Post Doctor Appt. For Depression
June 23, 2020 9:31 AM   Subscribe

If it’s not depression then what is it?

I’ve posted previously on here regarding my symptoms of depression and how I finally planned to seek help. Please see here: I think I have depression. My DR screened me with questions for depression. He said it sounds more like mood swings and very mild depression. He said I’m a product of the times of what many people are feeling due to all that’s going on in the world. He doesn’t think I need medication since I am functional, he says most depressed people who need meds are those that really struggle to get out of bed or get through the day but I manage fine. Also they tend to be stuck in that area of emptiness, numbness, sadness, etc. whereas I seem to be fine for days and here and there it’s like I have episodes. He suggested more exercise and getting out is all, and to call if I ever get stuck so they can then prescribe me.
posted by Asian_Hunnie to Health & Fitness (20 answers total) 4 users marked this as a favorite
what kind of doctor did you go to - just your general practitioner? if possible I'd recommend seeing a psychiatrist or other psych med provider rather than an internist or GP. It's probably possible to find a low cost clinic with MDs (psychiatrists) and psychiatric nurse practitioners, PAs, and other prescribers, in your area... I'm not necessarily saying psych meds are the answer for everyone - psychiatric medicine is in a slump compared to other fields (eg, cardiology), the last 40 years have seen little in the way of novel drug targets in the field. THAT SAID, some people really are greatly helped by so called "first line" treatments - for the last 20 years to first line treatments = some kind of SSRI or another.. and if you are lucky enough to be in percentage of people who WILL be helped by one of these first line meds, AND not have a high side effect burden from them, then IMO it would be a shame to not take advantage of that, and the only way to find out is to keep trying providers until you find someone willing to work with you. The symptoms you describe in your previous post do indeed sound like ..well, like the sort of thing many providers *would* take more seriously than it sounds the doctor you consulted with did.
posted by elgee at 9:44 AM on June 23 [8 favorites]

So, in that other post you said you have random thoughts about how not existing would be easier, you wouldn't commit suicide but you still have those thoughts. I had those thoughts, too, and when I told my doctor about them, he immediately put me on medication and found me a therapist. I don't think your doctor is taking you seriously and it certainly wouldn't hurt to get a second opinion.
posted by cooker girl at 9:58 AM on June 23 [14 favorites]

It sounds like your doctor may have a somewhat oversimplified view of depression. Was this a psychiatrist or just a general practitioner/primary care person? Did he elaborate any more than "mood swings"? A male doctor describing/dismissing a woman's possible depression as "mood swings" does not inspire confidence in his judgement.

I've been on meds and off meds. I don't think they're magic and I don't think they're right for everyone, but they can be helpful. In my opinion you deserve a more nuanced and thorough evaluation, either from a therapist or a different doctor.
posted by needs more cowbell at 10:02 AM on June 23 [6 favorites]

It was a general practitioner. I think because I had those thoughts a couple times but no longer do it’s okay? I haven’t felt that way in sometime. I’ve been feeling fine the past couple days but then days like today I feel a bit of sadness but not the numbness, I think that’s why he doesn’t diagnose it as depression because it’s all over the place and there and not.
posted by Asian_Hunnie at 10:09 AM on June 23

I think your doctor has a somewhat rigid, not terribly well-informed and unhelpful viewpoint and isn't addressing your genuine struggle. So you either go to a therapist who tells your doc Asian_Hunnie needs meds, srsly, you get a 2nd opinion and maybe prescription from another doc, you look doc in the eye and say I am depressed. It affects my sleep, my ability to get exercise, my ability to do ordinary tasks of daily life, and I am miserable. I need you to take this seriously, or you get a new doc.

There *are* things that help. Do them, as much as you can. Ordinary doses of Vitamin D, exercise, sunshine, nature, music. But medication sounds worth pursuing.
posted by theora55 at 10:19 AM on June 23 [3 favorites]

Yes I think I’ll go that route before going on medication which I would like to avoid. If it helps good, if not then I’ll revisit.
posted by Asian_Hunnie at 10:36 AM on June 23 [2 favorites]

Is therapy still out of the question? Last time it sounded like you were looking into it...
posted by nebulawindphone at 10:44 AM on June 23 [1 favorite]

I started with my general doctor first and I’m going by what he says first before I try anything. It seems I’m managing okay right now. it seems to come and go, so I’m not looking into therapy right now but definitely not ruling it out.!
posted by Asian_Hunnie at 10:56 AM on June 23

It's a lot more helpful to get some therapy in when things are better so you have the coping skills on board already when they get worse. Getting into therapy during a depressive episode is like trying to climb a mountain of mud with no shoes on.
posted by Lyn Never at 11:19 AM on June 23 [18 favorites]

Most general practitioners are not really qualified to diagnose moderate/controllable depression, they really only see patients who are either severely depressed and need treatment now, or people who have already been diagnosed by someone else and the GP is just there to continue prescriptions. What your doctor said is what I would expect most GPs to say, and you would need to talk to a psychiatrist/clinical psychologist/other specialist for a proper diagnosis.

