Our expert says:
Of course the depression will increase the pain, and the pain will increase the depression.
Unless and until the usual antidepressants have been tried properly individually in normal doses, I don't see any reason to give 2 ADs at once.
The main variety of counselling / therapy that has been shown by good research to be effective in managing depression and anxiety, is Cognitive-Behaviour therapy, CBT. And that would sound really advisable for him. CBT works fine with medication, but selecting, monitoring and balancing meds is best done with the advice of a psychiatrist.
Chronic pain hurts, whatever proportion is "physical" or "psychological", and both causes fed each other, so trying to sepaate them is artificial.
Learned helplessness is surely part of the mechanisms that relate to a person with any chronic condition tending to give up or even sabotage their treatment. Such self-defeating attitides are best dealt with by CBT
One of the useful truths of tough love is to love the person, not necessarily the behaviour.
His wife surely sounds like a significant risk factor. People who say dangerously stuipid things about "pull yourself together" and "it's all basicall a matter of will" are not practising tough love, but reckless ignorance. Especially if she is foolish enough to discourage him from seeing a proper mental health expert - clearly her expertisde hasn't solved any of the problems.
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