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More than the blues: How to get the depression help you need


Depression is one of the leading causes of disease or injury worldwide, according to the Centers for Disease Control and Prevention. It can cause troubles at home, at work, with money and in relationships. It can lead to self-harm or death. Symptoms include loss of interest in activities, feelings of hopelessness and changes in sleep or appetite. If you have been experiencing these symptoms for more than two weeks, medical experts say that you could have depression.

Depression is a medical illness. As a consumer, you need to know the resources available: how to get the best care, your insurance benefits, the doctor-patient relationship, choosing a therapist, paying for therapy, drug options and psychiatric hospitals. Here’s a look to help you and your family members navigate this difficult situation.

Getting help. While licensed psychologists, counselors, social workers and psychiatric nurse practitioners all treat depression, seeing a psychiatrist is recommended if you have depression symptoms along with thoughts of self-harm. Psychiatrists’ medical training includes four years of medical school and four years in a psychiatric residency. They are trained to prescribe and manage psychotropic medications. The American Psychiatric Association has a physician locator.

If you live in an area with a lack of mental health providers or lack of access to mental health services, some mental health experts recommend consulting with a primary care physician as a good first step. In certain states, clinical psychologists can legally prescribe medication for mental health treatment. There is debate about this among medical health professionals. Discuss treatment options with your physician.

According to Dr. Philip R. Muskin, a professor of psychiatry at Columbia University, research indicates psychotherapy with psychotropic medication is the most effective overall treatment for depression. However, individual treatment plans vary. Art, music, group or equine therapy or self-help groups may be part of a treatment plan. Treatment could include tests by other physicians that screen for illnesses that could mimic depression symptoms.

Medication. Some psychotropic medications could make your symptoms worse at the beginning of treatment; you could have uncomfortable side effects or an increase in thoughts of self-harm. Tell your physician immediately if symptoms occur. If you have been treated with medication before, one way to potentially get clues about how your body may respond to a new medication is to ask your physician to administer a genetic test.

Treatment-resistant depression. When depression is unresponsive to other forms of therapy, brain stimulation therapy, such as repetitive transcranial magnetic stimulation or electroconvulsive therapy, or pharmacotherapy using ketamine may be suggested. Be aware that while the Food and Drug Administration has approved ketamine as an anesthetic, it is not approved for treating depression. Physicians may choose to use it unapproved (“off label”) when they judge it is medically appropriate. Consider the available data on ketamine and the potential risks associated with the drug before using it.

Costs. Check with your health insurance coverage provider for access to mental health benefits (also called behavioral health benefits). Check your plan for providers in your area. Note that not all providers accept insurance. A provider may charge patients on a sliding scale to assist those with financial challenges. Patient-assistance programs and discount drug cards may make medication affordable for some individuals. Physicians sometimes can provide free samples of certain medications.

If you are in crisis. In these cases, don’t hesitate to call or go to the local emergency room. Also, the National Suicide Prevention Lifeline is available for support 24/7/365 at 800-273-TALK (8255). If necessary, an inpatient hospital stay can provide a safe space to formulate a treatment plan. Residential care facilities and clinics offer mental health services. Ask a trusted mental health provider for a referral. Programs and cost vary.

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