What I learned from seeing a doctor again a month after being diagnosed with depression.

For one, I was a lot less anxious than going into the first consultation. Perhaps this was because I knew what to expect this time around, had met the doctor before and actually woke up feeling a whole lot better than the last time I had to get myself out of bed to admit I was depressed.

You still have these unsettling doubts though, that the doctor is going to switch up your medication, tell you you’ve been doing a bad job prioritising your recovery and leave you to get on with dealing with it. At least that’s what my depression tried to convince me it would be like. Naturally, in reality this wasn’t the case at all, and I had some valuable learnings from the experience which I wanted to share with you today.

  1. If you speak honestly about what you’ve been experiencing, a GP can help you more. I opened up about my loss of appetite and feeling like a walking zombie when I combine the anti-depressant with the anxiety medication, which we could address once I had put it on the table. It turns out that only happens to a small percentage of people, especially with the brands I am on, which I was surprised to learn. I haven’t taken an anxiety tablet for a few days and I’m coping fine, so the recommendation is to leave them and just focus on the anti-depressant for now. What this means is that I only have to take one tablet a day, which is a winner in my books. It also got me thinking: If I take an anxiety tablet systematically when feeling anxious and highly stressed, is that not the same as reaching for a beer after a long day? It’s all about the how, not necessarily the what. I don’t need more bad coping mechanisms. I’d prefer to focus my energy on positive ones, like writing, walking on the beach, reading my book or cooking a healthy meal.
  2. Loss of appetite and fluctuating energy levels are part of the first couple of weeks on Nuzak. The doctor told me to expect the loss of appetite to subside by month 3 (after 8 weeks), not any sooner. This was reassuring as I had been wondering if my system was actually rejecting the medication but this isn’t the case. I now have a framework of what to work with and what to expect, which does really help me, and I’m happy to know that this is mostly a phase that comes with the territory when you start on anti-depressants and particularly this kind of medication.
  3. You don’t have to buy all your meds in one batch. While I don’t have to see her again for a consultation until the end of the script (December), I could arrange with the dispensary that I come collect and pay for the medication each month. As I’ve never been on chronic medication, I thought you had to pay for it all upfront, which was a point of anxiety for me. Call me naive if you want, but I imagine other people wonder the same thing. Bottom line, is that you get to dictate when and how you collect your meds, which I thought was pretty cool, and reassured me that I did actually have some element of control in a process which is largely uncontrollable.
  4. This is only the beginning. She was pleased with the lifestyle changes I had made, and commented that it seemed like things were going better with me (“You smiled at me when you greeted me this time”). She did remind me that this is only the beginning though, and that the SSRI’s will “level out” (peak) at the 6 week mark only, so we’re still building the levels of serotonin in the brain. She told me to be patient, and that the lifestyle changes now might not have immediate positive benefits, but that in six months they definitely will. The alcohol abstinence, for example, does wonders not only for my mood, but for my liver, which took a hammering in my 20’s. I really, really, really don’t want to be 35 and suffering from liver disease (there are some really interesting documentaries about this on Youtube, if you want to learn more).
  5. I’ll be on medication for the rest of the year, and I’ve come to terms with that. Like I mentioned, she’d like me to see her again early in December, for us to discuss how I’ll be reducing the dosage going into January, so that ultimately I can (hopefully) be completely off’ the anti-depressant by February next year. That’s the goal for now, and it is a fluid one. Situations change, my body could respond differently to the medication a day, week or month from now, but it does seem like there is a bit more clarity about the process now and I am happy to proceed with the framework for the rest of the year. While it seems like a long time away, it really isn’t that far away, and also gives me a bit of a benchmark and a goal to work towards.

The ship is slowly starting to steady and even though I’m aware that we’re still in the early days, I’m starting to feel more of a glimmer of hope about the future again, and quite frankly, heading in a new direction that I know can only bring me better things. Let’s keep the conversation (and the momentum) going as we look towards August.

Conrad was here.

Returning to the doctor’s office for a 30 day follow-up consultation.

The first 30 days of taking medication for my depression has certainly had its ups & downs, but I can definitely say that I’m happy to be this far into the recovery process and I’m glad it isn’t the 18th of June anymore. A lot has changed and there are many things to be thankful for since that fateful weekend where I realised everything needed to change.

Tomorrow I’m going back to my GP for a one month check-up, to discuss the medication and to see if any adjustments need to be made. I’m also going to be picking up a new script, as I completed the first one, and I’m proud of myself because I didn’t miss any doses this month.

A couple of things I’d like to bring up with her:

  • My appetite is still greatly reduced, even after four weeks of taking the medication. I’m barely eating 1000 calories a day, which is resulting in rapid weight loss, which I know isn’t uncommon. Perhaps she will have some tips to help increase my appetite. I have noticed that my appetite comes and goes and can change pretty quickly.
  • The anxiety medication, in combination with the anti-depressant, has been rather debilitating at times. You really feel like you’re in a haze when you take it. I’ve greatly reduced when I take the anxiety medication, and have felt I can cope better at work and in general by not combining the two, unless I absolutely have to. Thankfully the anxiety medication is not meant to be taken each day, only when necessary, so I’m trying not to make it a crutch. There is no point in “self medicating” with an anxiety tablet, similarly to how I would have done with sugar or alcohol in the past. Solve the problem, don’t change the means to an end only.
  • I’d like to discuss if she believes the medication has kicked in yet. I’m told it takes between 4 and 6 weeks and while I do feel better, I’ve also made some drastic lifestyle changes, like only eating takeaways once in the last month, and cutting alcohol out of my diet. Do I feel visibly better? I definitely feel better than a month ago. Am I able to cope a little better? Definitely. Is it a drastic change that would have happened without the medication? Doubtful, but I’m not feeling amazingly better, just incrementally so. Perhaps that’s how it works, I don’t know.

