My husband is sixty. Over the past few years, he’s been having problem with decisions and organizing things. We’ve stopped playing our favorite game, Chinese Checkers, because he never even comes close to winning anymore. He is depressed and anxious, but says the SSRI does nothing for him. The family doctor says there’s no cognitive impairment because he scored 27 on his mini mental. His memory for people and things is normal, but he can’t remember how to do complex things he used to do, like carpentry or home repairs. What kind of depression is this? What should we do?

A: I’m not sure the problem is depression. A depressed person feels sad much of the time, feels hopeless and helpless to change it, doesn’t enjoy doing things he used to enjoy doing, and has sleep and appetite problems. You don’t describe any of those symptoms. Difficulty with organization and decisions can be caused by many, many medical problems from thyroid dysfunction, to a vitamin deficiency, to heart disease, to name only a few. (The last time I got a letter like yours it turned out the woman had a vitamin B12 deficiency.) Please get your husband to see his doctor for a complete medical work-up.

If he is healthy, I would then suggest he consult with a psychiatrist regarding the SSRI. People respond idiosyncratically to many of the antidepressant medications. He may not be on the right one or at the right dose. Since he has not had a positive response, he should see a doctor who is very experienced with psychopharmacology.

Finally, medication alone rarely is sufficient to bring someone out of a depression. If he is depressed, he should be seeing a counselor as well. He should work with his psychiatrist and his counselor regularly so that they can continually adjust his treatment to be as effective as possible.

I wish you both well.
Dr. Marie