For over 3 months you feel tired and work is getting more hectic. On this particular evening when you go to bed, you notice that you are anxious. It’s probably the deadline you won’t make that worries you. Your team has worked really hard, but with the Covid-19 situation, things are just delayed. As you turn off the lights and place your head on the pillow, all of a sudden you notice your heart pounding. It won’t stop, you toss and turn, trying to think about happy things. But your heart beats faster, and then it skips a beat. You sit erect in your bed, knocking over your pillow. Anxiously you put two fingers on your left wrist, the way you have seen on television. You notice the thud thud thud of your pulse against your fingers and your chest is rising faster and faster.
Eventually you fall asleep. You wake up tired, like many mornings.
When you speak to your GP that afternoon, you mention having muscle aches and that in fact you do not feel like doing much on most days. Things are just getting too much. But what worries you the most is your heart rate and palpitations. You ask your GP if your thyroid is playing up.
Your GP examines you physically and notes no alarming findings that could explain your symptoms. Your blood pressure and pulse are within normal range. Your thyroid gland is not enlarged.
Your GP says it could be a number of possible things and lists the following
- Anxiety syndrome
- Regularly irregular heartbeat
At this stage your GP tries to reassure you that your symptoms are less likely caused by a thyroid problem.
For now, a general health check with blood tests should be requested.
It is affecting your sleep and day to day functioning. It is important to highlight these changes to your GP so that a general blood test is done to check your blood count, kidney, liver and thyroid function and blood sugar level.
In order for your GP to consider depression, there are two very important symptoms that must be present.
- Low mood during most of the day (>8 hours a day)
- Clear lack of interest or enjoyment in things you do during most of the day. For example, lack of interest or enjoyment in your work, sport, interaction with friends or family.
In order for your GP to diagnose you with depression, you must have at least 5 symptoms made up of at least 1 of the very important symptoms above and the other symptoms listed below.
- Weight loss or weight gain
- Sleepless nights or too much sleep
- Agitation or lack of motivation
- Tiredness and lack of energy
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating or not able to make decisions
- Recurrent thoughts of death, suicidal thoughts, attempt to commit suicide or a specific plan to end one’s life
If you feel that you are not getting the message clear to your GP make sure to highlight how your feelings IMPACT your life using these 5 dimensions:
- Behaviour: Let your GP know whether you take initiative to make changes. If you are more of a passive spectator into your condition, tell your GP what it takes to motivate you to make changes.
- Social: Share this information early on because it is a very vital part of getting you the help you need. Let your GP know what and who your social support is, whether it’s family, friends, colleagues, or curious neighbours.
- Physical: speak about pre-existing conditions, use of medication (type and dosage), alcohol consumption, smoking habits and physical impairments.
- Emotional: Be detailed as much as possible about your emotions, for instance speak about the feelings that this situation causes you (sadness, anger, guilt, shame or powerlessness)
- Mental: Explore what triggers cause you to feel this way, could it be stress from work or your private life? Isolation or the loss of something important in your life (a job, a loved-one, not passing an exam). Even (past) events like abuse (physical, sexual, emotional), aggression, conflicts at work and war can trigger emotions.
You can prepare for your consultation with your GP by filling out the Four-dimensional symptom questionnaire (4DSQ)
This questionnaire is useful to explore symptoms that you have had in the past 7 days. If you bring this questionnaire with you to discuss with your GP it can save time. It mainly helps as a tool to speak about things that may be challenging to interpret during a consultation. The 4DSQ does not diagnose you with depression – further tests and consults are still needed.
Your GP along with a nurse practitioner can start management to help you that consists of
- Advice on how to better structure your day and activities
- Engage in sports or hobbies that interest you
- Learning Problem Solving treatment which is a short psychological treatment based on cognitive behavioural therapy (CBT). The main goal is to learn how to be active in dealing with the problem by formulating positive and concrete goals. This increases your ability to manage with your mood and find solutions that work for you.
Don’t feel afraid to speak to your GP and the nurse practitioner about how you are feeling and how this is impacting your life. They have plenty of tools to help you on your road to feeling more like yourself again.
However, your GP will always assess you on an individual basis to see what the best management option is for you. Sometimes reviewing your life structure, setting goals and learning simple self-help psychological therapies are sufficient in helping manage depressed mood. Other times further referral to a psychologist, discussions regarding antidepressant medication or a referral to psychiatrist may be required.
Remember, if it all gets too much and you are having any suicidal thoughts and feel like you are in crisis, you must call emergency services on 112. Alternatively you can speak to someone on the Netherlands suicide prevention hotline on 0800-0113 available 24/7 or visit www.113.nl for more advice.