Confronting Depression for the First Time

Medical Reviewer

It's a big step admitting you may be depressed. Nobody seeks out a mental illness and neither do they want the stigma or the stereotypes that could follow them around. Even so, enough people recognize that depression is very common and in order for things to improve professional help may be needed. If you feel depressed what should you do and where should you turn?

Perhaps you've already done some research around the signs and symptoms of depression and it has brought you to this point. You've maybe been wondering whether it is worth troubling your doctor? After all, things have been dragging on for a while, and things might improve? Perhaps all you need is a break? Although, all those aches and pains, the stomach upsets and the broken sleep doesn't help matters. So you've been putting off the appointment, trying to distract yourself, and maybe self-medicating?

Let's put things into perspective. First, symptoms of depression are important. Whether or not you can identify a specific reason for feeling depressed is beside the point. There is a difference between a low mood that may last just a few hours or days and depression that can last for weeks, months or even years.

Depression may be a disease in its own right or it may be the symptoms of some other physical problem and that's why it's important to see your doctor. Your doctor will want to run blood tests. They will want to talk about events leading up to your mood, and your current situation, your work, or anything that may have a bearing on your situation. Then, once physical conditions have been excluded, your doctor may agree to treat you for depression.

But I've already made a few jumps. Perhaps your biggest hurdle is going to see the doctor? It's something many people find difficult especially if they feel otherwise healthy. It's also highly symbolic. I've spoken to many patients who in different ways say broadly similar things. For example - once you open your mouth about the way you feel, you've crossed a line. You've moved beyond a state of self-containment. Now you're exposed. You've become a medical statistic, a diagnosis and a person who is asking a total stranger for help. Your self-confidence, low as it has become, now scrapes along the bottom. Far from feeling better, you leave the consultation feeling depleted, despite reassurances that things will improve.

Well, that's one possible scenario, but we're all different and the way we use the opportunity to speak to a doctor, psychiatrist or psychologist, can have big implications. All health professionals agree that the best way for them to offer help and advice is to be told accurate information about how the patient is feeling. Patients may share the sentiment, but things may be quite different in practice. Here are just a couple of well-known examples:

A new patient spends most of their time making small talk and perhaps touching vaguely on one or two symptoms. The doctor, uncertain about what they are meant to be picking up, may take blood pressure and ask a few standard questions in order to focus the situation. It can be like getting blood out of a stone and eventually time runs out. Others turn up for some apparently minor complaint and just as they are making to leave come out with an apparent afterthought: "Oh yes, while I'm here I thought I'd just mention." Yet others don't turn up for appointments because the whole thing is just too intimidating, or they feel insecure, or unconvinced and embarrassed by their own emotions.

There are some alternatives. First let's keep in mind that doctors are there to serve their patients best interests. In most clinics or shared doctor surgeries there are usually one or two who have a particular interest in mental health issues. It can sometimes help to phone ahead and ask who might be the best person to see. Three things in particular will be of interest to the doctor so it will be useful if you consider these issues and perhaps jot things down in a diary or sheet of paper. They will want to know your thoughts and feelings and how things have changed in your life so far as your normal routines and behaviors are concerned.

If you find it hard talking to people, or you think you might freeze during the consultation, write a letter ahead of your visit. This will give you time to focus your thoughts and say what you need to say. By all means go with a trusted friend or relative. They may also be willing or better able to advocate on your behalf, if this is what you wish.

Finally, there's no harm in pointing out that doctors are human too. Sadly this can mean not all are as supportive, informed, interested or worldly wise as others. Youth or age isn't necessarily an indicator of best practice, neither is clinical efficiency if this doesn't equate with effectiveness. You may not feel you have the motivation or energy to compete with an awkward or unsympathetic consultation, but it's important that you don't settle for inadequate care. If you plan to accept and remain under treatment it is important that you find a doctor who accepts that your depression is as meaningful as any other disease they may be treating. It's sometimes a difficult judgment to make on your first visit, but it's something only you can really do.