When You’re Depressed and Doctors Aren’t Great, What Do You Do?
“When you hear hoofbeats, don’t look for zebras.” Why? Because horses are far more common so, probably, that’s what you should be expecting to see. Here’s the thing, though; the commonality of horses does not negate the existence of zebras. So, what happens when doctors insist on looking for horses, because that’s easy, when it became clear a long time ago that the hoofbeats are something else entirely? At what point does it make sense to go find someone who is at least open to the existence of zebras?
In 2017, in the depths of the worst depressive episode of my life, I started to question whether my doctor, my helper, was actually helping. Sure, he thought he was helping; but that’s not enough. He was doing his thing: chucking various SSRIs at me, and not reacting to the information I was providing him with; that SSRIs seemed to not actually work for me at all. On top of that, he was adding more and more supplements that came with complicated instructions—“this one with food, this one two hours after or one hour before food, this one nowhere near food but also not near bedtime”—and that did nothing but add fuel to the fire of my out of control anxiety). He told me that the side-effects that started when I began taking each med and went away after I stopped weren’t being caused by those meds because, from what I could tell, he saw something that said they were not likely while he Googled the meds in front of me. It was then that I lost my shit on my doctor and enlisted the help of a psychiatric nurse practitioner who ran DNA testing, identified that certain meds did and did not work for me, and got me out of the depressive episode with the off-label use of an unconventional medication.
“Great!” I thought, “This is another clue, another thing that could help us look at the big picture of my health issues and figure out what’s going on!” NOPE. Instead, my PCP (usually a lovely person) took to reminding me over and over about how I lost my shit on him (“You were in a bad place, you yelled at me!” Yeah, dude, I know. YOU were in a bad place and sucking at your job but I don’t bring that up every time we talk because I’m not an asshole), talking about the psychiatric nurse practitioner like he was competition and never communicating with that person, even though I specifically signed forms authorizing them to collaborate on my care, and continuing to play Whack-a-Mole with individual symptoms, getting excited when he had a new idea that might work and irritated when it didn’t as if I was willfully not improving just to show him up. Meanwhile, my anxiety kept increasing and I was angry all the time. I suspected it was time for a new doctor.
Good thing I had a therapist! Or maybe not. The facility I have been going to for my therapy gets a new batch of interns every year and last year’s intern was (and I say this after giving the situation much thought) not good. She was a master of grabbing the wrong end of whatever stick I held out. Career anxiety? She would get whiny about how she didn’t know how my industry worked. I didn’t need her to know how my industry worked; I just needed her to help me feel functional enough to navigate my profession. When I, a sex educator and raging introvert whose social anxiety was turned all the way up, fretted about my lack of sexual interest/relationship concerns, she called me to suggest a therapy group for people who wanted to learn about sex things. I know sex things and group therapy sounds like the 3rd ring of my own personal hell… I just needed to talk through my personal relationship. After a day when I walked into her office a bit anxious about some stuff and she proceeded to use her ineptitude to stir me into a full-blown screaming, crying panic attack. I knew I needed out.
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The thing was, I didn’t get out. I stayed with both my doctor and my “therapist”. Why? Because depression and anxiety tell you that everything is SO. HARD. Like insurmountably hard. They also tell you that nothing is going to work out for you; that “things working out” is some kind of illusive pipe dream. So, when a different doctor’s office, just blocks from my home was repeatedly recommended, I assumed (without checking) that my insurance wouldn’t cover it. When the “therapist” suggested we keep trying, I thought “well, it’s not like my insurance will let me see anyone better”. I kept going to both practitioners and let the dominos fall on their own.
The first to fall was the terrible therapist. One day about two months after the horrible in-office blow-up I looked at my calendar and saw that we had an appointment and I was filled with rage. I couldn’t handle another hour with her. I called the office, made an excuse, and avoided this woman’s calls for months.
The domino that was my PCP’s was actually toppled by another doctor in his practice. Over the summer I was feeling terrible and had been struggling with my weight. With my regular doctor out on vacation, I saw his colleague. She looked over my information, listened to my experience and then suggested I cut out dairy. When I gained 8 pounds in five days and my anxiety went through the roof this doctor replied not by recognizing that the degree I was having to fight to get even an ounce off my body was weird and maybe, if looked at as part of the big picture of my health, an indication of something being wrong but instead by recommending Keto because one of their secretaries was doing it and “looked great!” To make matters worse, when I, as politely as I could, demurred citing the established link between carbohydrate consumption and serotonin production this person, this DOCTOR, responded “what, like you eat bread and then you’re happy?”. I had already been on the fence but this was the last straw and the motivation I needed to investigate a different doctor.
