If you haven’t quite been feeling yourself lately, you may be struggling to understand what’s going on, much less how to bring it up to someone. 

There’s no denying that living with depression can be an overwhelming experience, but it's important to remember that you don't have to face it alone. Seeking help from a trusted health care professional, such as your primary care doctor, is a crucial step toward understanding and managing your depression.

However, approaching your doctor about mental health concerns can feel daunting. You may not know where to begin, what to say or how to explain what you’re feeling. While Alex Podowski, LPC, an intensive outpatient program therapist at Texas Health Behavioral Health Center in Uptown Dallas, says this apprehension is incredibly common, it shouldn’t stand in the way of you getting the treatment you need and deserve.

Recognizing the Need for Help

Sometimes it can be hard to differentiate between common changes in your mood or being temporarily overwhelmed by life events and something more serious like depression. Talking to your doctor can help you sort that out, but it often starts with acknowledging what you’re feeling. Podowski suggests reflecting on your emotions, thoughts, and behaviors, and consider the impact they are having on your daily life.

“I think the first question you really need to ask yourself is ‘What is my baseline?’ In other words, what does healthy or sustainable or productive functioning look like for you,” she explains. “Then you can start to evaluate if you’ve been maintaining that or if you have fallen off, and how long it’s been since you fell off.  This way you can have tangible things that show how you are doing and how long you’ve been feeling this way.”

Podowski also notes that it’s important to be honest with yourself about your symptoms. Some general things to look for include:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness or pessimism
• Feelings of irritability, frustration, or restlessness
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy, fatigue, or feeling slowed down
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, waking early in the morning, or oversleeping
• Changes in appetite or unplanned weight changes
• Physical aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause and do not go away with treatment
• Thoughts of death or suicide or suicide attempts

“As I stated earlier, I think these symptoms become more obvious when we know what’s normal for us and what’s not. Just try to be perceptive and check in daily (how am I feeling, what do I need, what is going well, etc.),” Podowski explains. “We generally do not check in with ourselves, which leaves us potentially missing major signs for progressing sadness or depression.”

In fact, friends and family members often are the first ones to recognize a change in behavior and can play an instrumental role in encouraging you to seek professional help.

Finding a Provider You Can Trust

First and foremost, Podowski says having a doctor you feel comfortable with is essential in addressing your depression.

“It is incredibly important to have a provider you feel safe with. If you already have a health care provider, I would encourage you to think about why you are feeling hesitant to talk to them,” she explains. “Do you feel like your doctor will be receptive, kind and listen to you and you’re just nervous to have the conversation or do you already feel dismissed in appointments and more like a number at the office and that’s where the hesitation is coming from?”

Robert Smitherman, M.D., a primary care physician on the medical staff at Texas Health Arlington and at Texas Health Family Care, a Texas Health Physicians Group practice, seconds the importance of finding a doctor you can trust.

“I’ve seen patients who have not had doctors that were personable, or they’ve been in situations in which they felt like they could not trust their physician, or they were talked down to in the past,” he explains. “This hesitation can lead to withholding information even when they do head in to see someone. In my world, I like to see people pretty regularly so that I, at the very least, have a rapport with them so they’re more apt to go ‘Oh, I know Dr. Smitherman, he’s not going to judge me or belittle me; I can trust him, and he knows what he’s talking about.”

When you have a trusting relationship with your provider, you’re more likely to come in and seek care, whether you’re having an issue or you’re just coming in for your annual exam. But Smitherman admits that finding a provider you click with can sometimes be easier said than done.

“Talk to your friends and colleagues; get recommendations from them about who they see. It’s not a guarantee you’re going to hit it off with them, but it’s a good first step,” he says. “Then, be honest with them once you do go see them.”

Preparing for the Conversation

Once you’ve made an appointment with a trusted health care provider, your mind may begin to spiral about what’s going to happen during your appointment and how to discuss what’s going on. You may even feel compelled to call back and cancel your appointment but remember that your doctor is there to help you. Arming yourself with what you’d like to say can go a long way in helping to ease any nerves you have.

