My nurse asked Megan to complete a simple questionnaire that helps identify if a person may have depression. Megan’s high score on this questionnaire indicated a possible diagnosis of depression. After seeing her responses, I spoke to her. Megan told me that she felt a little embarrassed to admit out loud that she was struggling. Like many people, she had a hard time explaining exactly what she felt. She took several long pauses, but I was careful not to interrupt her.
Megan told me she felt sad and anxious at the same time. “I feel like I’m coming out of my skin,” she said. Although she felt tired all the time, she couldn’t fall asleep at night. She often tossed and turned for hours, usually thinking about past mistakes. Sometimes she wished she could disappear. Fortunately, she had not thought about harming herself or committing suicide.
As Megan spoke, I noticed her body language and speech patterns. She played with her hands a lot and looked mainly at the ground. I asked her a few questions to make sure she was safe and to rule out other things that can make depression worse. Megan said she did not use drugs or alcohol or engage in high-risk sexual practices. She said that she felt safe at home and in other places, but that she did not feel comfortable talking about her feelings with her parents. I thanked him for having the courage to come and ask for help. She admitted that it had been difficult for her.
I let Megan know that it is common for depression and anxiety to go hand in hand. I explained to him that they don’t just cause psychological symptoms. They can also affect you physically, causing symptoms such as chest tightness, fatigue, headaches, and nervousness. Since I realized that Megan kept many of her feelings in her body, I recommended that she take a few minutes each day to play music and dance. Dancing is a great activity to help relieve tension and improve your mood. I also taught Megan a relaxation technique to use when she was feeling anxious. It is a simple and effective exercise called soft belly breathing. It involves breathing slowly through your nose and feeling your abdomen fill with air before exhaling through your mouth.
In addition to counseling, I put Megan on a low dose of an antidepressant. (Learn more about antidepressants and how to take them safely.) I explained to Megan that it can take several weeks for an antidepressant to start working. The side effects of these medications usually subside after a couple of weeks.
When a person starts taking medications to treat depression, there is a risk of increased suicidal thoughts, especially in young people. Although this is rare, I discussed the risk with Megan and made sure she had a plan, just in case. She was already aware of suicide hotlines that can be accessed by phone, text message, or online (e.g., the National Suicide Prevention Lifeline at 1-800-273-8255). She also identified a friend to call if she had thoughts of harming herself. I assured her that she could always call her counselor or my office, or go to an emergency room if she needed help right away.
I asked Megan to come back for a follow-up visit in a week so I could see how she tolerated the antidepressant. She told me that it was a relief to talk about her feelings. She was hopeful that her symptoms would improve over time. As Megan’s family doctor, I will continue to guide her treatment for depression and provide her with the necessary care and support.
I looked for help
People who suffer from depression sometimes think about suicide. If you have thoughts of harming yourself, tell someone. Tell your doctor, friends, or family. You can also call a suicide hotline, such as the National Suicide Prevention Lifeline at 988.
Get help right away. There are people who can help you. Depression can be treated successfully.
