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Mental Health

Working With Your Doctor When You Have Depression

 

Author: Canadian Mental Health Association, BC Division

 

Talking to your health professional about depression is a very important first step in your journey to wellness. Once you've received a diagnosis, you and your health professional will need to build a treatment plan that works for you. This is vital—if your treatment plan doesn't address your own needs and concerns, you may not see the benefits in areas of your life that are most important to you.

What mental health professionals might I visit?

You will likely encounter different mental health professionals on your recovery journey. They have different kinds of training and offer different services and supports. Here are the professionals you might work with in your journey:

How do I talk with these health professionals?

The most effective way to take charge of your health is through shared decision-making, which means you and your doctor (or other health care professional) work together to make a treatment plan that works for you.

Some people prefer to be very involved in their care while others prefer less direct involvement. Your role may vary depending on the stage of your illness you're at: whether you've been recently diagnosed or whether you have a lot of experience with your illness. Regardless of your preferred level of involvement, you do need to be involved in some way.

Depression can affect how you interact with your health professional. It can affect your memory and concentration. It's helpful to look for ways to keep track of everything so you have the information when you need it. You could use apps on your phone to take daily notes, track changes in your mood, write down questions you'd like to ask at your next appointment, and set reminders so you don't forget appointments. Some people carry a notebook with them. Online screening self-tests are another great tool: you can print out your screening results to bring to appointments. (This can be a great strategy if you have a hard time talking about your symptoms or experiences.) Some people also find it helpful to bring trusted family members or friends to appointments.

Shared decision-making is a series of steps that lead to an effective treatment plan for you. These steps are:

  • Family doctors or general practitioners (also called GPs) are medical doctors. Family doctors are the people you'd see first for most health concerns. You may already have a family doctor, but you can also talk to a family doctor at a walk-in clinic. They are also your first step in navigating the mental health system. Family doctors can diagnose depression, prescribe medication and refer you to specialized services. Nurse practitioners (NPs) can do much of what family doctors can do and often work alongside one in a family practice.

  • Psychiatrists are also medical doctors with specialized training in psychiatry. They can diagnose depression, prescribe medication and provide different psychotherapies. Many psychiatrists work at hospitals or mental health centres. Your family doctor can refer you to a psychiatrist.

  • Registered psychologists can give a diagnosis and provide different psychotherapies, but they don't prescribe medication.

  • Counsellors (such as Registered Clinical Counsellors or Canadian Certified Counsellors) provide a clinical assessment, prevention strategies and psychotherapies. Many counselors also provide support through Employee and Family Assistance Plans (EFAP) as part of workplace benefits.

  • If you have a mental health team or use services at a mental health centre, professionals like social workers, registered nurses, occupational therapists, and vocational rehabilitation therapists may help you learn new skills and achieve your goals.

    1. Defining the problem. Your role is explaining the problem in your own terms.

    2. Setting goals. Deciding what the goals of treatment will be, or deciding what will happen as a result of treatment.

    3. Making decisions. Developing and deciding on treatment strategies. You'll want to balance the advice of the mental health professional with your own expectations and priorities for treatment.

    4. Monitoring results. Evaluating whether strategies are working, and re-assessing the treatment plan as needed.

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Step One: Defining the problem

When you go to see a mental health professional, they will talk with you to assess your problem. Your job is to give as much information as you can in your own words to give the doctor the full picture of what's going on. Your doctor will also need to know what you’ve experienced in the past and what treatments you’ve tried in the past.

It's also important to talk about how your mental health is affecting different areas of your life, such as your job, your home life and your relationships. For example, do you have a hard time concentrating at work? Do you spend less time with family and friends? Do you feel like you don't have the energy for social events? Are you less certain that life is still worth living? This information will help health professionals understand your experiences.

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Step Two: Setting goals and making decisions

Before you decide on a treatment strategy, you need to think about what you want to change. Your eventual satisfaction with your treatment plan will depend on whether it helps you deal with the way depression impacts your life.

Your sense of priorities may be different from those of your health care professional, so you will need to be able to explain what your priorities are and why they’re important.

When you’re working these issues out, you’ll need to be open to advice from your health professional or support network, and open to consider new information and perspectives that may change your ideas. The ideal situation is one where you can communicate your own concerns, list new information and perspectives, and then come together and agree on a strategy of what goals to address first.

Once you’ve decided on some of the issues you can realistically address, you then need to decide on some concrete goals that you plan to achieve. Concrete goals are specific enough that you can picture what they will look like and mean in your daily life. For example, if you’ve become more socially isolated, a goal may be to become more socially active. To achieve this, you need to be more specific. A concrete goal out of this might be to phone one friend in the next week.

