Is my doctor going to laugh me out of her office?
May 8, 2012 7:54 AM   Subscribe

So, I think I might be depressed, but I'm not sure, and I'm worried my doctor will think I'm just whining about nothing.

I'm not a particularly happy or active person anyway, and last year wasn't great, but I moved cities late last year and have been pretty low since around the same time. I started going to therapy in December, and my therapist has made me feel better about some specific things, but I'm still generally feeling low and apathetic a lot of the time and mostly failing to get anything done.

I made a real effort at the start of this year to eat properly and get some exercise, and I did feel better for a while. But then I stopped and it just seems like too much effort to start again.

I've done a few of the online questionnaires like the PHQ9 form, and the results vary by the day but they generally say I'm mildly or moderately depressed. Except I've been tracking my mood, and over the last two weeks or so I've felt utterly awful on about a third of the days, vaguely miserable on about a third, and sort of neutral on the rest. And looking at the depression criteria, I get the impression you have to feel really awful every day. (E.g. from one health site: you have to have the symptoms "most of the day, every day for more than two weeks.") And I don't, there are days when I see friends and have an OK time, or I do actually manage to do something productive instead of sitting around guilt-tripping myself about all the work I'm not doing.

So I'm worried that I've just blown this out of all proportion. But I'm sick of crying, and worrying about this, and I have an important task coming up that I'm going to really screw up if I carry on at this rate. So I finally made myself sit down and call the doctor to make an appointment, and I have one next week. But the doctor they've assigned me to is one I saw last week for a routine procedure, and there was a nurse in the room so I didn't want to talk to her about this then. And they were both being very friendly and chatty and I hadn't met either of them before and didn't want to be rude, so I chatted too. (When the nurse left, I asked the doc if I could talk to her about something else but she said I had to make another appointment.)

So I'm worried that because I wasn't sitting there in tears last time I saw her that she'll think I'm faking it for attention or just having a bad week and overreacting, or something.

So I guess my question is, if it turns out I'm not depressed and I'm just wasting the doctor's time, what are the chances she's going to tell me off or tell me to go and read a self-help book or something? I mean, she's a professional and I'm reasonably sure she'd be nice about it, but if there's one thing that could make me feel even more pathetic it would be having someone tell me that everyone feels like this and I should just be an adult and suck it up. And I'm worried this might affect any future visits if my doctor thinks I'm just a giant whiny hypochondriac - she's nice, but definitely the matter-of-fact, no-nonsense type.

Does anyone have any advice? Thank you!
posted by puppetofsocks to Health & Fitness (29 answers total) 3 users marked this as a favorite
If your doctor dismisses your complaints because you're not "in tears" or accuses you of "faking it," you have a bad doctor. Period.

You have every right to talk to your doctor about this. They are there to help you. Even if it isn't depression, it's something, and your doctor's job is to help you figure out what is going on so you can fix it.
posted by EmpressCallipygos at 8:00 AM on May 8, 2012 [12 favorites]

All this catastrophising and what if it isn't real and everything is really common among people with depression, and even when I was undeniably depressed I could have fun sometimes, or be productive sometimes, or appear normal for an appointment. Your doctor will not make fun of you for getting help. Feeling sad the majority of days and never better than neutral is a real problem.

What has your therapist said about this?

If your doctor tells you to suck it up -- which she won't, because not everyone feels like this, and those who do are ill -- then you should complain to whoever is appropriate, because if it is preventing you from living your life then it is a problem, and doctors should not be mocking their patients. But she will not do this, because she is a professional.

(Also, look into dysthymia, which is a chronic depression.)
posted by jeather at 8:03 AM on May 8, 2012 [2 favorites]

Unless the doctor is totally incompetent she's not likely to dismiss your depression. Please don't worry about this possibility. Do try to get back into exercise as it often really helps alleviate depression.
posted by mareli at 8:03 AM on May 8, 2012

One: you are paying for your doctor's time. Use it as you wish.

Two: your concerns are valid and you should be proud of taking steps to improve your situation and get help. Your mental health is part of your health, so it is completely appropriate to discuss them with your doctor. If your doctor is not responsive, it's time to find a new doctor.
posted by workerant at 8:04 AM on May 8, 2012 [1 favorite]

The every day for 2 weeks thing is for Major Depressive Disorder - there are other conditions and flavours of depression. Take your mood diary with you, it will be a big help to your doctor in assessing your condition.
posted by missmagenta at 8:08 AM on May 8, 2012

Oh yeah, you need to speak to a doctor. Ask to be assessed. Don't be surprised if you get a prescription. Also, don't be surprised if you have to tinker around with your prescription until you find one that works for you.
posted by Ruthless Bunny at 8:08 AM on May 8, 2012

So I guess my question is, if it turns out I'm not depressed and I'm just wasting the doctor's time, what are the chances she's going to tell me off or tell me to go and read a self-help book or something?

