Antidepressant Medications and Hypomania

Reader’s Question

I am desperate for help. My husband and I have been together for 24 years. Not to make excuses for my behaviour, but I have had 4 affairs in our marriage, the latest one a year ago and I believe because my of husband’s withdrawal of affection, because of his depression. If that makes any sense.

We have been working on getting our love back this year, and I thought, in my own little world, we were. I love my husband, I would never be the same without him. I would live but not be the same.

About 3 or 4 months ago my husband wanted to change his antidepressants (he’s now on Citalopram, Trazodone, and Novo Venlafaxine), because of no sex life and a constant deep depression.

Since then there has been changes in my husband’s personality, he doesn’t seem to be the same person.

About a month ago, my husband started talking online to a woman. He says it was powerful and he says it gave him control of his life. He was ready to leave to this woman. He had only been talking to her for three weeks and felt he was in love and just wanted to be happy. But he said he couldn’t do that, he loved me and wanted to work at our marriage. But now I feel that he has withdrawn again. He doesn’t want to talk to our adult kids or me. There seems to be no emotional connection to his family.

What I’m asking is, is this what I have read as a manic episode and could the change in antidepressants have cause this drastic change? I believe he still does love me or he would not be here, even though I get conflicting feelings from him.

Our Consulting Clinical Psychologist’s Reply

Antidepressant medications can produce a “hypomanic” reaction — a form of being too happy. Hypomanic symptoms include excessive energy/talkativeness, decreased need for sleep, racing thoughts, overproductivity, and inflated self-esteem. I don’t see any symptoms or descriptions in your question that would suggest a hypomanic episode however. Rather, it’s possible that his depression is now lifting with treatment. His sense of empowerment and control may be a very positive feeling for him, but something you’ve not seen for several years.

As you describe, he may now have conflicting feelings and thoughts. While leaving to have a relationship with an online fantasy after three months is unrealistic, it does suggest that he is now willing and motivated to make changes in his life. He is sending out conflicting messages because he is conflicted. Depression at his age often produces a “midlife crisis’ reaction where the individual becomes preoccupied with “the road not taken”. He may be thoughtfully exploring decisions he should have made, things he could have done, etc. Encourage him to continue to talk to his mental health professional during this time. He may not be comfortable exploring his thoughts with family members.