Help me figure out how to get treated for depression.
December 16, 2009 6:43 AM Subscribe
Help me figure out how to get treated for depression.
I have been struggling with depression on and off for years.
In general I get so little enjoyment out of life, much less than I would think I deserve based on what other people say that they think of me. When something really fantastic happens I feel excited, but my mood quickly reverts to a feeling of dull dissatisfaction.
Then when something genuinely bad happens it is excruciating. Earlier this year I was laid off, and after some job interviews where I made it through multiple rounds only to be rejected, my girlfriend started cheating on me and made me move out of our house.
I am so depressed that it hurts. My brain feels like an engine running without oil.
I am in Scottsdale, AZ and I have Blue Cross Blue Shield health insurance. I am mid-20s male and otherwise healthy and so I don't really know how to go about this. What kind of doctor do I need? How do I find a good one? What do I tell them? Will they be able to make it stop hurting? How much will it cost?
I have been struggling with depression on and off for years.
In general I get so little enjoyment out of life, much less than I would think I deserve based on what other people say that they think of me. When something really fantastic happens I feel excited, but my mood quickly reverts to a feeling of dull dissatisfaction.
Then when something genuinely bad happens it is excruciating. Earlier this year I was laid off, and after some job interviews where I made it through multiple rounds only to be rejected, my girlfriend started cheating on me and made me move out of our house.
I am so depressed that it hurts. My brain feels like an engine running without oil.
I am in Scottsdale, AZ and I have Blue Cross Blue Shield health insurance. I am mid-20s male and otherwise healthy and so I don't really know how to go about this. What kind of doctor do I need? How do I find a good one? What do I tell them? Will they be able to make it stop hurting? How much will it cost?
There are various options; initially, you probably want to see your primary doctor (if you have one) and ask for a referral to a psychiatrist or a therapist. Tell them the same thing you wrote here - you're depressed, you find it hard to feel more than just "dull dissatisfaction", and your brain feels like an engine running without oil. Any mental health professional can take it from there. (Although it might be good to think in advance about timing, just because that can be hard to do on the spot - things like how often do you have a "bad spell", and how long does it last, etc.) Depending on that consult, they may prescribe an antidepressant, or therapy (probably weekly or every other week), or both.
I can't tell you what it'll cost, unfortunately, since my school's mental health services are free.
Will they be able to make it stop hurting?
Yes. Probably not overnight, though just knowing you're taking steps to get better may be of some help. But yes, depression can be treated and managed.
posted by spaceman_spiff at 6:57 AM on December 16, 2009
I can't tell you what it'll cost, unfortunately, since my school's mental health services are free.
Will they be able to make it stop hurting?
Yes. Probably not overnight, though just knowing you're taking steps to get better may be of some help. But yes, depression can be treated and managed.
posted by spaceman_spiff at 6:57 AM on December 16, 2009
I'm in the UK, so am obviously unable to give you specific advice, but for what it's worth, therapy is very effective and worthwhile, albeit slow going. I pay £45 per hourly session, which works out at about $70 (but naturally the price in the US may vary substantially from my UK experience). Your compatriots on Metafilter will be able to advise you better about prices and insurance coverage.
As for finding a therapist, do some research about state/national regulatory bodies for psychotherapy, and choose a therapist who is a member of and/or is accredited by these bodies.
As for what you tell your therapist, to an extent they will guide you. I find it useful to maintain an anonymous, password-protected blog in which I set out all my feelings and experiences so that my therapist can read it, and I have things set out clearly for myself.
Will they stop it hurting? Eventually, with some considerable work done by both you and your therapist. Many people swear by Cognitive Behavioural Therapy, of which I have no experience. I am under the impression that CBT doesn't delve into your past to any great extent and uncover the reasons behind your moods and reactions, whereas most other disciplines within psychotherapy do. Personally, I am finding Transactional Analysis helpful. There are many other flavours of therapy, and I think they're all equally valid.
Regular exercise also works to lift your mood. It won't cure your depression, but it will put you on a firmer footing and give you a sense of progress and proactiveness (is that a word?).
If you haven't done so already, search through previous AskMes relating to depression. There are some very helpful answers there.
Avoid alcohol. I cannot stress this enough.
posted by idiomatika at 7:09 AM on December 16, 2009
As for finding a therapist, do some research about state/national regulatory bodies for psychotherapy, and choose a therapist who is a member of and/or is accredited by these bodies.
As for what you tell your therapist, to an extent they will guide you. I find it useful to maintain an anonymous, password-protected blog in which I set out all my feelings and experiences so that my therapist can read it, and I have things set out clearly for myself.
