Depression is such a loaded topic. I'm going to flounder through my opinion about it briefly. Feel free to comment.
What is comes down to is that if you've been sick for a long time, undiagnosed and passed from doctor to doctor or not optimized and feeling lousy due to poor medical guidance, you're going to be depressed. If you are NOT depressed and have felt lousy for an extended period of time, you are crazy. Who in his or her right mind can suffer from impaired quality of life for an extended time and take it in stride? Is THAT normal? No, it's clearly not.
I am advocating for a patient who admitted to "situational" depression to his physician. The physician immediately wasted about 25% of the session recommending a psychiatrist, discussing the anxiety (in a very unconstructive way) and talking about how the depression could affect sleep and other things in his life. The physician should have seen that what the patient was acceptable and completely normal given the years of illness and poor quality of life. The physician should have moved on to the blood work, radiology reports and explanations of the past results as well as my client's symptoms. Most likely, situational depression didn't cause his ANA and RF to go high, rashes to appear on his body or give him frequent debilitating headaches.
I have learned something. As an advocate, I will never again allow a doctor to waste a patient's time discussing SSRIs, psychiatry and mood unnecessarily. I will keep the physician focused on the matter at hand, finding solutions to my client's physical problems.
There are very, very few people in this world who go from doctor to doctor to doctor seeking degradation and questioning of his or her mental state. People who have issues with their mental state seek help for their mental state. A rhuematologist or dermatologist is not qualified to discuss a person's mental state when there are undebatable physical symptoms coupled with abnormal lab work. It's the physician's job use his or her expertise in his or her field to put pieces of puzzles together. It is NOT the physician's job to ignore or refuse to explain the results and symptoms so that he or she can focus on an area outside of his or her realm.
For a patient who has no advocate, please keep discussion of your mental state to a minimum. Get your paper out with the top three things you would like to discuss and hand it to the doctor. If you have mental issues (and you might and that's OK), discuss your issues with a profession in that field, not your proctologist or hematologist. I mean, unless you want to open that can of worms and discuss the wrong issues with the wrong medical professional. If that's how your roll, roll that way. It's not efficient nor helpful to getting well.