Editorial Note: This post is about an issue covered before – the effects of antidepressants on relationships – see My Wife Has Left Me. This post had thirty-four follow-up comments which show that this issue gets at the heart of doctoring – what do you do when a wife or husband tells you the SSRI their partner is on has changed their personality and this wish to leave the marriage is something their partner will regret when they finally do stop treatment. What do you do? Do you insist the partner has a “holiday” from treatment?
There was also an internet thread on similar topics some years ago. We would like to hear from others with similar stories. SSRIStories.org might provide a home for this topic which contrasts curiously with attitudes people have to a wife or husband who kills their partner while on treatment. This will feature in next week’s post.
Jane and her husband John are professionals in their early forties. They have three children under the age of twelve. They met in university twenty years ago. John was something of a pessimist, but he had a very gentle, caring and sensitive side, which is what appealed to Jane. He had another side, too. He could be sarcastic and make comments with a cruel edge to them.
John is extremely intelligent, an analytical thinker and a formidable opponent in an argument. He excels at work, and tends not to do anything by half-measures. Whatever he does, he goes all out, whether it is drinking alcohol, exercising, smoking, or arguing. He likes to be in control and often dictated what the couple did with their spare time.
John found that shift work and the working patterns of his job negatively affected his moods and anxiety levels, so he decided to move work to an area that would also be more ‘child friendly’. He enjoyed the new more regular work regime. When the children came along, the sleep deprivation that kids can bring again affected his moods and anxiety levels. The family moved, and John upped his hours to pay for the mortgage.
When a professional law suit was issued against him, his anxiety levels got worse. He started to exhibit OCD-type behaviors, became indecisive, felt bleak, talked about suicide and ending it all. He began to drink heavily and his contribution within the family declined over a couple of years and finally ceased altogether.
His GP decided that he was depressed and prescribed Zoloft. John stopped drinking and his anxiety waned. He started to read and spend time with the family. After a few months the GP doubled the dose of Zoloft. A few weeks later John suddenly started wanting to exercise and get out. He immediately took on a major exercise routine and overdid this until he hurt himself. He saw a therapist for a couple of sessions and came back positive and reported feeling a lot more like his ‘old self’. His wife Jane agreed that he was more optimistic, caring and more like the man she fell in love with. After a month he stopped therapy and returned to work.
Over the next while he seemed to regain his zest for life, enjoying everyday things, was fun to be around, and took an interest in others. Holidays were good, and he felt like an active part of the family again. He had started to drink moderately, and was exercising regularly. It appeared that he was in control and stable again.
His GP suggested that John try and reduce the dose of Zoloft, which he did without telling his wife. This partial withdrawal made him ‘manic’. He began to drink heavily and got excited easily. He did odd and atypical things and spent money he did not have on expensive items he did not need. He signed up to take courses
His drinking was so heavy he was having memory blanks and collapsing. He decided that the problem was the lower dose of Zoloft and he decided that he simply couldn’t manage on less than 100 mg/day. In his mind it was like someone with a thyroid problem who cannot do well without their medication.
John switched back to 100 mg of Zoloft but his heavy drinking continued. He obsessed about changing careers again saying that he was dissatisfied – new course fees were paid and he bought an expensive laptop for himself. He was spending all the family’s discretionary income on himself. Jane and John stopped renovating the house, and shelved plans to build an extension.
John began socialising with people from his new job. This seemed to involve pubs, lots of alcohol and night clubbing, a very different life than what John used to live. He started staying out very late and coming home so drunk that he couldn’t get up the next morning. He jokingly commented one day that he thought he was having a midlife crisis because he wanted a tattoo and a Motor bike. His demeanor became increasingly jittery, and he continued to make expensive purchases.
Eventually John began to complain about his marriage. He was increasingly agitated and dissatisfied. He distanced himself from Jane and the kids, and when Jane’s parents experienced a health crisis, he remained detached and uninvolved. By this time, he had exchanged his former friends for a new social circle.
Zoloft or not?
Several weeks later, John announced that he no longer loved Jane enough to stay married to her. He made no effort to salvage the relationship and it turned out that he had been having an affair for several months. Jane was devastated. The man she loved and married had been replaced by an insensitive, self-centred and distracted heavy drinker who sees nothing wrong with abandoning his family.
Jane is convinced that Zoloft is responsible for this change. John’s doctor says that all the reports he has are that John is doing his day job fine and in the circumstances therefore there is nothing he can do to intervene and he cannot stop the medication.
What would you do?