Regularly talking to your provider about your mental health is the best way to get ahead of any problems and get treatment if you need it. | Paige Vickers/Vox; Getty Images I don’t know about you, but whenever I go to see my primary care doctor, my mental health isn’t usually at the top of my list of things to talk about. But it should be. In fact, experts say that all of us could benefit from more candid conversations with our doctors about our mental health. (This story discusses mental health issues and suicide. If you or someone you know is struggling or in crisis, help is available. You are not alone. You can call the national 988 hotline for support.) For years, the United States has been trying to figure out “parity” for mental health care — to have it treated and paid for like any other medical need, not something that is carved out and separate. A big part of that has been pushing primary care doctors and OB/GYNs to do more screenings, to make your mental state a part of your well-being that you discuss with your doctor the same as your blood pressure or any physical ailment. But that is easier said than done. A lot of people may not even realize that their depression or anxiety or stress is something they should talk about with their primary care doctor. Others might fear being judged, and for good reason — national policymakers warn there continues to be a stigma toward mental health conditions among doctors. About one in three Americans say they have never been asked about their mental health by a doctor, which is unsettling considering that the nation has been going through a collective mental health crisis for several years. Men are significantly less likely to be asked about their mental health than women — perhaps a reflection of a culture that expects men to “tough it out” when it comes to their feelings. But those attitudes come with a price: Men are diagnosed with depression at half the rate as women, but die by suicide much more frequently. Much of the burden for starting these conversations should fall on your doctor to be more curious and accommodating during annual exams. But you don’t have to wait to be asked to bring it up. Regularly talking to your provider about your mental health is the best way to get ahead of any problems and get treated if you need to be. In honor of Suicide Prevention Month, I reached out to a handful of doctors who have studied why it’s sometimes so hard for patients and doctors to talk about depression, anxiety, and stress — and learned some novel strategies for how you can take charge, push through any stigma, and start having more honest talks with your doctor about your state of mind. Here’s what you should know. Know the relevant symptoms before you talk to your doctor One of the tricky things about depression or any serious mental health problem is that it isn’t always easy to identify when you’re the one experiencing it. “Patients need to recognize their distress…as potentially emanating from depression,” Dr. Richard Kravitz, a general medicine professor at UC Davis who has studied depression screening in primary care, told me. There is a checklist of sorts that you can go through on your own to understand whether you’re just having a tough couple of days or there’s something more serious at work, said Dr. Maria Garcia, an internal medicine physician at UC San Francisco. You might be feeling down or unmotivated or have a lack of energy, or be more agitated, angry, or irritable than usual. Sometimes there are less obvious signs, like trouble with money or problems at work. Symptoms of depression Here are some of the possible signs of depression, according to the Mayo Clinic. If you or someone you know is struggling or in crisis, help is available. You can call the national 988 hotline for support. Feeling sad or hopeless or like you are a burden to others Feeling more irritable and angry than usual, losing your temper more easily Losing interest in most or all normal day-to-day activities and hobbies Sleep problems, whether you are sleeping too little or too much Feeling less energetic than usual Changes in appetite — whether you are eating less and losing weight or eating more and gaining weight Concentration and memory problems Unexplained physical symptoms “If you’re not getting enjoyment from your normal hobbies or talking to the people that you would normally really enjoy talking to, if you find yourself isolating from people that you normally really enjoy spending time with, I think those are certainly triggers,” she said. Consider the duration of your symptoms, too: “If it’s every day for a couple of weeks, that definitely isn’t normal.” And oftentimes, depression symptoms can mirror symptoms of other ailments or problems, like a lack of sleep, low appetite, or physical aches and pains. This is one reason why it is so important to talk with your doctor about it, Garcia said. Is that fatigue a result of depression — or is it a problem with your thyroid? Your primary care physician is best positioned to help you figure that out. One of the benefits of a long-term relationship with a physician is that they may be able to help you recognize symptoms of depression even if they aren’t obvious to you. It’s hard to be that self-aware; I’m certainly not all the time. But the more you pay attention to your mood and how it’s affecting your life, the more you can tell your doctor about what’s really going on. You don’t have to know all the fancy clinical terms, said Paul Duberstein, a clinical psychologist and professor of health behavior, society, and policy at the Rutgers School of Public Health. “The language that people are most comfortable using are words like stress or frustrated or impatient or something like that,” Duberstein told me. “Those are the kinds of things we really do want to incentivize and encourage people to talk to their doctors about.” How to bring up your mental health with your doctor Okay, you feel like something might be off and you have a doctor’s appointment coming up. What do you do? You might not have to do anything. These days, you are likely to be given a depression screening by your physician’s office before you ever arrive (usually as part of your pre-visit paperwork). Garcia said it’s important to be honest and to be thorough when answering those questions, as that will tell your doctor that your mental health should be a focus for your upcoming visit. 