Depression is definitely a disease, but it's also just kind of a thing that you feel, you know? It seems like you're worried that there's some diagnostic protocol whereby "I feel bad and down and kind of like life isn't worth living, most of the time but not all the time" isn't worth treating because it's not "real" depression.

That's your depression talking. That's your depression telling you that you're not worth fixing. That's your depression lying to you about itself, because it wants to stick around and keep tormenting you.

If you've got feelings that you don't like, that are keeping you from being okay with yourself, there's help. There's help even if it turns out that you don't meet the clinical definition of depression. You might just feel bad and need somebody to talk to about it. That's okay too. It's not like an emergency room, where your dislocated shoulder has to take second place to the three-car pile-up that just came it. It's your time with your therapist, and if you want to talk about your hard feelings of awful sadness, you deserve to have those feelings taken seriously, even if there's no clinical diagnosis at all.
posted by gauche at 8:09 AM on May 8, 2012 [2 favorites]

Depression isn't necessarily about being constantly miserable. Being functional, being able to fake being cheerful, or being able to get on with life even though you don't feel like it are not contraindicated. In fact feeling very up-and-down, or feeling guilty in the evening over having enjoyed the afternoon, are very common in depression.

It seems unlikely that your doctor would ignore your complaints, but if this doctor doesn't help you out, ask your therapist to refer you to a psychiatrist.
posted by aimedwander at 8:15 AM on May 8, 2012 [1 favorite]

Man, have I been there and done this, and I truly feel for you. My doctor WAS sympathetic and I hope, hope, hope that yours is as well.

If you're looking for a wee bit of bibliotherapy to go in addition to whatever your doctor prescribes, please do check out David Burns' "Feeling Good".

It got me through many a day and night.
posted by THAT William Mize at 8:16 AM on May 8, 2012

Your depression is telling you you're not depressed and generating anxiety to keep you from going. That's its survival mechanism.

People go to the doctor for yellow toenails, elbow twinge, funny smells, and weird genitals. They don't get laughed out of the office, either, because they might have a problem that requires prescription/specialized medical attention and they didn't go to medical school so they don't know. That's what the doctor is for. Plus, even if their toenails only look yellow in yellowish light, their money pays the bills just as good as any other patient's.

You can explain it in very simple terms: "I feel awful. I've been trying to handle it with diet/exercise/sleep/etc and my therapist and I agree that it's time to discuss medication. I also need a full bloodwork panel with thyroid, of course, to rule those things out." (You might want to call ahead, in fact, and tell them you want a physical with bloodwork so they know before you come in. You may need to fast, and/or they may use an off-site lab you'll have to go to.)

A couple of things: there are often nurses in the room for liability reasons. You can say this in front of the nurse, they are also medical professionals. Also, most GPs know far more about yellow toenails than mood-altering medications - they have almost no training in the field, and probably get most of their info from drug reps - so if you really don't want to go into it with her you can just ask for a referral to a prescribing psychologist and go from there.
posted by Lyn Never at 8:18 AM on May 8, 2012 [3 favorites]

So I'm worried that because I wasn't sitting there in tears last time I saw her that she'll think I'm faking it for attention or just having a bad week and overreacting, or something.

That's not how depression is diagnosed.
posted by empath at 8:19 AM on May 8, 2012 [5 favorites]

One of the main symptoms of depression is that you don't feel you deserve help/you think you're not suffering enough to go to a therapist.

This was the first thing my therapist told me.

But I'm sick of crying, and worrying about this

This is NOT how life should be like. Go see a therapist!
posted by Tarumba at 8:22 AM on May 8, 2012 [5 favorites]

A list of things I have been to the doctor for include "I'm yawning a lot"(diagnosis: too little sleep) and "My foot hurts"(diagnosis: uncomfortable shoes), and I wasn't laughed at either time; even if you're not depressed, she's not going to laugh at you for asking.

You have enough symptoms that you might be depressed, so it's worth checking with a professional. You probably wouldn't have this question if you only met some of the criteria for a physical illness, mental illness is no different.
posted by Bulgaroktonos at 8:24 AM on May 8, 2012 [1 favorite]

I agree with what everyone else has said here. You really do sound like you are mildly or moderately depressed.

