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Sertraline for Diabetes

She was here for her diabetes.  Her blood pressure was high, she said, because she expected me to scold her.  She hadn’t brought her log, but her sugars were in the 200s overall.  Not good.  She hadn’t been exercising, but she had been taking all her medications.

Again we talked about options: cut out carbohydrates, increase exercise, add medicines.  She admitted a predilection for bread, and I talked about mood eating: how stress can drive us to eat.  She smiled back at me, shaking her head.  I mentioned our counselors and the option of coming just to talk.  She shook her head again, but her smile broke and her eyes closed.

Her one son, whom she brought here as a six-year old, had been deported back to a country he doesn’t know, where he has no one, where life is dangerous.

Of course her sugars were high.  Her screening questionnaires for depression and anxiety were both fully negative.  Counseling, which we are so lucky to have, she cannot do—the ride she has to get, the work lost.  Instead she gratefully accepted something that might quiet her racing brain and anxious heart, and so might help with her sugars.

I’ve been prescribing a lot of antidepressants recently for reasons that don’t entirely fit within the parameters of the DSM manual, the book that establishes the currently understood diagnoses and norms of mental health care.  I do not feel good about this, but I’m at a loss for better options.

The week before I’d seen someone back for whom I’d prescribed an antidepressant to treat—what?  To treat acute life-crushing anxiety in the setting of an unbearable situation that she doesn’t control.  To mitigate fear.  To manage her diabetes.  She—short, brown skinned, indigenous to elsewhere—had stopped leaving the house for anything beyond taking her young daughter to school and going to the grocery store as absolutely necessary.  Her one-hour walk had entirely disappeared, her life newly restricted to an apartment in a parking lot far from her native mountains.  Thank goodness, she was now feeling much better and again she was starting to take care of herself.  She was sleeping, and her sugars were coming down.

Some days I think about an antidepressant for me, for the stress I feel from holding my patients’ stories.  But so far I manage by running late, working half time, hugging my family, writing here.

Sarah Buttrey
Austin, Texas


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