“I am a HUGE fan of scripting,” Podowski says, referring to planning ahead on what you’d like to say. “The conversation does not have to be random or on a whim. It is totally fine to write it out verbatim on a piece of paper and read from that paper if you are nervous. It can be helpful to even lead the conversation at the beginning, so time does not get away from you at the end of the appointment. This is about making sure your needs are met and the details you want to provide are shared.”

The following are some examples of what you might say to start the conversation:

• “I've been feeling extremely low, and I think I may be depressed.”
• “I am concerned about the way I’ve been feeling lately.”
• “Do you have any specific resources or referrals for a therapist/mental health evaluation/psychiatrist/etc.?
• “I've been researching depression and I feel like I have many of the symptoms.”
• “My friends and family have been telling me that I’m not acting myself lately.”
• “I’ve been having some difficulty getting up in the morning/concentrating at work/feeling motivated, etc.”

“Remember, this time in the doctor’s office is YOURS, so make sure you are vocal if you need to be,” Podowski adds. “It can be very easy to get overrun in those quick appointments and leave feeling like nothing you wanted to address was addressed. Being prepared with what you want to say and starting the appointment with your concerns can help lead the appointment in the direction you are hoping for.”

If you have an annual exam coming up and would like to take advantage of this time to discuss these feelings with your doctor, both Podowski and Smitherman note that while basic mental health screening is pretty routine during wellness exams, you need to take an active role in your health and be vocal about your concerns instead of waiting to see if your provider will bring it up.

Some questions your doctor may ask during screening can include:

• Are you having trouble sleeping, concentrating or focusing?
• Have there been any changes in your eating habits and/or weight?
• Are you having difficulty keeping up with your daily routine?
• How often do you feel stressed on a weekly basis and how do you typically handle stress?
• Have you been connecting as usual with family, friends, colleagues and others? Is there conflict happening more frequently with these people?
• Do you find yourself questioning your short- or long-term goals?

“You’re completely validated to not answer any question I pose to you, I won’t take offense to it, but I hope you know I’m not asking to be presumptuous or to offend you,” Smitherman says. “Oftentimes, if I bring it up first and give you a safe space to talk about it, you’re more likely to feel free to discuss uncomfortable topics or issues you’re dealing with that you’re embarrassed about. I know this saying has been said so many times, but really, we’ve heard it all and seen it all, so it’s pretty hard to faze us. We’re not here to judge you, we just want to help you. Don’t ever feel like you’re wasting my time by asking me about something, or that something is too little or silly.”

Getting the Help You Need

Once your doctor understands your symptoms and medical history, they can discuss various treatment options with you. These may include therapy, medication, lifestyle changes, or a combination of multiple treatments.

“Talking to your primary care provider is such a great place to start when it comes to getting the treatment you need and deserve,” Podowski says. “They can get you started on some basic medication and refer you to a mental health professional to jumpstart that relationship so you can get comprehensive, specialized care. It can give you a place to start rather than feeling lost with options or not even knowing where to start.”

Texas Health hospitals and Behavioral Health centers all provide free assessments to anyone looking for guidance on where and what help to get.

Treatment can look different for everyone, from individual and group therapy to inpatient and outpatient services. The beauty of treatment is the abundance of options, especially now as the pandemic has normalized telehealth services that make getting behavioral health treatment even more accessible to more people.

Podowski encourages people to start the dialogue early, saying it’s never too early to get help, even if that help just looks like carving out an hour of your time once a week to talk about your stressors with someone that can help you increase your coping skills and relieve your stress.

“Sometimes we minimize the help we could get, the skills we could get and the progress we could make when things are ‘not as bad,’ but honestly, that is the time to build skills so you can recognize and intervene earlier in the future,” Podowski explains. “As Dr. Smitherman mentions,  nothing is too small or trivial — everything you feel is valid and worth exploring.”