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To my patient with depression: What I want you to know

Dear patient,

The first time you came into my office to discuss your mood, I was hopeful. You were here, and you were asking for help. You had finally taken the first step to feeling better and improving your mental health. I was hopeful that together we would find a treatment plan that worked for you. I was hopeful that you’d fully recover from your depression and lead a happy life. First and foremost, I want you to know that that hope has never left me. I still hope for those things, and I still believe we’ll get there, regardless of the time we’ve been trying for. Please believe that I still have hope.

Sometimes you break down in tears in my office, overcome by sadness. Sometimes you’re distant and emotionless. Completely flat. The latter scares me much more, because I worry it means you’ve stopped caring. But then I remember: You’re here. Please know that I notice your demeanour, the words unspoken, and I worry about you more than you know. I’ve gotten to know you over the many visits we’ve had, and I know you care about others — sometimes too much. I also know that there are people — including myself — who care about you. I know that the people who care most about you don’t always understand what you’re going through, which is not only frustrating but hurtful. Please know that I am here for support whenever you need it.

I know that sometimes you carry a lot of guilt. At times you may feel as if that guilt is swallowing you whole. Did you know that guilt is often a part of depression? I want you to know that your guilt is a symptom, like the pain in a patient with arthritis. I want to help you with your symptoms, so please be honest with me. Sometimes you speak of so much self-hatred that it hurts my heart. I know this isn’t something that happened overnight — it’s too deep. Please know that when treating your depression, I always keep this in mind. It is my greatest goal in your treatment to help you learn to love yourself. I know it won’t happen overnight, but I have faith it will happen. Small steps.

Please know that I’m not a drug pusher. I know that counselling and exercise are often the first-line treatment for mild depression. I also know they are both vital in your treatment plan regardless of the degree of your depression, and I will continue to discuss them throughout our time together. But sometimes we need to consider medication. And if the first one doesn’t work, please don’t give up. Work with me. When it comes to exercise, I don’t expect you to run a marathon if you’re currently not exercising at all. Start off slowly — go for brisk walks. Sometimes you tell me that counselling isn’t for you. You think it won’t be helpful. Did you know there are many different types of counselling? If traditional psychotherapy isn’t right for you, then please consider cognitive behavioural therapy or dialectical therapy. I know you want to get better — you’re here. Please consider my advice. Let me know what’s getting in your way. We’re in this together. And if you have questions, I’m here to answer.

Sometimes I’m frustrated. I’m frustrated because I feel like I care about your mental health more than you do. You don’t always take my suggestions seriously. I know your lack of motivation is also a symptom of your illness, and I am so sorry if my frustration shows. I often blame myself for not being able to motivate you, for not having all the answers.

When you tried to hurt yourself, I cried. I never told you, but I did. I felt like I failed you. Sometimes I worry that I don’t know how to help you. What I do know is that I won’t give up on you. I will keep trying. Please don’t give up on me. Keep fighting.


Your Doctor

If you or someone you know is struggling with depression, there are resources available. Find resources and help in your area here.

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