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Case 1: Analysis (Continued)

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After talking to JK, you tell him that you are very glad he came in to see you today. You explain that in many doctors’ experience, men in particular seem to have a difficult time admitting when they are suffering emotionally. They often don’t seek help, and when they finally do, they learn that they could have been helped earlier. You explain that you know it was hard for him to come in to see you today, and that you realize he has been struggling for a long time - but you’re very glad you did and you’re eager to help him deal with his concerns.

You inquire more about his use of alcohol, and discover that he often feels guilty about how much whiskey he consumes. He would like to cut down on his drinking, but does not know where to start. You ask him if he would like to attend a group session, and he expresses his willingness to try. You provide him with a resource list for the local Alcoholics Anonymous groups and encourage him to attend.

JK expresses that he is still concerned about his fatigue and loss of productivity. You explain that you can prescribe him an antidepressant. He says he would be willing to give such a treatment a chance. You suggest that one option is an SSRI, and explain that while it is effective, the side effects include nausea, vomiting, and diminished sexual function. The other option is a tricyclic antidepressant, which has been shown to be an effective choice in men. Side effects include weight gain, constipation, dry mouth, blurred vision, and drowsiness. JK decides that he does not want his libido to be affected. You provide him with a prescription for amytriptyline.

4 weeks later

You see JK in your office again. He says the amytriptyline has been working steadily well, and he is sleeping full nights again. He would like stay on treatment for the time being. You agree, and increase his dosage accordingly. He says that while he went to the AA meeting in his area but he felt anxious that somebody might recognize him and has not been back  since. He says he has been thinking a lot about his life and his marriage, and would like the opportunity to talk with you individually. You agree to see him in your practice once per week for psychotherapy, to talk about his relationship with his former wife, and his approach to life.

1 year later

JK is active again, drinking substantially less alcohol, and is functioning again at work. He has an amicable relationship with his former wife, and has started to date somebody exclusively. He feels much happier, and thanks you for your help.