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Step Two: Setting goals

Before you decide on a treatment strategy, you need to think about what you want to change. Your eventual satisfaction with your treatment plan will depend on whether it helps you deal with the way depression impacts your life.

Your job is to explain what you hope to achieve as wells as what doesn't work for you. For example, if you feel best when you can work, you may not be satisfied with a medication that makes it hard to get up in the morning. However, if your doctor understands your priorities, they can recommend a better option.

You'll also need to be open to advice from your health care professional. Ideally, you can communicate your own concerns to your health care professional, listen to new information and perspectives, and then come together to find a treatment strategy.

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Step Three: Making decisions

Now that you’ve decided what you want to change, the next step is figuring out how you're going to change it. Deciding on a treatment plan that you can live with involves different parts:

  • Considering the evidence

  • Considering your own preferences and values

  • Considering other people’s experiences

Considering the evidence

When you consider an option for treatment, you need to know some basic facts about the treatment. You need to find out how the approach works, how long it will take to work, what the potential risks and benefits may be, and whether it's an appropriate choice for you. Here are some questions to keep in mind when you consider the evidence, whether it came from your doctor, another health care professional, or you came across it on your own:

  • What are the potential risks or benefits? How probable are the benefits? How probable are the risks?

  • What might happen if you do nothing?

  • How do the benefits and harm weigh up to you? What risks are you willing to take to achieve your goals?

  • Do you have enough information to make an informed choice? Are there any options or perspectives you haven't considered?

If you're considering information you heard from a friends or information from the media, online, or in a book, check out our Evaluating Mental Health and Substance Use Information info sheet.

Considering your own preferences and values

Making a decision includes your own attitudes, including your values and fears.

You will need to consider all the things that influence your thinking, including your personal values, emotions, and attitudes about your illness and potential treatments. For example, some people have concerns about medications, like concerns about becoming too reliant on medication or fear of side effects. Talking about your preferences and concerns help your health care professionals understand your perspectives and help you look at your concerns more realistically.

Considering other people's experiences

Other people's experiences can provide a lot of valuable information, and can often provide reassurance. It's best to talk to several people, not just one or two, to get a variety of perspectives. Everyone's situation is unique, but there are often things in common. Support groups are a good place to learn from others. You can also find stories of other people’s experiences in books and online.

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Step Four: Monitoring results

Once you've developed your treatment strategy, your next role is to help monitor the results. For this, you'll need to know when and how to measure success. For example, you'll need to know how long it may take for the medication to start working or how long it may take to see results from psychotherapy. You also need a clear idea of how a treatment may impact your daily life.

Once you start a particular treatment, you need to be able to tell your doctor or mental health care professional what has been happening between visits, such as side effects from treatments and changes in symptoms. It's also important to see if treatment is meeting your goals. There are many tools to help you track your progress, such as apps, journals, and charts. We've included one here, but you can use others you like better. Then when you meet with your health care team, you'll have the information you need to assess your current treatment and look into other options, if needed.

In the early stages of developing a treatment strategy, you should meet fairly regularly with your care team to monitor your progress and make adjustments to your treatment plan when they're needed.

It can be very disheartening when a treatment doesn’t work as well as you hoped. It's impossible to predict exactly how a treatment will work until you try it, and that means a treatment might seem perfect on paper but fail to help once you start. It's common for people to try multiple treatment options before they discover what works best for them. It's important to maintain hope and keep trying. If you and your health care team take a systematic approach and work through options, the odds that you'll find a treatment that works are high.

If nothing seems to work, it may be a sign that you need another assessment. There may be another health problem involved or the diagnosis may be incorrect. If you feel like your health care professional is unwilling to listen to you or consider different options, it's a good idea to seek a second opinion from someone who may be able to help you better.

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Sticking with your treatment plan

Once you've arrived at a treatment plan that works, it's important to stick with it. For many treatments, this means continuing treatment even when you start to feel better.

Suddenly stopping a medication like an antidepressant can cause uncomfortable side effects. If you want to stop taking the medication, your doctor can help you taper your doses slowly to make sure you continue to feel well.

If your treatment plan no longer works for you, have an honest discussion with your health care professional. Your doctor can help you re-evaluate your treatment plan and move to a different strategy safely.

Preparing for a health appointment

Talking to health professionals may be intimidating, but you and your health professional do need to work together. Remember, your doctor can't provide the best information if they don't know what the problem is, and they can't offer the best-suited treatment options if they don’t know your goals or concerns. Here is a checklist to help keep you on track during your appointments.

