Positive Health Online

It is interesting to ponder on the statistics regarding depressive illness. 20 to 30% of the population are thought to suffer from symptoms of depression in the course of one year. Most cases are mild, but one person in 20 will be moderately or even severely depressed.

However, only one in five of the severely depressed will seek medical help and indeed, doctors often "miss" the diagnosis in patients consulting for other problems.

I am sure this was the case with a patient of mine in general practice who consulted me for some years regarding pain in the neck. This pain was very severe at times and interfered with his job at an engineering works. He would have episodes where the stiffness and discomfort was so great that he had to take time off work – an action which he deplored as he was extremely conscientious and hated the thought of letting anyone down.

I felt sure that Colin was suffering from arthritis in the neck and treated him accordingly with arthritis medication. This was only partially beneficial and we then started to use acupuncture. By treating the tense neck muscles, quite a lot of Colin's pain was relieved and, initially, he was able to go back to work and function reasonably normally. Sadly, the improvement was not sustained and, despite regular treatments, Colin had to take ill health retirement eighteen months later. It was as if something was blocking Colin's improvement. I was still sure that the obstacle was actual arthritic damage in the neck but I was wrong.

Colin had to claim Incapacity Benefit and I felt that I needed further evidence to support his claim. I was also perturbed clinically at how immobile his neck was becoming. He was having burning pains down his arms and I thought that he may be developing a pressure syndrome on the nerve roots in his neck. I therefore arranged an X ray examination to be performed. Imagine my surprise when the result came back as "Normal apart from some muscle spasm". There was no evidence of arthritis or any other cause for Colin's pain other than muscle spasm. What then was the source of his muscle spasm and thence his pain?

Over the years, I had got to know Colin reasonably well, although he was a very private person and did not offer much information about his home life. I knew him to be meticulous both in his work, in his personal grooming and dress and in his timekeeping; he would even absentmindedly straighten out the articles scattered on my desk. His record at work had been exemplary.

I decided to be quite straightforward with Colin and asked him if something was troubling him. He looked at his shoes for a few seconds, then straight at me and took a deep breath and began to talk. Twenty five years ago Colin had married a girl from the village and they had been very happy initially. However, within two to three years things had begun to go wrong, largely due to his wife having an alcohol problem. Colin tried everything to rescue the situation. He had approached his wife's doctor, taken her to AA meetings, paid for her to go for rehabilitation – but all in vain. She relapsed every time. Eventually he could take the strain no longer and filed for divorce. They had separated and his wife moved back to her mother's village.

Three years ago, his wife's mother had died and this left his wife living alone with no one to call on except himself. He was being called at all hours of the day and night to bail her out of drunken messes.

This task would be hard for anyone, but for Colin, with his fastidious nature, it was purgatory. Colin had tried to get help from social services, but his wife always refused to let any carers in and Colin did not have the heart to abandon her completely to her fate. Little wonder, then, that over the ensuing months and years, his pain in the neck had deteriorated so severely, in parallel with his deepening depression. The pathology was not, as I had thought, arthritis, but rather the continuous emotional strain reflected in spasm of the muscles of the head and neck.

By this time, I was becoming very concerned about Colin's condition. He expressed dark thoughts of despair and had contemplated suicide.

Something had to be done for him as rapidly as possible. I decided to prescribe a conventional antidepressant, fluoxetine, which is known to work fast and to have a low risk of harm in overdose. By the next week, Colin had improved somewhat and was no longer suicidal but it was going to be a long journey to health.

Over the next year, Colin made quite a lot of progress but never fully recovered. Despite increasing the dose of his antidepressant, he remained very gloomy and pessimistic about life and his ability ever to recover his previous sense of well-being. He acknowledged that the fluoxetine had been essential and probably a lifesaver, but it was not the whole answer.

I decided to offer homoeopathic treatment on top of the antidepressant which was now at maximum dosage.

Colin's fastidious nature as well as other features pointed to a prescription of Arsenicum album. These included a very low point in the very early hours (between midnight and two am), a desire for salt and fatty foods and a tendency to be a worrier over small details.

People who respond to Arsenicum album can certainly get to the state of despair that Colin achieved and he has now received several doses at approximately monthly intervals whilst continuing the antidepressant. The two medications seem to be working well together, with Colin achieving better sleep and also a better tolerance to his situation regarding his ex-wife than previously. In particular, he is less stricken about the opinions of the rest of the village regarding her alcoholism. However, being the type of person that he is, he will probably never be completely free of that burden and is therefore unlikely to recover his own health completely. At least the combination of modern and homoeopathic medicine has helped him to cope. Incidentally he still needs occasional acupuncture for his neck.