Returning to Brian – The overlap between distress and depression

Throughout this week’s learning we have been discussing Brian, the 81 years old man who attended for a review of his medication. He has returned today to discuss his chronic pain management and mood in more detail.

Brian appears low and his tone is quite monotonous, so you enquire how he has been feeling lately:

• He discloses that she’s been feeling very low in mood. He again recounts the terrible loss of his wife 3 years ago, from which he feels he could never recover. His brother had been a lifeline to him before he died suddenly last year, so he has felt very lonely since.
• He’s stopped going to church where he used to see people and draw some solace from his faith. His garden, which he once pruned to perfection has been left neglected and he hasn’t been visiting the post office as frequently to withdraw his pension as he doesn’t like going out. He was late paying his council tax recently as a result.
• Brian hasn’t seen his son for months, as he lives 40 miles away and is very busy with his work and family. Brian used to drive to see him, but hasn’t felt like making the long journey recently.
• He’s had fleeting thoughts he would be better off not here but has made no plans to harm himself, as he wouldn’t want to hurt his son. He also reports being close to his dog Bruce and wanting to be there to care for him.

We’ll consider in the next section whether we should be jumping to a diagnosis of depression for Brian, or whether we need to take a step back…