The Question: My husband is having panic attacks, trouble sleeping and has felt "dull," "empty" and "disconnected" from me and his friends for months. His work and home life are stable. I think he's depressed – he's used the word himself. Our doctor seems to feel he should "get over it" as he doesn't have anything to complain about. He recommended a counsellor who suggested relaxation exercises. I'm not trying to push pills on my husband, but he needs more treatment than breathing exercises on a brochure. How do we get someone to take this seriously?
The Answer: It is difficult enough to ask for help but when your family physician doesn't take it seriously and your husband's concerns are not validated, it can compound his psychological distress. To me, a brochure of breathing exercises trivializes a condition that sounds deserving of prompt medical treatment.
The symptoms of depression are many and include hopelessness, loss of interest in activities he used to enjoy, fatigue, changes in appetite, early morning awakening and difficulty concentrating. If he has felt symptoms for most of the day, nearly every day for two weeks, it might be a sign of clinical depression, according to Katy Kamkar, a clinical psychologist at the Centre for Addiction and Mental Health's psychological trauma program.
Depression and anxiety can occur at the same time, said Dr. Kamkar, noting that "it is not uncommon to experience panic attacks … that are cued or triggered by specific stressors."
Anxiety can vary in severity from mild uneasiness to panic and it can vary in frequency from occasional distress to constant unease.
Hallmark features of all anxiety disorders, she wrote in a e-mail, include the following: feeling anxious when placed with particular objects or in specific situations, the tendency to underestimate our coping abilities, excessive fear, difficulty coping with daily activities, the tendency to overestimate danger and difficulty tolerating uncertainty.
Look, I bet you are more than a little frustrated with your family doctor right now. Maybe he was having an off day and didn't take your husband's condition seriously enough. Or he's had such a miserable time trying to obtain timely referrals for other patients that he just wanted to make sure your husband got quick help from a counsellor. Whatever the case, you need him to help your husband.
Make an appointment with the physician and say these three things: thank him for the referral to the counsellor, let him know you followed the counsellor's advice and tell him that unfortunately it didn't have the impact you were all hoping for. Whatever you do, do not leave that room until you have a plan, which should include a referral to a psychiatrist or other mental health professional for your husband.
Where to get more information
Centre for Addiction and Mental Health (CAMH) www.camh.net
The Panic Center www.paniccenter.net
The Depression Center www.depressioncenter.net
Canadian Network for Mood and Anxiety Treatments (CANMAT) www.canmat.org
NIMH Anxiety Disorders Education Program www.nimh.nih.gov/anxiety
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to firstname.lastname@example.org.