One other thing you could do prior to the appointment is call your doctor's office and explain that you think you have depression. This may help you because then the doctor know why you are there and he/she can bring it up in the appointment.
posted by emilynoa at 8:26 AM on May 8, 2012

There is no such thing as wasting a doctor's time. I think it's lame that your doctor dismissed you when you had something else valid that you wanted to talk about, too. Who is wasting whose time? Go get the care you want and deserve.
posted by amodelcitizen at 8:33 AM on May 8, 2012 [1 favorite]

You know the cliche "make them read this thread" answer? This is one of those times when it's a good idea to literally print your question out and hand it to the doctor. Not only do you describe your concerns very well here, but I've found that it's immensely helpful to have what you want to say planned or even written out in advance, because it's not hard to get flustered around doctors with this stuff.

It sounds like you have depression or dysthymia, which is a milder but longer-lasting form of depression. If you ever catch yourself thinking things like "well, I've never exactly been happy," or "I can get out of bed and function, sort of," or "It's not like I feel miserable all the time," or "I probably just need to pull myself together," that's often what dysthymia is like.

I've made doctor appointments for the most minor conditions with no shame (like the time I discovered my own lymph nodes and mistook them for tumors), but I didn't see anyone about depression for ages, for the very reasons you're telling yourself now. But it was so worth it to finally make that appointment. What you're going through - whatever the diagnosis - is worth a doctor's full attention and compassion, and if you don't get that from your current doctor, ask your therapist to help you find a better one.
posted by Metroid Baby at 8:35 AM on May 8, 2012 [3 favorites]

I get pretty anxious about seeing doctors and feeling like I'm wasting their time. Rationally I know I'm not, but I get a bit fuzzy when I'm in the appointment and feel like I poorly communicate what my health (physical or mental) concerns are. Perhaps my suggestion below can help.

I've found it really useful to write it down before I have the appointment. This helps me ensure that I cover off all the bits and bobs that are occurring, and means that I don't forget in a general haze of doctor anxiety. Your mood diary would be a great thing to bring along to your appointment. I have brought along diary records and spreadsheets for other things too.

I also realised way too late in the game that I was taking the piss out of myself during a session, in an effort to downplay the whole thing and thus re-inforce my view that I was wasting their time. Try not to belittle yourself or be too self-deprecating, it can interfere with your doctor getting the info they need. I'm sure they see through it, but I'd prefer not to make it more difficult for them.

And on preview, Metroid Baby's last paragraph. Read that a lot. It's bang on.

I wish you well with this!
posted by pymsical at 8:42 AM on May 8, 2012 [1 favorite]

You might also consider asking your general practitioner (&/or your therapist) for a referral to a psychiatrist rather than having her prescribe medication directly. There are real nuances to which drugs work best for which people, and a specialist might be able to help you feel better faster and with less experimentation. You totally deserve treatment.
posted by judith at 8:44 AM on May 8, 2012 [2 favorites]

Response by poster: Wow, everyone, thank you all so much, I really didn't expect to get so many responses, or such nice ones. (Or so quickly - I've been so wound up about this for ages and you've made me feel much better in minutes.)

Bulgaroktonos, I promise I'm not laughing at you, but that bit about lack of sleep/uncomfortable shoes really made me smile for the first time in ages - thank you!

THAT William Mize, my copy of Feeling Good literally just arrived in the post while I was writing this, so I'll have a look at it in a minute. I finally got round to ordering it at the weekend after seeing it recommended constantly on the green.

pymsical, those are really good points about writing things down and not down-playing it. Thanks.

Everyone, thank you, I really appreciate all your answers. I won't mark any as best answer because you're all amazing.
posted by puppetofsocks at 8:47 AM on May 8, 2012 [3 favorites]

I'm not a particularly happy or active person anyway...

...and mostly failing to get anything done.

...there are days when I see friends and have an OK time, or I do actually manage to do something productive instead of sitting around guilt-tripping myself about all the work I'm not doing.

...and I have an important task coming up that I'm going to really screw up if I carry on at this rate.

but if there's one thing that could make me feel even more pathetic

These kind of statements are very familiar to me. I think a lot of people, including myself, feel like they should be doing productive things in order to feel good about themselves. You might put a lot of value on being productive. What kinds of things do you think you should be doing?