Will they stop it hurting? Eventually, with some considerable work done by both you and your therapist. Many people swear by Cognitive Behavioural Therapy, of which I have no experience. I am under the impression that CBT doesn't delve into your past to any great extent and uncover the reasons behind your moods and reactions, whereas most other disciplines within psychotherapy do. Personally, I am finding Transactional Analysis helpful. There are many other flavours of therapy, and I think they're all equally valid.
Regular exercise also works to lift your mood. It won't cure your depression, but it will put you on a firmer footing and give you a sense of progress and proactiveness (is that a word?).
If you haven't done so already, search through previous AskMes relating to depression. There are some very helpful answers there.
Avoid alcohol. I cannot stress this enough.
posted by idiomatika at 7:09 AM on December 16, 2009
Reading your description made me think that you may be experiencing dysthymia, or chronic low-level depression. A primary symptom of dysthymia is anhedonia, or inability or difficulty experiencing pleasure. Often people with dysthymia also experience what's called "double depression," where your already low mood slips into a major depression, which sounds similar to what you're feeling now.
Here's the link to the referral line for the Mental Health Association of Arizona - you could start by calling them and talking to someone. I wouldn't worry too much about what to tell them - there are standardized diagnostic procedures for depression screening, so they'll ask you questions to elicit the information they need to know. You can anticipate possible questions about your mood, energy levels, sleeping and eating habits, suicidal thoughts, and the severity and duration of any symptoms you've identified. (That level of screening would be done during an appointment, not over the phone, but there would likely be a briefer version at first.) I would also tell the referral service that you have Blue Cross Blue Shield so they can help you identify possible providers who will accept your insurance. (You may also want to check with BCBS to see how much they will cover; I had BCBS and when I went to an in-network provider, I just paid the specialist co-pay rate.)
Seeing both a psychiatrist for medication and a therapist for talk therapy may be more effective than either one individually; dysthymia in particular can be exacerbated by chronic negative thinking patterns, and cognitive behavioral therapy can be quite helpful in learning different ways of thinking. Medication, on the other hand, can help you get to a place where you're able to do the work of the therapy.
I noticed on the MHAArizona website that they have support groups for people with depression as well - it can also be helpful to hear how other people with depression cope. Especially if you're feeling isolated and lonely.
YMMV, of course - most of my advice is from personal experience. I have been in and out of treatment for dysthymia for almost 15 years and can tell you that while there is no magic cure, good treatment can really make a difference. You can stop hurting.
posted by Neely O'Hara at 7:14 AM on December 16, 2009
Here's the link to the referral line for the Mental Health Association of Arizona - you could start by calling them and talking to someone. I wouldn't worry too much about what to tell them - there are standardized diagnostic procedures for depression screening, so they'll ask you questions to elicit the information they need to know. You can anticipate possible questions about your mood, energy levels, sleeping and eating habits, suicidal thoughts, and the severity and duration of any symptoms you've identified. (That level of screening would be done during an appointment, not over the phone, but there would likely be a briefer version at first.) I would also tell the referral service that you have Blue Cross Blue Shield so they can help you identify possible providers who will accept your insurance. (You may also want to check with BCBS to see how much they will cover; I had BCBS and when I went to an in-network provider, I just paid the specialist co-pay rate.)
Seeing both a psychiatrist for medication and a therapist for talk therapy may be more effective than either one individually; dysthymia in particular can be exacerbated by chronic negative thinking patterns, and cognitive behavioral therapy can be quite helpful in learning different ways of thinking. Medication, on the other hand, can help you get to a place where you're able to do the work of the therapy.
I noticed on the MHAArizona website that they have support groups for people with depression as well - it can also be helpful to hear how other people with depression cope. Especially if you're feeling isolated and lonely.
YMMV, of course - most of my advice is from personal experience. I have been in and out of treatment for dysthymia for almost 15 years and can tell you that while there is no magic cure, good treatment can really make a difference. You can stop hurting.
posted by Neely O'Hara at 7:14 AM on December 16, 2009
Depending on the kind of coverage you have you may need a referral from a general practitioner, you might not. If you don't you can go on the Blue Cross/Blue Shield website and choose the kind of services you would like to pursue and it will provide you with a list of providers near you. You can Google the various therapists and psychiatrists they list as in your network but honestly I have found that unfortunately behavioral health providers in private practice are sadly behind the curve and typically don't have websites where you can view their credentials and practice specialties. So, unfortunately, unless you know someone who can refer you to someone they liked who is also in your network there is a little bit of a crap shoot element to choosing a provider and you may need to change providers in order to find a fit that works for you in terms of treatment modality and personality. You should check with BCBS to see what you have in terms of coverage, typically you're limited to a certain number of visits per year and this number is less than one visit per week so you may need to determine how to space visits out unless you can pay for the gap in your coverage out of pocket. You will also likely have a copay with each visit which could be in the range of $20-$30 so you should figure out in advance how much the copay is so you can budget appropriately.