It does sound like you have things under control, but also want to do something to improve it, which to me sounds like the perfect time to start therapy. Most of the time depression has both chemical and behavioral/cognitive aspects to it. The ideas your doctor mentioned will help with minor chemical issues that can cause depressive episodes, but may not help your concerns. Anyway, it is up to you as the patient but I would personally try to see a therapist.
posted by JZig at 11:54 AM on June 23 [1 favorite]

I would suggest you seek a consultation with a psychiatrist. What you're experiencing may or may not meet the clinical criterion for major depressive disorder (MDD) (Mayo Clinic), but it does sound like it rises to the level of clinical concern, and if your GP isn't particularly experienced with or knowledgeable about psychiatric disorders specifically then he may not be considering other possibilities than MDD. I am not a clinician and not qualified to diagnose you, certainly not over the Internet, but there do exist disorders like persistent depressive disorder (Mayo Clinic), also called dysthymia, in which sufferers may not experience major depressive episodes, but there is an impact on quality of life and it's treatable. I mention this not to suggest that this is what you're experiencing but just as an example of the kind of disorder that GPs are more likely to miss if they're focused only on MDD. A psychiatrist (a medical doctor who has studied physiology and can prescribe drugs in addition to talk therapy but may have less specialization in talk therapy) or psychotherapist (a licensed practitioner who is not a medical doctor and cannot prescribe drugs but specializes in talk therapy) is more likely to be familiar with the spectrum of mood disorders and may catch something your GP missed. It is perfectly acceptable to want to try other options before medication, and a good psychiatrist shouldn't try to push you into any therapy, pharmaceutical or otherwise, that you're not comfortable with.

Speaking from personal experience, though, I was extremely reluctant to seek medical help for my depression for many years, largely from concerns about the medications' side effects, but when I finally started taking an SSRI it was a very rapid improvement in my overall quality of life, and I wish I'd started on it much earlier. It's not perfect and after taking it for years I've actually gone off it for a while now, to explore whether it's had some subtle side effects that might clear up. It's also complementary to, not a real replacement for, talk therapy, something that I've had more trouble being able to pursue thanks to the American system of health insurance. So that's to say, if you do get to see a psychiatrist, and they suggest an SSRI, it's completely fine not to want to go that route or to want to try other options first, but I suggest not being afraid to give it a try just based on my own experience.

In the meantime, your doctor's immediate practical advice to get more exercise is probably good if you're not already exercising regularly: this is an effective way to stimulate your brain's natural production of the neurotransmitter serotonin and has been found to reduce symptoms of depression.
posted by biogeo at 12:35 PM on June 23 [3 favorites]

This sentence is not true: "most depressed people who need meds are those that really struggle to get out of bed or get through the day". Many depressed people are probably highly functional at getting by but feel like they're in a cloud of cotton balls or easily irritated or something, and meds really help take the edge off and stop taking things so personally and get more motivated. It's just that highly functional depressed people are not as visible because everyone just assumes they are fine, or because they are afraid to talk about their diagnosis because of mental health stigma/discrimination. In your case, I think therapy is a great idea, as is exercise and other self-care, but feel free to be open with your (eventual) therapist about whether meds are a good idea, and they could refer you to a psychiatrist or psych nurse practitioner who can work with you to find a good prescription.
posted by matildaben at 1:34 PM on June 23 [6 favorites]

I had atypical depression and it took me a really long time to get help because I still had fun sometimes, it wasn’t the all consuming greyness that most folks expect from depression. I still managed to work, but I was very unhappy and that came out as anger more than sadness. Definitely consider seeing a different GP or a therapist if you feel like it would be helpful. My depression seems to be brought on by life circumstances, but sometimes I need some help to be able to make the changes I need to make, especially if I’ve put it off. Keeping a diary might help you keep track of whether you’re starting to have more bad days than usual if you’re not sure.
posted by momus_window at 1:46 PM on June 23 [1 favorite]

Just to second that it would be a good idea for you to start seeing a therapist now, rather than saving it for when you feel bad. Plenty of people see therapists just to cope with the ups and downs of every day life even when they're not depressed, so you won't be out of place if you show up and say "I've had some really low mood in the recent past. I'm doing a little better at the moment but experience tells me it'll probably show up again and I'd like to talk about it."

They'll also be a sounding board who can help you in preparing to talk to you doctor if you decide to give that another go, make sure you're ready to articulate all the important things, and give you a sense of whether you should find another doctor or go with this one's advice.
posted by penguin pie at 2:25 PM on June 23

In addition to the good answers above, I suggest you also look into meditation and grounding exercises. There are apps now (Calm is the only one I can think of off the top of my head), and there are things on YouTube as well. That is a simple way for you to practice being centered in your body and being kind to yourself. It can be used for immediate relief when you're having anxious or uncomfortable feelings throughout the day, but it's most effective when you practice every day for at least a few months.

