Thanks Dr Logo

Depression and Bereavement

My mother died five weeks ago after having a stroke and then a seizure. I have been her carer for a number of years and especially more so since my father died four years ago. Both my parents made wills to try and make everything as easy as possible when they died but when my mother's will was taken to a solicitor they realised it was wrongly worded so they is a lot of problems arising from that especially as I have three sisters who live a long way away. My question is that I have a number of health problems I have been taking Mirtazapine for over a year but they are not helping me now and my GP has prescribed Trazodone I presume to take as well. I also have a lot of back pain caused by arthritis of the lower back facet joints and for this I am on Paracetamol, codeine, and as these are not helping enough Naproxen with Omeprazole. I have just been back to the orthopeadic clinic and they want another scan to see if things have changed in the last two years and whether a fusion operation is needed. I have other things to cope with too and I am finding it so difficult to keep going and scared because I am now on my own and afraid of side effects or what I may do I am so mixed up and it is difficult to find motivation. I have also had a hysterectomy for cancer six years ago. The thing is that my GP has given me all these medications but I am afraid to take them all but I needed help and it gives the impression that I am asking for help then refusing it when it is given which I don't mean at all.

Doctor's Response

Date:Nov / 2011

Thank you for your question.

Hi there, I'm sorry you are having such a tough time at the moment. Lots of people are really worried about taking a mixture of lots of tablets and are frightened of side effects. I think a lot of the things you describe like lack of motivation, feeling 'mixed up' as you put it yourself, not feeling that you want to burden your GP by going back or appearing to be refusing their advice may all be part of your depressive illness. Depression can stop you thinking clearly or logically and can make other health problems, particularly pain, much worse.

To be honest i'm not sure if your GP would have intended you to take the trazodone as well as the mirtazapine. I suspect they may have meant you to take it instead of the mirtazapine. The doses used for depression of trazodone are between 150-300mg usually taken at night. You definitely need to clarify this with them. They won't mind at all if you contact them or make an appointment to see them to discuss it, they would much rather you were confident you were taking the right thing.

You didn't say anything about sleep, but as they have suggested mirtazapine and trazodone I suspect you may have been having big problems sleeping as these are two of the very few antidepressants taken at night which sometimes help sleep.

I would clarify with your GP that you are supposed to be one or both ( but I think trazodone alone probably) and then try the trazodone for a while. If it doesn't work well or you have side effects ( commonly dry mouth, sedation, drowsiness) i would maybe ask your GP about duloxetine as an alternative. It is an antidepressant but is also used for chronic pain including back pain, and may help both your problems.

Your painkiller cocktail is pretty standard, your GP has quite rightly given you an anti-inflammatory like naproxen but as you are taking it regularly and are over 65, you ought to have omeprazole to protect your stomach from side effects such as gastritis. Most people with chronic back pain are on a combination of parcetamol/ codeine, plus an antiinflammatory, plus the omeprazole for safety.

I would continue your pain relief medication as prescribed, but see your GP about the antidepressants and as above ask about duloxetine as an alternative to try to treat both.

Good luck, hope you feel better soon.

 

Thank you for using ThanksDr. I do hope this information is of use to you.
Yours faithfully,
The ThanksDr Team

Patient's Response

Date:Dec / 2011

I'm sorry I have had problems with my computer someone had hacked into it. I have been given Omeprazole. As I said I am in such a muddle I can't even think straight I don't know if it is all that is happening trying to deal with these problems, the medication, depression or the loss of my mother. It is very hard to know just where to start or whether to hope that there will be some relief somewhere. My own GP is away at the moment but as he renewed the prescription for Mirtazapine I assumed he meant me to have both, though I am not having them both at the moment.

Doctor's Response

Date:Dec / 2011

Thank you for your question.

In that case I would continue with the mirtazapine until your GP is back and you can clarify with him whether you should be taking both or not. Has he suggested some counselling for you? He should be able to refer you locally, and there are plenty of online resources such as mood gym, which can help with low mood.

moodgym.anu.edu.au/welcome

As bereavement is part of the problem, Cruse the national bereavement charity have some excellent resources and may be able to offer you some support as well.

www.crusebereavementcare.org.uk/


I hope this helps.

Thank you for using ThanksDr. I do hope this information is of use to you.
Yours faithfully,
The ThanksDr Team

Patient's Response

Date:Dec / 2011

My apologies for asking another question but I realised that I had not put down clearly what I wanted to know as I was so upset by things going wrong, I tried to alter my reply but did not see a way of doing it. Yes in the past I have used Mood Gym but Cruse will not help before two months have elapsed from the person's death. I am having some councilling but that does not help me coping with my physical problems. Does the Naproxen work on an acculative bases or can it work just by having one dose like paracetamol because I have been prescribed three a day which I am finding quite hard as even with one they iritate my stomach. I am told that one should keep taking painkillers etc every six or eight hours and not allow the pain to become too bad but I'm afraid that there maybe too many side effects and that they will not have the desired effect if I just keep on taking them. Am I wrong in this view.

Accepted Answer

Date:Dec / 2011

Thank you for your question.

Naproxen has a cumulative effect, but if one a day is irritating your stomach, especially as you are taking the omeprazole, I think you should stop it. The risk is that it can cause stomach ulcers and / or bleeding in the stomach. This can make you very unwell very quickly and is not worth taking the risk.

There are plenty of alternatives, as well as your paracetamol and codeine your GP might give you an alternative antiinflammatory that might be less likely to upset your stomach, such as meloxicam or celecoxib. These are not suitable for everyone and with your full medical history available to them your GP may decide these are not suitable. You need to see him to discuss this. 

If you need another alternative, they might try gabapentin or pregabalin. These are sometimes used to treat neuropathic pain, and are not anti-inflammatories. They can be very effective for chronic pain.

Your GP may also consider referring you to your local pain clinic if they are struggling to find suitable treatments for you. They could also refer you to physiotherapy if this hasn't been done already.

Lastly, I think it's impossible to separate the two processes of pain and depression, They can make each other worse and both need treated in their own right. I hope you see your GP soon to discuss this again.

Thank you for using ThanksDr. I do hope this information is of use to you.
Yours faithfully,
The ThanksDr Team

Doctors' Login Join the team News Sitemap Terms & Conditions

©2010 All Rights Reserved. Thanks Dr Ltd.