posted by The Straightener at 7:18 AM on December 16, 2009
posted by The Straightener at 7:18 AM on December 16, 2009
Reading your description made me think that you may be experiencing dysthymia, or chronic low-level depression. A primary symptom of dysthymia is anhedonia, or inability or difficulty experiencing pleasure. Often people with dysthymia also experience what's called "double depression," where your already low mood slips into a major depression, which sounds similar to what you're feeling now.
As a mental health professional I refrain from making diagnostic claims based on extremely limited information posted anonymously on the Internet and generally recommend that others do so, as well.
posted by The Straightener at 7:20 AM on December 16, 2009 [7 favorites]
As a mental health professional I refrain from making diagnostic claims based on extremely limited information posted anonymously on the Internet and generally recommend that others do so, as well.
posted by The Straightener at 7:20 AM on December 16, 2009 [7 favorites]
A year or so ago (closer to 2 now, eek), I had a horrible crisis happen and had just moved to a new hometown where I didn't know any of the local mental health professionals, but I knew I wanted insurance coverage to apply to the maximum extent. I made an appointment with my primary care doctor (GP/family doctor), and I brought a list printed from my insurance company's website of the local mental health professionals. I asked the doctor to review the list, and from it give me if possible 3-5 names he could recommend. He did so, but highlighted one and said "This individual is particularly specialized with the issues that are bringing you to therapy." I made an appointment with her, and it was probably the smartest thing I ever did. Almost everything "good" in my handling of that crisis and its aftermath has arisen based on the learning and healing process begun in that therapy. You won't always click with the first therapist you meet, and that's a-okay. You aren't looking for 'love at first sight,' but more whether you feel comfortable opening up to and trusting the professional. It might take visiting a few different docs before you find the one. And the issues you are feeling won't be cured overnight, but if you are anything like me you might feel a sense of relief and a new glimmer of hope for just starting the process. A little hope can mean a lot. Good luck!
posted by bunnycup at 7:41 AM on December 16, 2009
posted by bunnycup at 7:41 AM on December 16, 2009
As a mental health professional I refrain from making diagnostic claims based on extremely limited information posted anonymously on the Internet and generally recommend that others do so, as well.
Sorry about that - good point. I should have been more clear that I was only speaking from my personal experience with similar symptoms and my non-professional knowledge of them.
posted by Neely O'Hara at 7:47 AM on December 16, 2009
Sorry about that - good point. I should have been more clear that I was only speaking from my personal experience with similar symptoms and my non-professional knowledge of them.
posted by Neely O'Hara at 7:47 AM on December 16, 2009
Before you try the drugs (which can increase the risk of suicidality) try reading "Feeling Good" by David D. Burns, MD. It has pulled me out of depression.
If that alone does not work, try taking three 300 mg capsules of john's wort per day. A recent survey by the cochrane database attempted to discredit St John's Wort. Rather than discrediting the herb, he investigators heartily recommended the drug over prescription therapy.
I realize that a lot of people will say there are a lot of drug interactions with Saint John's Wort. This is true - especially if you were taking antiseizure medication, anticoagulant medication, or antifungals (especially with an HIV infection comorbidity). St John's wort does all but abolish the effect of protease inhibitors, so it is not for people with HIV.
Saint John's wort is also potentially dangerous because it can increase your sensitivity to sunlight (by a lot) so protect yourself. Wear sunglasses when driving as this can also increase sun damage to your retinas.
Like me, you may not need to take the herb for long to get yourself out of the funk, and then you can maintain the benefits with daily self-therapy.
Seriously, get this book though. It really helps.
posted by verapamil at 8:09 AM on December 16, 2009
If that alone does not work, try taking three 300 mg capsules of john's wort per day. A recent survey by the cochrane database attempted to discredit St John's Wort. Rather than discrediting the herb, he investigators heartily recommended the drug over prescription therapy.
I realize that a lot of people will say there are a lot of drug interactions with Saint John's Wort. This is true - especially if you were taking antiseizure medication, anticoagulant medication, or antifungals (especially with an HIV infection comorbidity). St John's wort does all but abolish the effect of protease inhibitors, so it is not for people with HIV.
