Six weeks of feeling flat is worth a medical appointment, even when the year has been hard enough to explain it. Everyone feels sad or low sometimes, but these feelings usually pass with time, and depression is more than a feeling of being sad or irritable for a few days: it is a serious mood disorder. If you are also eating less on purpose and feel tired and less hungry, the eating can seem to explain both, and both still belong in that appointment. Book it with your primary care provider.
How long a flat stretch can go on before it needs an appointment
A flat stretch needs an appointment once severe or distressing symptoms have lasted 2 weeks or more. Examples include difficulty getting out of bed in the morning because of mood, and inability to complete usual tasks and activities.
A diagnosis of depression needs more than the two-week rule for seeking help:
| Seeking professional help | A diagnosis of depression | |
|---|---|---|
| How long, and how often | 2 weeks or more | at least 2 weeks, most of the day, nearly every day |
| What the symptoms must be | severe or distressing | several persistent symptoms, at least one of them a depressed mood or a loss of interest or pleasure in most activities |
You do not need to fit the diagnostic pattern before you book. Signs of depression that persist or do not go away are reason enough to talk to a health care provider, and how often the flatness has been there, most of each day and nearly every day or on and off, is among the things the provider may ask.
What else the tiredness and smaller appetite can mean besides the weight coming off
Tiredness and a change in appetite are both common signs of depression, so having another explanation for them is no reason to leave them out of the appointment. Common signs and symptoms of depression 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
- fatigue, lack of energy or feeling slowed down
- difficulty concentrating, remembering or making decisions
- difficulty sleeping, waking too early in the morning or oversleeping
- changes in appetite or unplanned weight changes
- physical aches or pains, headaches, cramps or digestive problems without a clear physical cause that do not go away with treatment
- thoughts of death or suicide, or suicide attempts
If you are having thoughts of suicide or are struggling, reach the Suicide and Crisis Lifeline by calling or texting 988 or through its chat at 988lifeline.org, without waiting for the appointment. In life-threatening situations, call 911.
Whether a smaller appetite counts as a sign while you are eating less on purpose, and which explanation fits the tiredness, are for the provider to sort out. Tell them you are eating less on purpose, and since when.
Not everyone who is depressed shows all these symptoms. Some people experience only a few, while others experience many, so three or four matches is no reason to stay home, and even a long list of matches needs a provider to diagnose. Depression can also involve other changes in mood or behavior, among them becoming withdrawn, negative or detached, isolating from family and friends, and being unable to meet responsibilities. If you have been canceling plans and leaving messages unanswered, tell the provider about both.
What happens at an appointment for a flat mood
A provider seeing you about the flat mood will ask about your symptoms and may check for other things that can cause them. Certain medications and medical conditions, such as viruses or thyroid disorders, can cause the same symptoms as depression, and a provider can rule these out with a physical exam, an interview and lab tests, so tell them about every medicine you take. The provider may ask when your symptoms began, how long they have lasted, how often they occur, and whether they keep you from going out or doing your usual activities. It may help to take some notes about your symptoms before the visit. Put the plans you have canceled in those notes: they answer the provider's question about whether your mood keeps you from going out.
The provider may also take a medical history that asks about your symptoms and family history, and do a mental health evaluation or have a mental health provider do one.
If you think you may have depression, you can talk to a health care provider such as a primary care doctor, a psychologist or a psychiatrist, and a primary care provider is a place to start, because they can refer you to a psychologist, psychiatrist, clinical social worker or another qualified mental health professional, who can help you figure out the next steps.
If eating less on purpose has turned into being fixated or obsessed with weight loss, body weight or shape, and controlling what you eat, tell the provider that too: those may be signs of an eating disorder, and people with eating disorders are at higher risk for co-occurring mental illnesses, including depression. If you were treated for an eating disorder in the past, mention that history as well (see A past eating disorder belongs in your weight-care medical history).
Looking after yourself in the weeks before you are seen
Ordinary self-care fits the weeks of waiting, because it can play a role in maintaining your mental health. Among the self-care tips for mental health are these:
- Get regular exercise, such as walking 30 minutes a day; small amounts add up if 30 minutes at one time is too much.
- Eat healthy, regular meals and stay hydrated, and pay attention to how caffeine and alcohol affect your mood; for some people, cutting back on both can be helpful.
- Make sleep a priority: stick to a schedule, get enough sleep, and cut down on screen light from your phone or computer before bedtime.
- Decide what must get done now and what can wait, and say no to new tasks if you start to feel you are taking on too much.
- Stay connected by reaching out to friends or family members who can give emotional support and practical help.
If eating less has meant skipping meals altogether, tell the provider that at the appointment. Staying connected can start small, with an answer to one of the messages you have let sit, or with keeping the next plan you have made.
Other things that may help a person with depression include holding off on important life decisions until you feel better, talking decisions over with people who know you well, and avoiding alcohol, nicotine or drugs, including medications not prescribed for you.
If your weight care is coordinated through NicoCares, message your care team on Spruce, the secure app NicoCares uses for patient messages, about the flat weeks and the primary care appointment you have booked; the primary care provider is the one who can do the physical exam. A Spruce message has no promised reply time, so thoughts of suicide go to 988, never to a message there.
