Today I went to my GP for a consult on potentially starting anti-depressants. Despite shifting societal views towards mental health, I still feel like there’s a general lack of awareness going on. My social circles are awash with individuals who struggle in some capacity or another. It’s an everyday part of life for many, many people. I firmly believe that normalising the notion of seeking help and destigmatising mental illness is pretty fucking important. Which is all to say, what’s to follow is a rundown of how my experience went, to give some idea of what a diagnosis looks like.
The first thing my doctor asked me as she walked in the door was, “how are you?” I thought this was a conspicuous question to someone sitting in a doctor’s office. It’s hardly that they’d be feeling in prime health. I said as much. I then immediately realised that this could also be a shrewd way of instantly getting the information she needed for her consult. I said as much. She saw my smirk, and raised me a flat stare. It’s fine, she’s been seeing me for years. She knows which comments of mine to take seriously by now.
Before she’d entered the room, I’d filled out a couple of forms. I’d been supplied a generalised anxiety checklist and a generalised depression checklist. There was also a sheet asking me to rank how my moods had been affecting different aspects of my life: Work, home life and social relationships. She took a look through the forms and did some quick tallying. She then began to ask me questions on how my moods had shifted over time. It’s not the first time we’ve brought up this topic. She helped me get registered for OHIP sponsored therapy, which didn’t turn out to provide sufficient help. Before we parted, the therapist recommended that I considered talking to my GP about whether or not she thought medication could help with my symptoms.
I said that I’d first acknowledged signs of depression during my teenage years, with frequency and severity increasing as I entered adulthood. She asked how depressive episodes would manifest for me, and how long periods would last. I told her that they ranged from shorter periods of hours, to days and sometimes weeks off and on. That during depressive states I’d withdraw emotionally, that I’d lose touch with a desire for anything. Functionally I could complete tasks, go to work, exercise, eat healthily and sleep enough, but with no desire for more than keeping the engine running. During these periods, I’d generally prefer to no longer exist. In no way would this manifest as a desire for self-harm or dangerous behaviour. It would be more likened to hunkering down and waiting for the storm to pass.
We talked about the action that I’d taken to combat this over time. I said that I’d been going to therapy for years, but that financially I couldn’t afford to see my therapist as often as I’d need to in order to do the necessary work. I said that I exercised regularly, tried to get sufficient sleep, was conscious of nutrition, and general intake. She asked about alcohol and drug use. I said that I’d admittedly been smoking weed regularly since it was legalised. This had also severely lowered both the frequency and quantity of my alcohol consumption. While I hadn’t been smoking vast quantities of weed, my frequency was giving me trace concerns. I didn’t want to rule out the idea that regular use could be having negative mental effects, and creating a certain dependency. She agreed that it would be wise to ease up, and use it more recreationally than habitually.
She asked about any family history of mental illness. She asked about periods of increased or erratic energy. I replied that while these periods existed, they felt less symptomatic of a response to depressive episodes, and more like my normal personality. In short, if my excessive pun-making was wrong, I didn’t want to be right. She said her line of questioning was to establish whether or not elements of hypomania were present. We agreed that while this very well may be the case, they’ve never been harmful behaviours, or had negative consequences. She also mentioned that she wanted to account for this with potential medicinal side-effects.
At this point she declared that she had enough information to comfortably diagnose Major Depressive Disorder (which is just a fancy doctorly way of saying “depression”), and she wanted to talk options. She outlined the potential routes we could take. She gave me a quick run down on each type of medication, taking care to mention the benefits and/or possible side-effects. She said my options were as such:
- I could choose from the medications she listed, she’d give me a prescription and I could start right away.
- She’d list the options, I could go off and do my own research, then come back to her once I’d made my decision. After that, it was basically back to option 1.
- She could register me with a psychiatrist, who could give a more in-depth diagnosis. It could, however, take months for me to get the appointment.
- I could trust her judgement, then circle back to the second part of option 1.
- I could trust her judgement, but also get bloodwork taken to rule out any underlying conditions. She could give me a prescription, which she advised me to fulfill after getting the bloodwork back. Realistically, about three days later.
We talked it over, and decided on option 5. She’d narrowed it down to two medications, and she thought one of them would narrowly edge out the other for suitability. She gave me the forms to get my blood work taken next door. She said that once I had my prescription filled, to start off at a very low dose for five days, then increase my dose. She told me to book a follow up appointment for a month after I’d started the medication, so that she could gauge how my body was responding and decide whether it would be necessary to up the dose or not.
I could not have imagined the consultation going better. At every stage, I sincerely felt that my GP had my best interests at heart. She gauged all of my symptoms and history in her diagnosis. I felt both informed and involved in the decision. She carefully outlined the risks and benefits. At no point did I feel like she was trying to give me a quick answer and move on. Medication is a big step, and was giving it the gravity it deserved. I’ve been seeing her for over five years, and I’ve always felt like this has been the case.
I don’t know if my experience has differed from that of others. I get the feeling that unfortunately not all doctors would treat it with sufficient respect, as I was incredibly fortunate to receive. I hope I’m wrong. I also hope that if there’s anyone who’s felt like medication could be a positive step, that they feel validated asking for help. It’s not easy to do. Fingers crossed that it’s worthwhile.