Saint John's wort is also potentially dangerous because it can increase your sensitivity to sunlight (by a lot) so protect yourself. Wear sunglasses when driving as this can also increase sun damage to your retinas.
Like me, you may not need to take the herb for long to get yourself out of the funk, and then you can maintain the benefits with daily self-therapy.
Seriously, get this book though. It really helps.
posted by verapamil at 8:09 AM on December 16, 2009
In addition to the warning about sun protection, here is a list of drug contraindications for St. Johns Wort, and foods to be avoided, especially "foods and beverages that contain tyramine, such as Chianti wine, beer, aged cheese, chicken livers, chocolate, bananas, and meat tenderizers."
posted by bunnycup at 8:52 AM on December 16, 2009
posted by bunnycup at 8:52 AM on December 16, 2009
Just a voice chipping in to say, hang in there. I have been successfully treated for depression after many years and enjoy my life after struggling with chronic depression since high school. Yes, it does hurt, doesn't it? In a weirdly physical way? Research shows that pain and depression share neural pathways in the limbic portion of the brain. Yes, it can stop hurting.
I want to second Cognitive Behavioral Therapy. Also, please don't let your general practitioner prescribe an antidepressant until you have established a relationship with a therapist. It is really more helpful to have whomever is prescribing you the antidepressant (if you decide to try one) work in tandem with someone who is giving a third-party perspective on your mood on a regular basis. Plus, you'll need a support system for that ramp up phase because it can be frustrating to wait for it to work, and sort out side effects from what is unrelated to the medication.
Also, you don't have to just "go" with your first choice of therapist. You can interview or try out therapists until you feel that someone is a good fit for you.
Right now, you're probably trying to remember what it was like to ever feel good. I call this "good feeling amnesia". It's hard to feel hopeful for feeling better when you can't remember (REALLY can't remember at all) what feeling good feels like. Just trust me when I say...you can feel good again. Write it down. Post it on your bathroom mirror. Even when you can't feel it yourself, let us feel hope for you.
If you want a referral in your area for a cognitive behavioral therapist, you can reach out to the national or local chapter of the DBSA for names and numbers of potential providers.
Remember that your mood, what you think, how you feel physiologically, and what you do (activities) are VERY closely connected. Like a mobile hanging from the ceiling. Touch one piece and all of the other pieces move. So, if the biochemicals in your brain are depressing the generation of positive mood chemicals (like serotonin), this won't ONLY affect your mood. It will affect how you think about things, how your body feels, and how motivated you are to physically move. It then becomes a cycle. Lack of physical movement depresses your biochemistry, leads to more negative thoughts. More negative thoughts leads to self-defeating thinking and behavior which leads to a more depressed mood. Etc.
Here are some interventions that you can use for each of the "levers" that can affect mood:
-Physical stimulation > yoga, swimming, massage. If you aren't experiencing pain from it, exercise, dancing, running...even if you don't feel like doing it. It's weird how the endorphins and such can get tripped in a positive way through these and improve mood for a short time.
-Negative thoughts/self-defeating patterns > cognitive behavioral therapy, journaling
I've got chronic depression (not everyone has long term depression) and it is genetic from both sides of my family. I had to face the facts in my late 20's that I would be on some sort of antidepressant for the rest of my life, much like a diabetic is, and I made peace with that. Not everyone will have to be on something like that for the rest of their lives. But it doesn't interfere with my daily living, and it makes a huge difference in the quality of my life. Finding the right drug was a bit of a struggle since many meds did not exist back in the early 90's when I was working that out. But I'm so happy that I hung in there and didn't quit trying. Because I have a really lovely life, with a fantastic family and a wonderful job, that I would not have had otherwise.
You can get better. Don't give up.
posted by jeanmari at 9:08 AM on December 16, 2009 [1 favorite]
I want to second Cognitive Behavioral Therapy. Also, please don't let your general practitioner prescribe an antidepressant until you have established a relationship with a therapist. It is really more helpful to have whomever is prescribing you the antidepressant (if you decide to try one) work in tandem with someone who is giving a third-party perspective on your mood on a regular basis. Plus, you'll need a support system for that ramp up phase because it can be frustrating to wait for it to work, and sort out side effects from what is unrelated to the medication.
Also, you don't have to just "go" with your first choice of therapist. You can interview or try out therapists until you feel that someone is a good fit for you.
Right now, you're probably trying to remember what it was like to ever feel good. I call this "good feeling amnesia". It's hard to feel hopeful for feeling better when you can't remember (REALLY can't remember at all) what feeling good feels like. Just trust me when I say...you can feel good again. Write it down. Post it on your bathroom mirror. Even when you can't feel it yourself, let us feel hope for you.
