Compassionate Doctor?

Question
QUESTION: Hi Dr. Pilcher,

In 2009, I weighed in at 417 pounds at 5'7" tall. I think I've suffered from depression for a very long time. Over the last 3 years I've taken off more than 200 pounds, on my own through diet #mostly# and more recently an exercise program. No crazy diet, just cutting calories and doing my own thing. I thought after I'd lost the weight that the depression I felt would go away--it did to a certain degree, but I've been facing a new problem which is an insecurity about my new body. I want to approach my doctor about my depression, but I'm just to scared too. Everytime I go to talk to him about it, he says "and what do you plan on doing about your weight?" I've gotten to the point where I just hold up a picture of my former self, because I can't bring myself to tell my story, again. I just went to see him about persistent diarrhea and headaches and came away with a script for Phentermine. Ugh, I'm so frustrated. This is the second doctor that I've had that's done this to me. Today, I'm 213 pounds, and I'm so sad and insecure about it, that I can't even enjoy my new life. I know I have another 50-60 pounds to lose, but right now I'm feeling very sad and it scares me. Can you please help me figure out what to do next? Do you think seeing a bariatric doctor even though I never had a surgery, might be my best bet to get a compassionate and understanding doctor?


Thanks!

ANSWER: Tanya,
You are certainly correct to expect understanding and compassion from your physician.  Also, you certainly deserve congratulations for losing more than 200 pounds through diet and exercise; great work!

Unfortunately, it often does happen that weight loss fails to correct depression.  We understand depression to be an imbalance of brain chemistry, and it seems to be an imbalance that is not really affected by weight change.  I agree it is important for you to have treatment for your depression, not only because you will feel better but also because you will have a better chance of maintaining health with a better mental outlook.

Finding the right doctor can be tricky, and there is no simple formula.  It seems reasonable to start by looking for a bariatrician.  I think that a doctor in this field is very likely to understand your weight control issues and give you proper credit for all the weight you have lost, but I worry that he/she may not be any more compassionate.  The other approach that is definitely worth a try is to ask around among your family/friends to find out who like their doctor; having a recommendation from someone you know is probably the most reliable path.

Best of luck to you!

Dr JP

---------- FOLLOW-UP ----------

QUESTION: Dr, JP,

Thank you for your reply and for the compliment, I really appreciate it.  Should I find a new doctor and approach him about the depression right away?  What am I looking to achieve--medications or possibly a referral, or both?  How do I go about bringing it up?  I'm sort of un-nerved about telling someone how I really feel.  I'm not sure what to say.

Answer
Tonya,
Depression is actually fairly common. It is not anything to be embarrassed about. A regular primary care doctor will welcome the opportunity to discuss this with you at the beginning of your physician-patient relationship. He/she will make a judgment about how much they treat you directly versus refer you out. The key thing is going to be a doctor listens to you.

In Health,
Dr. JP

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