Dear Doctor: My husband is in kidney failure, has chronic obstructive pulmonary disease, congestive heart failure and Type 2 diabetes. We have been married 48 years. He sleeps most of the day, is so short of breath that a walk to the bathroom is difficult and never leaves the house except to go to the doctor. He is angry and depressed, often taking his temper out on me. What can I do to help him (and us) besides watch his diet?

Dear Reader: My heart goes out to you and your husband. As you're now painfully aware, and as I've learned as a physician, illness affects not just the person stricken, but their loved ones as well. In your long marriage, you and your husband have undoubtedly had your share of ups and downs, persevering and working together. Now you have new challenges, possibly unimaginable when you were younger, focused on your husband's illnesses.

Let's start with the depression. Some people have the mistaken notion that depression is part of the aging process. In fact, healthy independent elderly adults have a lower rate of depression than the general adult population. But each physical malady increases the risk.

With his many troubles, treating your husband's irritability and depression won't be easy. He may not acknowledge that he is suffering from depression, or he may suggest that, because of his physical ailments, he has every right to be depressed and every right not to go out of the house.

So, if the only time he goes out of the house is to see the doctor, go with him to the doctor. Talk to the doctor about your husband's increasing isolation, his feelings of depression, his irritability -- and his nighttime sleep, which can be affected by his conditions. Notice whether he's having trouble breathing while asleep, snores or awakens frequently to urinate. There may be aspects of his medication that the doctor may want to change to help him sleep more at night and less during the day.

Also, ask your doctor about whether his medications may be causing drowsiness or having depressant effects. These include, but are not limited to, opiates, benzodiazepines (Ativan, Klonopin, Valium, Xanax) and gabapentin, which is often used in diabetic patients for painful neuropathy. Further, pain itself can lead to feelings of depression. So take note of your husband's level of pain and share it with the physician if your husband does not.

Regardless of the root of his depression, psychotherapy could help your husband feel more in control of his situation and help him communicate his needs to you. Similarly, although your husband is likely taking a host of medications and would be hesitant to start another medication, anti-depressants can help decrease his irritability and make him more alert.

With therapy and possibly medication, your husband may be more apt to go outside and do some form of exercise, which will additionally help his mood.

Your love and support for your husband may seem to go unnoticed, but be assured it's a stabilizing foundation for him. That said, improving his mood is ultimately up to him. Your doctor can partner with you both, but your husband has to commit to getting better. Whether he does or doesn't, only time will tell. But, regardless, please take care of yourself. That, too, will benefit you both.

Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. 

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