“You have depression?!”

Bill White, owner of http://www.chipur.com and fellow blogger extrodinaire, has allowed me to write this article as a guest post on his blog. I am honored to work with a seasoned blogger, experienced mental health provider and one who has “walked the walk” , seen depression from the patient’s point of view.

I had been seeing my pain management doctor for almost two years when I decided to bring up my mental health issues at my next appointment. To be more accurate, I’d talked with the previous doctor in the practice about my depression and anxiety. I had been up front with him about my antidepressant medications. Dr. XXX, however, transferred to another practice. So, it was time to educate the next physician who would treat me for chronic pain.

Me: “I’m going to take a big leap of faith and trust you with what I’m about to tell you.” Dr. XXX.: “Alright. Go ahead.” Me: “I’m also being treated for depression and anxiety. Both are at manageable levels right now. In remisson.” Dr. XXX.: “You?! Depressed?!!” Me: “No. In remission. I’m doing pretty good these days.”

This was an exerpt from one of my most recent doctor visits. “Why??” you ask, was it a leap of faith, a matter of trust for me to bring up my mental health issues? Well, to begin with, I wanted to be up front and remind her that I still took antidepressants. All of my doctors need to know about all medications that I take and how these may interact with each other. That’s pretty much standard fare for me at the doctor’s office. It is also a matter of trust. If I tell my general practitioner about my diagnoses (major depressive disorder, generalized anxiety disorder), whether they are in remission or not, will he/she continue to treat me with a consistent perspective? Or, will my symptoms (and me) been seen through a mental health filter? “She says she’s still having pain, but it might be the depression/anxiety/etcetera talking.” This is what I imagine may be going through the doctor’s mind after being made privy to my mental health issues.

The National Institute of Mental health (NIMH) recently reported results of a phone survey with over 1000 adults in the state of California regarding whether or not they would share their depression symptoms with their family doctor or not. All participants were asked to choose among 11 possible reasons for not sharing this information with their doctors. 43% of the participants said that they would not share this information during a “normal office visit.” The majority of respondants reported not being comfortable with receiving a prescription for antidepressants. These respondants endorsed an anti-medicine stance that depression was not something many felt a general practitioner was able to address. This is unsettling, as the general practitioner is the healthcare professional who most often takes note of his patients mental health. This may well be the initial contact for the patient to share troubling mental health symptoms. He or she should be able to recognize symptoms which may prompt a referral to specialists, such as a psychiatrist, psychologist, or counselor. Next on the list of reasons for not being forthcoming was stigma. Many people believe, and perhaps with a valid reason given the current data breach debacles, that their mental health information would become a permanent part of their medical record. Furthermore, what if their employer might able to see this information? Would it effect the employee’s position in the company? Would their co-workers find out? Would it effect a possible promotion?

Patients who fear the stigma of disclosing to their doctor mental health concerns may unknowingly risk worsening symptoms due to a missed opportunity and a chance for early intervention. Research is currently focused on neural pathways, or how a “train of thought” or belief set may become entrenched within the brain itself. Well worn pathways of neural circuits, some experts theorize, may become more difficult to interrupt (treat) over time. The path of least resistance could become the road to a more embedded perspective. (This theory hits very close to home for me. If you read my initial post, before I was formally diagnosed, I spent many hours/days trying to imagine a way that I could change the way I thought. The more time I thought about this dilemna, the more my brain may have chosen to remain on that path. (Thinking about thoughts gave me headaches.) Recent theories focus on how our brain as an organ may become “damaged” or “stuck” , forming if you will, well-worn neural pathways. Much has been theorized that, like other chronic conditions, the longer depression is left untreated, the more difficult it becomes to effectively treat. I can readily affirm this sentiment. After being pulled out of my first significant depressive episode, my psychiatrist shared the following with me: “We (medical professionals) are beginning to find support that some patients may need to continue taking antidepressants to prevent a relapse. ” I recall feeling a mix of emotions to that idea. The medication had certainly worked well for me in pullng me out of a very dark, difficult episode and it was with relief that I did not feel ready to have that support removed. Remaining on an antidepressant “for at least 9 months” seemed reasonable. That was paraphrasing as the actual conversation took place almost 30 years ago.

courtesy: Filip Kominik

* It is of note that I was treated initially with a tricyclic antidepresseant and I remember when Prozac hit the market. Here we are many, many years later and multiple antidepressant combinations are not uncommon for those of us who continue to grapple with treatment resistant depression. Perhaps it is telling that, for me to share my diagnoses with my pain management physician, felt like a leap of faith. 30 years after that initial clinical depression diagnosis I’ve encountered a range of physician perspectives; some biased, others more open-minded. My migraine headaches were diagnosed before the depression diagnosis by a neurologist in the town where I attended graduate school. This is not notable, except for the response I received during one of my early office visits . I waited for what seemed like an eternity as the migraine pounded and pulsed through the side of my head. After a brief neurological examination, my newfound neurologist let me know that he “did not prescribe pain medicine” and that “Pain never killed anybody.” What?!?! He really did say that and, me being a relatively naive patient in my early 20’s, did not challenge his “wisdom.” Perhaps it was statements like his and less than compassionate care by other physicians, which may have caused me to see doctors from a somewhat biased viewpoint. It may be that I, too, must make a leap of faith.

(W, hy people with depression hide their symptoms from doctors. http://www.recoveryranch.com/articles, Last modified: 4/22/19, Posted: 10/7/11)