Some people fall into bad habits and unproductive habitual thinking patterns that cause them to be "unproductive". You might be actually biochemically depressed. On the other hand, you might be depressed because you have a lot of guilt that you're not doing this thing or that thing that you think you should be doing in order to be a worthwhile human being. Work requirements are one thing but how are you approaching the rest of your life? Are you okay with how things are at the moment? Are you practicing self-acceptance? When you are having guilty feelings that you are being unproductive are you trying to do something to stop that thought pattern or are you allowing yourself to ruminate? Because all of those guilty feelings and thoughts are just bad habits and that kind of thinking can bog you down in depression and put you in a very bad place. Our thoughts are very important as you know and you can get the skills to stop those thoughts that cause you to procrastinate and feel bad and guilty.

I think it would be helpful to talk to your therapist about your guilt and worry about failing to get things done. Again, what things do you think you should be getting done? Define those. What are you doing to stop your worrying? Name the worry. Name what you are feeling guilty about and then try to come up with a positive statement -- an antidote -- to contradict the negative statement. Write them down. Practice often when you are having these thoughts. I have found that this exercise had retrained my brain to think negatively less, feel less guilty, stop ruminating, etc. Of course, I still occasionally have negative thoughts. I am very aware and can stop them and don't allow myself go down that path.

What makes you feel good? Hanging out with your friends? Do this more often. You say exercising and eating better made you feel better? You can take steps to start moving again. It does not have to be perfect. Take it one day at a time. If being around people makes you feel better an exercise class might be a good idea.

What other things make you feel good? How much fun are you have? Write down some things that make you happy -- a fun list -- and try to do some of those things. Some of my examples are going to the bookstore, playing team trivia, hanging out with friends, minor league baseball, bike riding with my husband, biking on the beach, reading fiction on my Kindle, reading fashion magazines on the back porch, shopping, playing dominoes, etc.

This is so overplayed but a gratitude journal is very helpful. When you are thinking about how things are wrong and bad it helps to write down what is going right. Once you start writing in a gratitude journal on a regular basis the gratitude will just flow and soon you won't be able to stop. You will fill pages.

I do not mean to trivialize depression. I know that making a "fun list" and doing fun things! is not a cure-all. I have been depressed. There were many dark times for a long time. In my case, my thought patterns were causing my depression. (My main negative thoughts were feeling like I was a victim, feeling less than, not good enough, and I should be doing xyz in order to be worthwhile. I also placed a great importance on doing certain things and activities and keeping busy.) I too took the quizzes too and came up with mild and moderate depression. Go to the doctor and do not feel for one second that you are whining. They say that even short term anti-depressant can be beneficial and help you get more out of therapy. I think it would be wise to continue seeing a therapist and taking active steps to help yourself (journal exercises, getting more fun into your life, etc.). You are capable of having fun. You hold down a job. It seems like you have a lot of negative self-talk and all of this talk can be incredibly destructive to your mental well-being. I found that negative thoughts were only a bad habit --something I was doing since I was a child -- and could be broken. My therapist helped me and I was willing to put in the work to help myself feel better. I am worthy and you are too. Good luck.
posted by Fairchild at 8:58 AM on May 8, 2012 [2 favorites]

This was me a month ago. See this thread. Like you, a lot of my depression was triggered by a long-distance move. Also like you, I didn't feel utterly awful all the time.

Since this was the first time I was seeing this particular doctor (a general physician), there was an intake questionnaire. Listed among the various physical symptoms was "stress/anxiety", and underneath them in big bold letters was a question that basically boiled down to "are you feeling depressed?" This was nice, because I didn't have to say to the doctor "I am feeling depressed and anxious", which would have been hard. (I managed to do it, though.)

I walked out of there with a prescription. Now I feel better. (Well, I feel like crap this morning, but that's because today will be a particularly unpleasant day at work for me.)
posted by omicron at 9:19 AM on May 8, 2012

RX and perhaps some discussion with a therapist.
Depression has it's ups and downs--don't worry if you feel better on some days--appreciate it for what it's worth, and get stuff done! Just try to roll with the punches on the lousy days. Your doctor should consider depression, and if you don't feel better with meds, you might even ask about Bipolar II. I wasn't diagnosed until my 30s, but it had been an ongoing problem for years. It finally took a very savvy psychologist to put 2&2 together. Since then, life has been good.

The doctor better not laugh, or else she's useless as a physician. I'm reading this that it was a woman doc, if so, there would be no liability issues. Otherwise, I have (politely) frequently asked that the nurse leave for a private conversation about depression issues, and it's been no problem with my male doctor. The reason I do so is that it's a small town and stuff gets out, never mind HIPPA.