Before the appointment

Plan—Think of what you want to tell your doctor or what you want to learn from your health professional at this appointment. Decide what is the most important to you. If you have particular questions, write them down. You can bring your list to the appointment. If you take any medication, including over-the-counter medication, plan to bring it with you.

During the appointment

Report—Tell your doctor what you want to talk about during this appointment

Exchange information—Make sure you tell the doctor what’s wrong. It may be helpful to bring in a self-test you’ve completed or a diary of symptoms. Remember to explain how your problem affects your day-to-day life. You can bring a loved one with you, and they can help describe changes they’ve noticed.

Participate—Talk with your doctor about the different ways to handle your health problem. Make sure you understand the positive and negative features of your choices. Ask as many questions as you need.

Agree—Be sure that you and your doctor agree on a treatment plan that you can live with.

Repeat—Tell your doctor what you think you will need to take care of the problem.

Adapted from the Institute for Healthcare Communication's PREPARE program at www.healthcarecomm.org

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Activity: Mood Journal

Use a sheet per week to track influences on your mood and/or anxiety and over time, look for trends. Add other influences in the last two blank rows (e.g., menstrual cycle, weather, etc.). For treatment, track medication dosages and side effects and/or counseling appointments. For alcohol use, track number of drinks. For all other categories, use a system of symbols or words that works for you. For example: poor = *; fair = **; good = ***; excellent = ****. OR mild/moderate/severe.

Example:

Mood influences

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

Medication (dose)

Effexor 150mg

Effexor 150mg

Effexor 150mg

Effexor 150mg

Effexor 150mg

Effexor 150mg

Effexor 150mg

Counselling

 

 

1 hr appt

 

 

 

 

Skills I practiced today

10 min mindfullness meditation

thinking traps worksheet

10 min mindfulness meditation

 

10 min mindfulness meditation

 

10 min mindfulness meditation

Sleep

6.5 hrs

6 hrs

7 hrs

7 hrs

7.5 hrs

8 hrs

8 hrs

Exercise

30 mins

30 mins

 

30 mins

 

1 hr

 

Overall stress level

2

2

3

3

2

1

1

Alcohol and other substance use

 

 

1 drink

 

2 drinks

2 drinks

 

Work time

5 hrs

5 hrs

6 hrs

5 hrs

5 hrs

 

 

Overall mood

3

3

2

2

3

4

3

Mood influences

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

Medication (dose)

 

 

 

 

 

 

 

Counselling

 

 

 

 

 

 

 

Skills I practiced today

 

 

 

 

 

 

 

Sleep

 

 

 

 

 

 

 

Exercise

 

 

 

 

 

 

 

Overall stress level

 

 

 

 

 

 

 

Alcohol and other substance use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Overall mood

 

 

 

 

 

 

 

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Where do I go from here?

Your doctor or mental health professional can recommend resources in your community. In addition to professional resources, you may find non-professional support helpful.

BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for more info sheets on depression and mood disorders, self-tests and personal stories. Visions Journal, our magazine, brings together mental health professionals, people managing mental illnesses, family members, and communities. You can also find the info sheets When You're Diagnosed with Depression and Preventing Relapse from Depression.

Support groups
Support groups are an important way to find support and information. They may help you feel less alone and more connected, even if you haven’t told many others about your diagnosis. You can find support groups in your community through the Mood Disorders Association of BC online at www.mdabc.net or by phone at 604-873-0103. You can also find support groups online. For more on choosing the right support group for you, see the info sheet Choosing a Support Group that's Right for You.

Understanding Psychiatric Medications
The Centre for Addiction and Mental Health in Ontario offers guides for four different kinds of psychiatric medications: antidepressants, antipsychotics, mood stabilizers and benzodiazepines. You can find these guides online at www.camh.net.

Canadian Network for Mood and Anxiety Treatments
Visit www.canmat.org for information on treatments for anxiety disorders and mood disorders. You can also find the Depression Guidelines, which lists evidence-based treatments for depression.

Reclaiming your power during medication appointments with your psychiatrist
Visit www.power2u.org for the article Reclaiming your power during medication appointments with your psychiatrist from the National Empowerment Center. It describes how to think about medication and work with health professionals as you work towards your treatment goals.

 
Learn more

This the second module in a three-part series. The other two modules are When You're Diagnosed With Depression and Preventing Relapse of Depression.

This tip sheet has been adapted from an older resource from BC Partners and HeretoHelp: Macnaughton, E. (2003). "Module 3: Becoming an Active Partner in Treatment: Shared Decision-Making." Depression Toolkit: Information and Resources for Effective Self-Management of Depression. Canadian Mental Health Association, BC Division.

 

 
About the author

cmha bc logo

The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.

 

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