If you want a referral in your area for a cognitive behavioral therapist, you can reach out to the national or local chapter of the DBSA for names and numbers of potential providers.
Remember that your mood, what you think, how you feel physiologically, and what you do (activities) are VERY closely connected. Like a mobile hanging from the ceiling. Touch one piece and all of the other pieces move. So, if the biochemicals in your brain are depressing the generation of positive mood chemicals (like serotonin), this won't ONLY affect your mood. It will affect how you think about things, how your body feels, and how motivated you are to physically move. It then becomes a cycle. Lack of physical movement depresses your biochemistry, leads to more negative thoughts. More negative thoughts leads to self-defeating thinking and behavior which leads to a more depressed mood. Etc.
Here are some interventions that you can use for each of the "levers" that can affect mood:
-Physical stimulation > yoga, swimming, massage. If you aren't experiencing pain from it, exercise, dancing, running...even if you don't feel like doing it. It's weird how the endorphins and such can get tripped in a positive way through these and improve mood for a short time.
-Negative thoughts/self-defeating patterns > cognitive behavioral therapy, journaling
I've got chronic depression (not everyone has long term depression) and it is genetic from both sides of my family. I had to face the facts in my late 20's that I would be on some sort of antidepressant for the rest of my life, much like a diabetic is, and I made peace with that. Not everyone will have to be on something like that for the rest of their lives. But it doesn't interfere with my daily living, and it makes a huge difference in the quality of my life. Finding the right drug was a bit of a struggle since many meds did not exist back in the early 90's when I was working that out. But I'm so happy that I hung in there and didn't quit trying. Because I have a really lovely life, with a fantastic family and a wonderful job, that I would not have had otherwise.
You can get better. Don't give up.
posted by jeanmari at 9:08 AM on December 16, 2009 [1 favorite]
One thing to note: using your insurance to help pay for services is helpful financially, but it also means that whatever mental health professional you see is going to give you a diagnosis and send it to your insurance company so that they'll actually cover your treatment. This diagnosis will be known by your insurance company, and part of their records. I explain this process to *every* client I see who uses their insurance, because every mental health care consumer should be aware of it.
Each state has a bit of variation in the names of the types of providers they license. In Arizona, you can find a psychologist, or a licensed professional counselor (I think there are other types, but I'm having trouble finding the titles). On the Blue Cross/Blue Shield website, though, you can do a provider search under the heading of psychology or counseling or behavioral health, etc.
posted by so_gracefully at 9:28 AM on December 16, 2009
Each state has a bit of variation in the names of the types of providers they license. In Arizona, you can find a psychologist, or a licensed professional counselor (I think there are other types, but I'm having trouble finding the titles). On the Blue Cross/Blue Shield website, though, you can do a provider search under the heading of psychology or counseling or behavioral health, etc.
posted by so_gracefully at 9:28 AM on December 16, 2009
Going to see a GP would probably be a good first step - sometimes depression is actually caused by a different problem (in my case, undiagnosed ADHD - got diagnosis and treatment, and am depression-free for the first time in over 10 years - and in my case, CBT actually made me *worse* because my negative thought patterns were being validated by reality, so being forced to work on them/think about them = sadness-making). Your GP may want to do a physical examination/lab tests and such to rule anything else out, and could refer you to a mental health professional if appropriate.
Good luck!
Oh, and exercise (even just getting out of the house and going for a walk) is good, for pretty much anything. I know how hard it is to force yourself to get up and around when you're feeling so low, but it's really worth it.
posted by purlgurly at 9:36 AM on December 16, 2009 [1 favorite]
Good luck!
Oh, and exercise (even just getting out of the house and going for a walk) is good, for pretty much anything. I know how hard it is to force yourself to get up and around when you're feeling so low, but it's really worth it.
posted by purlgurly at 9:36 AM on December 16, 2009 [1 favorite]
This diagnosis will be known by your insurance company, and part of their records. I explain this process to *every* client I see who uses their insurance, because every mental health care consumer should be aware of it.
Why would this matter? I'm honestly curious.
posted by jeanmari at 12:02 PM on December 16, 2009
Why would this matter? I'm honestly curious.
posted by jeanmari at 12:02 PM on December 16, 2009
About 80% of people who seek therapy are helped by it. So, that's pretty great news. In response to another question here, and based on what I know about the outcome research for therapy (and my own professional experience), I wrote a sort of primer on what to look for in a therapist. Best of luck.
posted by OmieWise at 3:34 PM on December 16, 2009
posted by OmieWise at 3:34 PM on December 16, 2009
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