How to react when asked by doctor if you are depressed when you don't want to discuss it.

[Elizabeth CP]

I had an appointment with a specialist for the first time for a physical issue. My husband had previously seen this specialist many times so he recognised me & first question was are you depressed. I said I was OK. He then insisted I didn't look OK. I had recently returned home from overseas holiday & still adjusting to jet lag so I thought I was tired rather than depressed. The doctors questioning led to a number of negative thoughts: I must look terrible for him to think I'm depressed, He probably thinks my problems are mental health related rather than a 'real' illness so he won't bother trying to fix me, I'm stupid because I can't control my depression/anxiety. (of course 'other' people have 'real' mental health issues so need/ deserve treatment but I don't so I'm wasting health professionals/ other people's time because I should be able to manage better.) I just wanted the doctor to discuss the physical problem I'd been referred to him for.

Do others feel like me & how do you deal with it.

I have difficulty determining whether I'm just very tired or actually depressed because the two are so closely linked.

[Doolhof]

Hi Elizabeth,

So did you manage to receive the help for the physical problem you had?

Regarding the question about depression, sometimes I believe it is possible to have depression and not realise how it is affecting you.

The Dr will have questionnaires he/she can ask you to fill in to score how you are coping. Through this the Dr will be able to discuss the results and then ask if you require assistance with any mental health issues that present themselves.

Here on this forum there are check lists you can read to see if you do feel like you are depressed or anxious. My suggestion is that if you do read any checklist for depression, you print out the results and take them to the Dr. for discussion.

Returning to your Dr. to discuss this further I believe is beneficial.

Cheers from Mrs. Dools

[Elizabeth CP]

Thanks for your reply Dools,

The specialist wouldn't prescribe medication for the infection I have as he believed the side effects weren't worth the benefits. He suggested trying something else for a few weeks & if not better more blood tests & CT scans before my next appointment. Because he was a specialist I didn't think discussing mental health issues would help. I am seeing a psychologist & psychiatrist already & was supposed to be getting better. Maybe the contrast between my GP & the specialist also didn't help. I want to change GPs but feel I need to follow up on the tests & specialist referrals first so results can be sent back to her & then hopefully then transfered to a new GP later.

Sorry I am a bit tired so I am not thinking as clearly as normal.

[Elizabeth CP]

I saw my psychologist this week & he wants to make sessions less frequent because things aren't changing enough. I think i'm not improving much so it isn't worth the time. I then saw my psychiatrist and he asked me if I am depressed. He told me my fatigue & poor sleep are signs of depression. Is my depression or low mood due to tiredness or the depression due to fatigue & what do I do about it???

[Dr_Kim]

Hi Elizabeth, it's a interesting dilemma - the old chicken or the egg question! It is true that tiredness and sleep disturbance can be a result of depression and it is also true that they can be a factor in causing low mood . I have had this conversation often in the context of new mums and PND. Often they are unsure whether they are depressed or just exhausted. 

It can be tricky to work it out. However , my sense is that it's not 100% clear cut. I would recommend that for everyone ( and especially those whose moods can tend to be a bit low ) it is a good idea to ensure we look after all our lifestyle factors- including eating well , exercising , doing regular Mindfulness practice and having good sleep routines. 

Ironically, when we feel lethargic and lacking in energy, in the absence of any medical issues causing it ( like iron deficiency or thyroid for example ) then exercising actually increases our energy levels .

Exercising has also been proven to improve mood so that's a win win ! 

But back to the main question of is it depression or lethargy .. well ... I know I am oversimplifying things by saying this but in general- depression usually has a number of other symptoms that are equally distressing to the patient- things like feeling negative , not finding joy in things , avoiding usual activities, poor concentration, guilt .. etc .

When someone is very tired , these things can occur but usually will be relieved with rest ,but with depression they won't , they just stay around . Even a "good nights sleep" may not leave one feeling rested or restored .. 

As to how you can be sure what caused what .. at some point it's academic. If someone is actually depressed - I would just treat the depression as needed, doesn't matter what the cause. 

[Elizabeth CP]

Thanks for the reply, I originally saw my GP last year & had blood tests urine tests & multiple other tests resulting in follow up by specialists & extra tests. While some physical issues showed up they were not severe enough to explain the excessive fatigue. Multiple factors have lead to poor sleep but even when I do get adequate sleep I don't seem to bounce back. I went on a diet (based on healthy eating not extreme dieting( last year & managed to lose weight through healthy eating & regular exercise. Walking or other similar daily exercise has had a positive impact on my fitness overall. I have tried to do what i can to give myself the best chance to overcome my fatigue &/or depression but still not succeeding. I need to relax more but I also struggle with feeling worthless when not being productive. When I push myself to do more I might feel more worthwhile but often fall back because I end up doing too much & get exhausted. If I try to rest or relaxto recover I feel useless & feel worse mentally so I bounce between the two extremes. At times I feel like things are improving but then something goes wrong eg I get sick or my husband gets sick so I can't sleep & I go backwards.

I have tried several different ADs but the side effects have been so bad I couldn't cope & then struggle getting off them.