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The Conversation: Talking to Your Doctor About Depression and Anxiety

The Conversation: Talking to Your Doctor About Depression and Anxiety
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By Mary Jane Horton

You may not even want to admit it yourself: That deep feeling in the pit of your stomach that you aren’t okay. But if it’s true, you know it, and you have to get outside help. It’s a commitment though, because once you talk to anyone – especially your doctor – about feeling like you are sad or too anxious to go on, there is no going back.

First, take mental stock. Everyone gets sad and stressed. But there are some telltale signs that it is more than that. If you’re noticing changes in sleeping or eating habits, a lack of energy, trouble concentrating or a loss of interest in activities you used to find pleasurable, these symptoms may indicate depression or a related disorder. According to the Mayo Clinic, http://www.mayoclinic.org/diseases-conditions/depression/basics/symptoms/con-20032977, even though depression may occur only one time during your life, usually people have multiple episodes of depression. During these episodes, symptoms occur most of the day, nearly every day and may include:

  • Feelings of sadness, emptiness or unhappiness
  • Angry outbursts, irritability or frustration, even over small matters
  • Loss of interest or pleasure in normal activities, such as sex
  • Sleep disturbances, including insomnia or sleeping too much
  • Tiredness and lack of energy, so that even small tasks take extra effort
  • Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people
  • Anxiety, agitation or restlessness — for example, excessive worrying, pacing, hand-wringing or an inability to sit still
  • Slowed thinking, speaking or body movements
  • Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that are not your responsibility
  • Trouble thinking, concentrating, making decisions and remembering things
  • Frequent thoughts of death, suicidal thoughts, suicide attempts or suicide
  • Unexplained physical problems, such as back pain or headaches

Symptoms of anxiety disorders can vary, depending on the type, but here are some general symptoms, http://www.webmd.com/anxiety-panic/guide/mental-health-anxiety-disordervary:

  • Feelings of panic, fear, and uneasiness
  • Problems sleeping
  • Cold or sweaty hands and/or feet
  • Shortness of breath
  • Heart Palpitations
  • An inability to be still and calm
  • Dry Mouth
  • Numbness or tingling in the hands or feet
  • Nausea
  • Muscle tension
  • Dizziness

Which doctor, and how to broach the subject

Too often, patients are afraid of bringing up their mental health concerns.  And even though there has been great progress in the field, mental illness is still a subject branded by shame, misunderstanding and stigma. It is especially bad when mental illness pops up in the news as in the recent Germanwings air crash. If you associate your symptoms with weakness or character flaws, it’s no wonder you will hesitate to discuss them. That’s why the very first conversation you need to have is with yourself. Depression is a serious illness, with specific medical strategies for managing it, and it doesn’t indicate that you are weak. And the same goes for anxiety, which – when it is pronounced – makes it harder to put one foot in front of the other every day. Once you have decided that you need help, talking with a doctor about what’s bothering you is the most direct route to determining what’s wrong and taking action to remedy the problem.

For many people, the prospect of discussing a mental health problem with a doctor is almost as scary as the problem itself. And, let’s face it, with medicine the way it is nowadays, doctors don’t always have time for leisurely conversation. So, the first thing you can do – to make sure you have the time for this conversation – is tell the person booking the appointment that you have something to discuss with the doctor, so you may need some extra time.

For many people, their primary care physician is the first person they will think of speaking with. The primary doctor coordinates the care delivered by specialists. Your primary care doctor may be a general practitioner, family practitioner, or internist. This doctor is in a good position to both assess your needs and work with you to develop a treatment plan. If you have a particular condition, however, you may be in more regular contact with a specialist such as an obstetrician/gynecologist (OB/GYN), cardiologist or endocrinologist. These doctors are also qualified to hear and respond to your concerns about your mental health.  In some instances a patient may decide to schedule an appointment directly with a mental health specialist such as a psychiatrist. Regardless of which doctor you choose to discuss your concerns with, the sooner you reach out and start the conversation, the better.

Before your appointment, think about what you want to happen. Remember that diagnosing and treating depression and anxiety disorders isn’t easy, it takes time and expertise, so if your goal is to make your symptoms disappear immediately, you’re probably going to be disappointed. Instead, set a few reasonable goals for the conversation, such as talking about the problem as you perceive it and setting some goals for treatment.

The conversation

Set an intention to be straightforward and honest with the doctor. If you describe your symptoms too vaguely, the doctor may look for physical causes, rather than honing in on emotional factors. Instead, use precise statements like “I think I might be depressed,” or “I am experiencing the following symptoms” to begin the conversation. The more direct and specific you can be, the easier it will be for your doctor to respond effectively.   Be aware, also, that some physical illnesses do mimic depression and anxiety, so your doctor may want to explore that route as well.

Once you’ve shared your concerns, realize that your doctor has the important and challenging job of arriving at a diagnosis. What may initially sound like depression may in fact be the result of more than one mental health issue, or a combination of mental and physical illnesses. For example, anxiety and depression often occur together, depression and bipolar illness share some common characteristics, and depressive illnesses frequently co-occur with chronic conditions like cardiovascular disease, diabetes or cancer. Your doctor may ask a number of screening questions and/or schedule a follow-up appointment to learn more.

Outcome and follow-up

You may, indeed, leave your appointment with a prescription for antidepressant or anti-anxiety medication. Today, over half of all antidepressants are prescribed by primary care physicians, so if an initial diagnosis can be made, your doctor may start treatment right away. In addition to the medication, your doctor may encourage you to be seen by another mental health provider such as a psychologist or social worker to provide counseling or psychotherapy. If he or she doesn’t, it is still a good idea to take the imitative to talk to someone to delve into the underlying problems as well as taking the medication.

When a new diagnosis is made, and especially it medication is prescribed, a follow-up call or visit should be scheduled within a few weeks. This way the doctor can confirm that the patient is taking the medication correctly, and assess symptoms and side effects. But as recent studies of electronic medical records from across the nation reveal, doctors often schedule the first follow up appointment a month or more after the initial consult, missing the opportunity to intervene early in treatment.

Also, ask your doctor to help brainstorm with you about lifestyle changes and other ways to deal with depression and anxiety. Meditation, yoga, exercise, a class, or even a much-needed vacation can be a great adjunct to treatment.

 

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