Richard, 52-year-old Male Suffering from Severe Anxiety and Depression Who Was Barely able to Work
“In these stories, the identities and locations have been changed to ensure client confidentiality.”
Richard is a 52-year-old attorney who came to me with symptoms of severe anxiety and depression. He had been to multiple medical doctors and emergency departments for workup of physical complaints. Richard was initially quite worried that he was gravely ill and that he had a significant cardiac and/or neurologic illness. In addition to visits to primary care doctors and emergency rooms, his vast medical workup also included recent appointments with both cardiologists and neurologists . When Richard came to me he was clearly worried about all of his physical symptoms, and didn’t understand why all this was happening to him. He reported having multiple physical symptoms which included lightheadedness, dizziness, nausea, fatigue, and weakness. Richard had formerly enjoyed working full-time and frequent travels to other countries, but by the time he came to me he was unable to manage his responsibilities at work and wasn’t traveling at all. During our initial evaluation, he endorsed having symptoms consistent with both Major Depressive Disorder and Generalized Anxiety Disorder. Richard’s wife was very concerned about his condition and also attended the first appointment with me. Richard was very honest with me. He stated that he was convinced that he had a real physical illness as he had never had any significant physical problems for the first 51 years of his life. Richard reported feeling quite surprised as he had been told by multiple medical doctors that his physical symptoms were most likely anxiety related. He stated that his symptoms felt so real, he just didn’t understand how this could be anxiety. During our initial evaluation, Richard was quite anxious and worried that his symptoms wouldn’t go away. He stated he didn’t feel as if he could ever work again. His wife reported being very concerned that his anxiety had begun to cause him to be quite depressed. The level of concern on Richard’s face was evident, it was clear that he had become so worried about everything that he was starting to have difficulty being himself. He also reported having difficulty with sleep because he was so worried about all of his symptoms. He appeared very tired during our first meeting, as if he was simply worn out from all the worry. He had difficulty focusing on my questions and was unable to relax at all.
I initially took the time to really understand what was occurring in Richard’s life as a backdrop to his current psychological plight. It turned out that he had multiple friends, all close to him in age, who had passed away over the past year. I carefully explained to him possible reasons for his anxiety, some of which could include the psychologic trauma associated with his friends’ recent deaths. I also started a medication regimen for him that would combat both his anxiety and depression. After gaining a thorough and complete perspective on Richards’ anxiety and depression, I was able to use psychotherapy sessions to teach Richard how to better understand his anxiety and how to manage it as well. The medication and psychotherapy worked. Richard quickly began to improve. His wife soon stopped coming to the appointments with me. His initial physical symptoms began to resolve. With fewer physical symptoms to worry about, he began thinking about going back to work. As his physical symptoms cleared up, so did his anxiety and depression. He began to work again and within a little over a month he was once again working at full capacity. Because Richard was feeling so much better, he was able to plan an extended trip out of the country for several months. It was great to see him feeling better and fully functioning again. During our sessions he no longer appeared tired and stressed, and was consistently smiling and talking about various career ambitions and his interest in traveling overseas. He had a dramatic turnaround. In a short time, Richard’s original presenting problems had completely resolved.