Overcoming barriers to treating your depression

As a general internist, much of my work involves assessing people's symptoms and helping them decide what we can do to help them feel better. It is very common for me to notice symptoms of depression in my patients—whether it is expressed as sadness or, more commonly, trouble sleeping, fatigue, or irritability.

If I am concerned that someone is depressed, I will ask him questions about his energy level, relationships, and concentration. I might also ask if he feels like he might want to hurt himself or someone else. This question often surprises patients. It's not meant to be an accusation, but it's a necessary question because depression, if it leads to suicide, can be fatal. As the patient and I consider various physical and emotional causes of depression, I might discuss the possibility that he may want to take medication or speak to a therapist. 

I find it extremely gratifying to be able to help people with this illness—when I see a previously depressed person smiling in my waiting room, it makes my day. The article below, reprinted from the Harvard Medical School report called Understanding Depression, explains that getting treatment for depression often involves overcoming some hurdles.

In a perfect world, every treatment for depression would be right on the mark, every doctor or therapist would earn his or her patient's confidence, and people would find it easy to follow each bit of helpful advice. Clearly, this isn't the reality. So what are some of the barriers to getting good treatment and sticking with it? And how can you surmount them?

Navigating the health care system isn't always easy. Some health insurance companies confine your choices to a narrow panel of doctors or therapists. Or there may be relatively few mental health professionals in your area. It may also be hard to advocate for yourself, especially when you're depressed. Perhaps a supportive family member can help you deal with your insurance plan or accompany you to an appointment.  Finding a good therapist can be challenging.  Remember, it's a relationship between two people.  If one therapist doesn't "fit" well, then another might be worth a try.

Most private insurers, Medicare, and managed-care plans provide some coverage for mental health treatments. However, copayments may be higher than for other types of care. There may also be a limit on how many visits the company will cover. Calling your insurer is the best way to figure out your out-of-pocket cost.  If your insurance does not cover a visit with a psychiatrist, then consider discussing your problem with your primary care doctor.  Many of us feel comfortable starting and monitoring anti-depressant medications.

If a psychiatrist or doctor is prescribing your medication and another person is conducting psychotherapy, it may be difficult to coordinate the different aspects of your care. Let both people know that it is important to you that they talk with each other.

It's also important that you do all you can to understand your treatment. Bringing a pad and paper to your appointment and taking notes may help you take in information that is sometimes confusing. For example, studies show that although doctors report telling patients about side effects, many patients don't remember hearing that information. Also, make sure you bring up any important and possibly time-consuming issues at the beginning of your appointment. Appointment time is often limited, so plan to make good use of the time, and make follow-up appointments when necessary.

Choosing the right treatment is difficult. While research provides guidance, it doesn't always point individuals in a specific direction. Which treatment works best for which person is still an open question. It's common to adjust dosages and switch or add drugs depending on your response and side effects. This can be a frustrating process, but your doctor isn't treating you like a guinea pig — rather, it's a normal part of good treatment. Until researchers discover a way to predict an individual's response to treatment, this step-by-step, trial-and-error process is the state of the art. With persistence, you can reach your goal.

Obviously, no treatment plan has a chance to work if it's not followed. Yet many, if not most, people don't take medicines exactly as prescribed, especially if they must take more than one drug at different times of the day.

An estimated 5% of patients flatly refuse to take antidepressants or mood stabilizers. Side effects make these drugs intolerable for another 10%–15% and may encourage countless others to occasionally skip pills, tinker with dosages, or stop taking a drug without their doctors' knowledge. If you're having trouble with your medication, talk to your doctor or therapist. He or she can help you sort out the problem and make adjustments if necessary.  It is important to understand that anti-depressants can't be used as "happy pills."  They only work when they are taken daily, even if you're not feeling depressed.

Some people who opt for therapy find that it can be difficult to keep at it. Change isn't easy. Even when you're willing to make life changes, the resulting ripples may affect your friends, coworkers, spouse or partner, and children, some of whom may not be as supportive as you'd like. It sometimes helps to encourage those most important to you to join you in a therapy session or to attend support groups.

Finally, there's stigma. Many people still erroneously see symptoms of depression and seeking treatment as a sign of weak character, lack of fortitude, or an inability to pull oneself up by the bootstraps.  Because depression can be a source of shame, people with this illness may suffer silently. In actuality, getting treatment for depression is a sign of tremendous strength.  Anyone who has ever been depressed can attest to the fact that depression is a real, physical, potentially life-threatening illness.

There is so much hope for treating depression! Therapy and medications can help tremendously, and given the advances in our understanding of this condition, it seems likely that people with depression will soon have even greater treatment options. Public awareness about depression is growing, partly as a result of national public service campaigns, and perhaps funding for the development of new treatments and for the treatment of mental health conditions will follow suit. As more and more people seek treatment, it may also be easier for families and friends of those suffering from depression to be more active in encouraging them to get help.

Have you sought treatment for depression? What has your experience been like navigating the health care system and finding a doctor and treatment plan that works for you?

Depression
Nearly 1 in 10 adults will suffer from some form of depression in a given year, affecting not only them, but also their friends and family. Thankfully, years of research and recent breakthroughs have made this serious illness easier to treat. With Understanding Depression, a special health report from Harvard Medical School, you can stay up-to-date on the latest information on depression symptoms and treatments to improve your life—or the life of someone close to you.

For more tips on staying healthy and advice from Harvard doctors, visit The LifeMasters Community on Gather.

This content is not intended to substitute for personalized medical advice, diagnosis, or treatment from your healthcare provider. Read our full disclaimer.