encourage seeking such assistance, but that would also depend upon the social situation. An antidepressant would be a reasonable consideration, but it would typically only be started after a diagnosis of depression, so would require a doctor visit for the problem. The most commonly used class of antidepressants would be the SSRIs, such as sertraline or citalopram.

Customer: replied 1 year ago.
Many thanks! May I request added clarification re choice of antidepressant - if fatigue/lethargy are accompanying symptoms, would these influence choice be regimen? How do Sertraline or Citalopram compare to Wellbutrin given these coexisting symptoms?
Expert:  Dr. D. Love replied 1 year ago.

Yes, but it is more complex. The fatigue or lethargy may be a primary symptom of the depression, but it also may be a reflection of inadequate sleep, and the choice of antidepressant would vary according to the situation.

In studies that look at overall effectiveness and incidence of side effects, the SSRIs are usually rated as the first choice of antidepressant. Wellbutrin is usually considered as a second line antidepressant, particularly if side effects occur to an SSRI to which the Wellbutrin is better tolerated, such as sexual side effects or weight gain. However, in someone that has never been on an antidepressant but concerned about these side effects, the Wellbutrin may be considered as a first-line agent.

Customer: replied 1 year ago.
Many thanks for the clarification and for the meaningful suggestions-most appreciated!
Expert:  Dr. D. Love replied 1 year ago.

You are very welcome.