An easy one is to close your eyes while sitting in a comfortable chair, feet on the floor/ground. Feel your feet on the floor; feel your body as it rests in the chair. Take a deep breath in, hold it for the count of four, and then slowly breathe out. Do this three times. While you are doing it, notice your thoughts and feelings. Your goal is not to be them or let them control you, but simply to see them, acknowledge them and let them be what they are. Then return to breathing normally for a while, allow yourself to return to the room.
posted by tivalasvegas at 2:58 PM on June 23

The latest science on depression is that it's an inflammatory disease with psychological symptoms and that NSAIDs can help as much as traditional antidepressant medications. So you could try OTC NSAIDs to see if they help your mood.
posted by Jacqueline at 1:51 AM on June 24

I agree with the posters who say your doctor isn't taking you seriously enough. For me, a compounding factor when that happens is often that I allow my viewpoint of my symptoms to be influenced by the doctor, so that instead of getting more assertive about what my experience actually is, I start to second-guess myself and downplay the symptoms in my own mind. Then I'm less likely to go back to the doctor or to make the effort to get other kinds of help. So it's good that you made the effort to ask this question. To me, it shows that you are taking yourself and your symptoms seriously.

It might help to take an informal evaluation for depression on the internet. You could take a printout of your answers to those questions with you when you next go to the doctor. Or if you're focused on sunshine and exercise for now, doing the evaluation now and doing it again after a couple weeks of sunshine and exercise could help you evaluate how much improvement in your symptoms you're getting.
posted by Former Congressional Representative Lenny Lemming at 4:20 AM on June 24 [1 favorite]

Thanks all. I’ve been going outside more often and exercising more and it seems to improve my mood a bit but as I mentioned meds and therapy aren’t out of the question. I’ll revisit should this not improve.
posted by Asian_Hunnie at 10:46 AM on June 24

Something that might be worth considering, based on my own experience and on what I've heard from others who also live with things like depression, autism, ADHD, etc., is that when talking with doctors we often have a tendency to answer in terms of what we could do if we tried hard, not in terms of how we actually feel.

So, when the doctor would ask "Are you able to go to work?" I'd say yes. I mean, yeah, I generally was lying awake from 2am to 5am with anxiety about work, but I managed to get up and go to work... most days. Yeah, I'd maxed out my sick leave due to mornings when I couldn't stop crying, but I almost always made it. And it never got bad enough that I couldn't force myself in on those days when I had zero sick days available but still felt miserable, so yeah, I'm able to go to work?

Or "Are you able to meet deadlines?" Sure, for the most part. Okay, I could never actually make myself address them before 11pm the day before they were due and would wind up staying up all night in a state of panicked hyperfocus, but I managed to pull them off. Usually. I'm too embarrassed to mention the opportunities I've lost because I couldn't pull things together and deal with them so my brain wipes that from memory and... yeah, I can meet deadlines.

For a lot of people, we find ourselves answering in terms of "what am I capable of, given the coping mechanisms I've developed over the years?" even though those coping mechanisms are sometimes ultimately counterproductive. It might be useful to spend a little while considering how you'd reply to questions like this if it felt safe to speak freely.
posted by Lexica at 1:11 PM on June 24 [1 favorite]

The latest science on depression is that it's an inflammatory disease with psychological symptoms and that NSAIDs can help as much as traditional antidepressant medications.

I'm a professional neuroscientist and mood disorders is one of the things I study, though it's not my primary focus, I am not a clinician, and I don't study them in people. Inflammatory models of depression are very exciting right now and there's a lot of really interesting science being done with them, but I think this statement is an oversimplification.

Like many neuropsychiatric disorders, what we call "depression" is almost certainly a complex cluster of diseases with similar symptoms. There's a lot of interesting research happening to try to better understand the various forms of depression and other mood disorders. Some of them are probably caused by or rooted in some form of inflammatory response in the body, but others aren't. Right now science doesn't have a definitive way to determine this for any given individual's depression, and in fact there are many open questions about the inflammatory model in general. While I personally find it compelling, the science is far from settled.

It is true that NSAIDS have promising potential to treat some forms of anxiety or depression. However, long-term use of over-the-counter NSAIDS (Cleveland Clinic) can have side effects (Mayo Clinic), including some pretty serious ones. While these are generally safe to take occasionally, please don't start long-term use without consulting with your doctor. As far as I know NSAIDS are not currently recommended for treating any form of depression, because while there is some promising evidence from basic science research, they have not been fully vetted for safety and efficacy for that purpose, so it's unlikely that your doctor will be willing to prescribe them to you for this purpose.
posted by biogeo at 2:46 PM on June 24 [4 favorites]

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