I’m definitely more relaxed about the appointment than I was going for the first time, and a part of me can’t believe that it’s already been a month since my breakdown. Things can only look up from here, and I’m proud of the progress I’ve made in a short space of time. I am still committed to seeing the medication through for at least six months and would be interested to hear if she feels I should be changing medication or not. I don’t think the dosage is incorrect, but perhaps I’m not on the right kind of medication and she has something that will help to increase my appetite. I have to be honest, that I’m not too keen to experiment that much and may ask to just carry on with the current meds for at least one more month, before looking at adjustments. I’m making strides in the right direction. Let’s see how it goes!

Conrad was here.

 

Talking myself out of my depression while sitting in the doctor’s office.

I was already talking myself out of going when I got in the car, but off I went to the doctor’s office. I had opted to go for a female GP, as it felt like it may be easier to open up to a woman about my depression. Not sure why, but it is what it is.

After I had paid for my consultation upfront, I sat down in a crowded waiting room and thought I would only need to wait for a few minutes. The doctor was running very late, though nobody was keeping me updated, and I hesitated to get up, because I worried that if I got up, I would walk out and not come back. Here I had decided to be brave, to be vulnerable, and to share what I was going through with a complete stranger with the hopes that I would be able to get some help, and I had to sit for an hour, questioning the decision, looking for ways to get out of there, even considering making a scene and telling the receptionist to go fuck herself.

At long last, I was moved to another waiting area, and a short while and a few forced smiles to people walking past later, I was sitting in front of a young doctor who had trustworthy eyes. “I’m so so so so sorry to have kept you waiting” she started, after which she rambled something about old people taking forever during consultations. I was too anxious to care or even listen, I just wanted to get talking. I had made it this far, and I just wanted to hear some sort of feedback for how I had been feeling. I had practiced over and over how I would start the conversation. How do you start the conversation? This is a great source of anxiety in itself. “Hi doctor, I’m depressed.” – too forward. “Hi doctor, my mental health is low” – low? What does that mean? I didn’t know how to do it.

I can’t recall what I said or what she asked, but a minute later I was rambling off about the last six months of my life, talking about how I had started to isolate myself from everyone for the past few years, mentioning the breakdown of my engagement last year, discussing how it had affected my work performance, how I had always been able to “put on a show” at work, and how I had somehow managed to make it here. “Suicidal thoughts?” she asked. I paused. I mentioned that I was unable to see past June. As in, unable to see past 13 days from now, when it would be July 1st. “So no plan of action yet then?” she continued, adding what I interpreted as humour. Time and place, lady.

Now this is where I need to give her some serious props. Following this and acknowledging my depression diagnosis, she started talking to me about mental health, the stigma around it and how by 2030 it will be the leading cause of death in the world.

She called it a disease, which automatically made me feel more scared, yet more validated. I had expected to be told that it was something “you just get over” but she really stressed the severity of the situation. I am thankful to her for doing so, because had she not, I may have walked out of there feeling worse about this illness, perhaps also thinking that it wasn’t serious and that my suicidal thoughts would go away. She told me that she was going to try me on an antidepressant called Nuzak for 1 month, but that I would need to commit to 6 months as a minimum if I wanted to see any long term changes. She told me it wasn’t a magic pill, and that I would need to make some serious lifestyle changes. We talked about marijuana, which I don’t use anyway, but funny enough she didn’t mention alcohol at all – something I do consume, pretty regularly. I was a little disappointed that it wasn’t mentioned as a go-to.

Regardless, and still feeling more assured and like a weight had been lifted off my chest, I left her consulting room and went to the dispensary in the same building, handing my prescription (which also contained some anti-anxiety medication – apparently anxiety is a side effect once you start taking anti-depressants for the first time) to a nice old lady who I felt was probably going to judge me for needing to get these medications, but I couldn’t dwell. All part of the stigma, all part of the fear that you’re somehow “broken” by suffering from a physical imbalance over which you have absolutely no say or control. She came back a little while later, I paid for both medications, happy that they were more affordable than I thought they would be (in your mind you also tell yourself that they will be ridiculously expensive to deter you from going), and I was on my way.

As I got into the car, it started raining and I sat for a minute staring at the boxes. I opened them frantically and started reading through the leaflets for information on anything I could expect to feel over the next few days. The doctor has simply mentioned headaches, but had not given me an indication as to what to expect. She didn’t give me an indication as to whether the dose would be low, or if it was high. I really was going in blind, which is something that is definitely also a part of the hurdle of getting treatment. I wish there was a simple way – a checklist of sorts – to help people get the information they want. If people had more of an idea of what they were in for – regardless of the fact that I know everyone responds differently and there is no ‘one size fits all solution’ – perhaps more people would reach out and seek treatment for depression.

After digging through the leaflets, still not satisfied but keen to get going with my treatment, I decided to head home, but not before calling my mom from the driveway, sobbing, and finally acknowledging that I had been diagnosed with that dreaded, never-to-be-spoken of disease called depression.

Conrad was here.