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Garcia said that, rightly or wrongly, doctors can sometimes be reluctant to dive deep into a discussion about mental health late into a visit; they only have so much time with individual patients, and they might balk at trying to squeeze in a mental health discussion at the end. The conversation is more likely to be productive if you proactively start it before your physician is sidetracked with your blood sugar. During this conversation, you can ask for a depression screening outright. Doctors have become adept at recognizing code words; if you say your mood has been off, they may pick up the signal that you may be experiencing mental health struggles. But there is a good argument for being very direct about how you’re feeling, Kravitz said. “My advice…is just simply to say to the doctor, ‘I’ve been feeling down’ or ‘I’ve been feeling irritable’ or ‘I’ve been losing sleep’ or ‘Something’s wrong and I don’t know what it is. Do you think it might be depression?’ Just ask,” Kravitz said. If you aren’t sure if it’s a mental or physical issue, tell them that. Activate your doctor’s curiosity, Kravitz told me. Get them invested in figuring out what’s going on with you. Once the conversation starts, your doctor is likely to ask how long you have been experiencing symptoms and how they are affecting your day-to-day function. When that happens, you should be as thorough and truthful as possible. “Is it affecting your ability to take care of your family? Is it affecting your ability to go to work, get up in the morning, cook dinner, get out of the house, go grocery shopping?” Garcia said. “Those things are really helpful because then we can tailor the treatments for the amount of functional impairment.” Talk to your doctor about your sleep, too, Duberstein said. Not only is it an important indicator of your physical health, but it will also tell your doctor something about your mental well-being. And it doesn’t require any special emotional vocabulary: You probably know if you’re sleeping well or not. “If you think about major depression as a collection of, say, nine symptoms and you ask, ‘Well, what symptoms appear first? Is it the depressed mood? Or the difficulty concentrating?’ The first thing that appears typically is sleep,” Duberstein told me. “Disrupted sleep is something that I think people do feel comfortable talking with their doctor about.” How to talk to your doctor about a treatment plan If you have a productive conversation with your doctor and they recognize symptoms of depression, they’ll want to establish a treatment plan. This has historically been another barrier to honest conversations between doctors and patients about mental health: Patients don’t want to be prescribed antidepressants or referred to therapy, so they don’t bring it up. But ignoring your symptoms is, of course, not the solution. Instead, use your appointment as an opportunity to ask all of your questions to make sure that you are fully comfortable with the doctor’s proposed treatment plan and can get on the road to better mental health. Many Americans have doubts about antidepressants, which have been egged on by high-profile figures like US Health Secretary Robert F. Kennedy Jr. If you’re hesitant to take meds, you should tell your provider about the things that you’ve heard that give you pause, the negative experiences people have shared, or whatever major questions or concerns you have. They can help you understand the very real trade-offs that come with taking an antidepressant, Kravitz said. Your doctor can also debunk some of the misconceptions that make people hesitant to take these drugs even when they are struggling. “The duration of therapy sometimes surprises people. But no, it doesn’t mean that you’ll have to be on it forever. No, most people don’t have serious withdrawal symptoms. Those can usually be managed by careful tapering if necessary and so on,” Kravitz said. He said you can ask your doctor outright: “What can I expect to happen over time? How long will I need to be on this?” If you’d rather not go on medication immediately, that’s totally valid. Your doctor may instead be able to help you find a therapist with a referral, Duberstein said. Therapists have historically been hard to find in the US — but one positive outcome of the pandemic was the proliferation of online mental health services. “I think it’s important for the public to know that one of the major barriers to getting into psychotherapy or even seeing a therapist — like getting into your car, driving, finding a bus, finding a subway, whatever — that those barriers are gone,” he told me. “Because you could see a therapist online now in all 50 states.” The goal is that you leave your doctor’s office feeling heard and feeling on-board with the approach, even if you still have some trepidation (which is very common). And if you don’t feel comfortable talking to your doctor about these issues, that may be a sign you need to find a new provider whom you feel you can trust with those sensitive discussions, Duberstein said. The point is, your doctor should be your ally in pursuing whatever treatment you need for whatever ails for your mental health. Nobody has to go through it alone.