I'm a bit disturbed by the fact that you had to waste a visit and copay while the doc and the nurse were chatting along. That doesn't seem like a very professional attitude, especially when your doc dismissed you, saying there was no time, after their gabfest. There's always other doctors. I know it's hard when you're depressed, but persevere.

Good luck!
posted by BlueHorse at 9:46 AM on May 8, 2012

been there as well, and only wish now that I had acted on it sooner.
while you wait for your next appointment and in between readings of Feeling Good - if you have a way of getting/using the iOS app iCBT, you could try that. It's a simple app that walks you through cognitive behavioral therapy steps for negative and obsessive problem thoughts you might be having and gives you a process to turn them around. It helps me a lot and I wish I had had it much earlier in my feeling-lousy-experience.
posted by ghostbikes at 10:04 AM on May 8, 2012

Response by poster: BlueHorse, it's OK, they were chatting while doing a minor procedure on me, so the visit wasn't wasted. Thanks for the concern though.

omicron - I was reading your thread this morning. I'm glad you're feeling better now! (And I hope that today wasn't as unpleasant as you feared.)

Once again, some really good ideas from people - thanks. I'll check out that iCBT app and think about Fairchild's gratitude diary/fun-list/etc.

Thanks again to everyone for taking the time to answer and share their experiences. Reading all the responses has made me feel a lot less alone in this, and less worried about the appointment next week.
posted by puppetofsocks at 10:59 AM on May 8, 2012

As a point of reference, I had(have?) major depression. I would be OK-ish for 2-3 weeks, and then I would be on the floor, crying about the meaninglessness of life for 2-3 days. The intervals in between crises were long enough that I could pretend it wasn't a big deal.

I lived like this for 3 fucking years. When I finally found myself mentally flirting with some very bad ideas, my husband got really scared and asked me to run to the therapist. Luckily I did. Do not let it reach this point. This is me giving you permission to make it a big deal! If you feel embarassed you can tell them I scared you and told you it was a HUGE thing.

If the therapist you're seeing is not a good fit for you, try to explain the magnitude of things to them, or go ahead and look for another one.

I'm saying this because while some books and apps are useful, you need to tackle this with all your might before it grows. Still do the books and the apps, but get the best therapist you can, and go to them religiously, it's worth it like crazy. I take antidepressants, too, but YMMV.
posted by Tarumba at 11:19 AM on May 8, 2012 [1 favorite]

You would be surprised at how much depression affects in your life, even when you are functional.
posted by Silvertree at 12:30 PM on May 8, 2012

Meds are safe. It is not like cancer treatment where the meds have horrible adverse effects. You may have some bad reactions. I know I have on two separate meds. But a trial period of a few months won't hurt you. Your doctor would not be unresponsable for prescribing them to see how it goes; unlike pain meds, for example.

So bring this up with your doctor. It is their job to listen to your concerns.
posted by munchingzombie at 2:58 PM on May 8, 2012

If it makes you feel any better, a medical doctor or a nurse's questions to help diagnose depression tend to be clinical "yes/no/describe your symptoms" questions. No one will ask you to prove anything, and you won't have to talk about your feelings in much depth, certainly not enough that it will seem like they need you to "prove it."

Your doctor is there to help you. Depression is a medical condition with physical effects, and it is certainly not rare. Good luck.
posted by houndsoflove at 3:54 PM on May 8, 2012 [1 favorite]

Just dropping in to wish you good luck and to share my experience. Don't be discouraged if the first medication doesn't work, or if it doesn't feel like it's working right away. Don't be afraid to ask about switching medications (or augmenting) if need be.

In my own experience, the frustration with depression over depression was almost as bad as the depression itself. I was taking steps to deal with it, and I just wanted to have it under control. It's easy to get discouraged, so be good to yourself. Exercising and eating well both helped me immensely. Even when I felt depressed, regular exercise -- hell, any exercise -- and good, healthy food helped to keep the frustration at bay. Running and eating were reminders that I was actively taking steps toward feeling better.

Maybe one of the most frustrating things was the lack of joy I experienced when I did things that I knew I used to enjoy. Just sort of a lack of affect. It helped to remind myself that, if nothing else, when I would write or draw or make art without enjoying it I was at least priming the circuits for a day when it would make me feel good.

In other words, know that you're making progress, even if it doesn't feel like it.

Good luck and good work. My biggest hurdle in dealing with depression was the step that you're taking now. Feel free to Memail me and I'll be happy to talk about the specifics of my experience.
posted by compartment at 9:46 AM on May 9, 2012

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