Then, just when I thought we were done, I went back to the doctor who was handling my meds- at this point the psychiatric nurse practitioner who pulled me out of the depressive episode had moved on—and told him about all of the things I had experienced in the recent months, all of the (ever-mounting) evidence that my depressive symptoms were caused not by major depressive disorder but by a physical root cause, and the realization that it was actually the off-the-rails anxiety that was causing the bulk of the issues in my recent history. He took this onboard by nodding, looking very understanding, and then—for no apparent reason, I feel—suggesting another SSRI. During that appointment I wept out of frustration and despair. I realized I was out of hope and this doctor, while a very kind person, was just doing what he knew how to do: suggest meds and refer to a book that swore they wouldn’t cause me the side effects that had, so far, been the hallmarks of my med experience. Another one bites the dust.
It seems to me that doctors often think they should have all the answers but this year has shown me that I am more interested in doctors admitting when they don’t, that I would have tremendous respect for a medical professional who could look at me and say, “You know what? I’m stumped. Let’s bring in someone else.”
After almost two decades of dealing with depression symptoms, I’ve stopped saying I have “depression” because so many things can cause the set of symptoms we recognize as depression and I am beyond done with doctors hearing “depression” and going about the standard Major Depressive Disorder treatment plan, adjusting nothing when it doesn’t work. I’m far more interested in getting to the root of why I feel this way than watching even more healthcare professionals behave as if I am willfully resisting the magical restorative effects of SSRIs. So, that being the case, what happens when I run out of patience with doctors who seem content that they learned all they need to know ever in medical school and any information that has come to light in the intervening years is of no value?
Think about how many articles you’ve seen in recent years postulating what the “real” cause of depression is and then, take a moment to make the (very small) mental leap to the idea that the set of symptoms we know as “depression” could maybe, just maybe, be indicative of a variety of conditions. Then take it a step further and consider that if treating depression symptoms with the “Major Depressive Disorder” protocol doesn’t work, it probably makes sense to investigate those other conditions. Or even… wait for it… we want to be ruling out the possible physical causes (inflammation, allergies, brain tumors etc) BEFORE we decide to treat depressive symptoms as Major Depressive Disorder, I know, I know “but horses!!!”.
But the thing is, one of the favorite critiques of people who have never struggled with depression usually goes something like this, “They just give out meds too easily and people don’t WORK THROUGH anything!” I’ve always hated that argument but these days I do see a valuable kernel of truth at its core: tossing meds at a problem and not actually paying attention to the outcome isn’t helpful. I’ve always hated that argument because so many of us are taking meds and working our asses off in a variety of ways—but it came to mind for me this year because I felt like my doctors were dispensing meds and becoming frustrated when their work didn’t end there. I needed healthcare professionals who were willing to—yes—prescribe meds as-needed, but also to work alongside of me as I toiled to feel better.
Lest this be read as some kind of anti-doctor, anti-medication screed, let me say that I appreciate medications. I’m glad we live in a time when they are available and I genuinely believe that there have been multiple times when medications saved my life. This isn’t about “medication is bad,” it’s about “when doctors aren’t great, what do you do about it?”
Here’s the thing: I believe in science, I believe in evidence, I believe in listening to people who know more than I do… but (You probably felt that “but” coming from miles away, huh?) I also believe in being listened to, I believe in collaboration, and I believe in being proactive about my health. Further, I believe in reading the writing on the wall– writing that, in my case, said we had gone as far as we could with the medical professionals I was dealing with and that continuing on this path was quite possibly making things worse.
The idea that my life was in the hands of people who were content to go through the motions and getting frustrated with me when their plans didn’t work was enough to drain every drop of hope I had left; and that’s unacceptable.
That’s why I fired my doctors, brought on a new PCP, a new therapist, and a bonus therapist (who I took on extra work to pay for) who is working explicitly on my disordered eating patterns, something that has been shunted to the side for YEARS by doctors who were always convinced it was the least of my worries (or that disordered eating that doesn’t make one thinner is just a question of willpower… another story for another day). I’ve long since given up on the fantasy of a life where I am magically “better” but I refuse to settle for a life that fluctuates between a debilitating depression/anxiety combo and maintenance-level-”meh”. I know it can be better and I’m willing to work for it, I need my healthcare team to be willing to do the same.
So now, as I settle in with my new healthcare team, there’s a bit of breath-holding as I suss out the dynamics. So far though, everyone seems more open to listening to my proverbial hoofbeats. Not simply noting there are hoofbeats and thinking “yep, horses” but really listening. There has been a lot more asking questions, running tests, and keeping a lookout for horses, zebras, reindeer, giraffes, unicorns and even guys clapping two coconuts together. For now, it seems, I have a team that’s willing to look beyond assumptions, see me as a whole person, listen to my experiences, and find answers, even if it takes some time. That, frankly, is what we all deserve.