How exactly does one get help for depression

August 12, 2014 4:54 AM

I know I am depressed and need help. I don't know where to start though. Do I look for a therapist first? Do I make an appointment with my PCP first? Going to the doctor because "I feel sad all the time" seems so stupid. Should I start with a psychiatrist appointment??

Likewise going to a therapist because "I feel sad and I don't know why, my life is basically perfect, I have no reason to be sad" seems really stupid also. And yes I know this is the depression talking... sigh. I'm not going to kill myself or anything so calling the suicide hotline seems a bit much.

posted by Librarypt to Health & Fitness (18 answers total)

If you're going through a particularly stressful period that you know to be temporary, then your PCP can prescribe something to help you get through this phase (eg. Xanax).

Longer term, you'll want to start therapy. It will help you get to the bottom of what's ailing your heart.
posted by Dragonness at 5:01 AM on August 12, 2014 [1 favorite]

It is totally fine to go to your PCP and say exactly that. It is also okay to go straight to a therapist and sat exactly that. There is nothing stupid about it - yoyu feel what you feel, and you are planning how to get the treatment you need, so I think you're smart and brave.
posted by gingerest at 5:03 AM on August 12, 2014 [14 favorites]

"I feel sad and I don't know why, my life is basically perfect, I have no reason to be sad"

This same attitude kept me miserable a lot longer than it should have. When I finally went to my family doctor and started on the road to kicking depression's ass, I only wished that I had taken action sooner. Start with your family doctor. I like and trust my own, so she'd definitely be my first point of contact.
posted by futureisunwritten at 5:05 AM on August 12, 2014 [7 favorites]

I would start with your PCP. They will know your history best, and have a good idea of what you need to be doing. They'll also have recommendations for therapists and psychiatrists if that is a good next step for you, which makes finding a good one a lot easier.

Don't be embarrassed about going to the doctor and saying you feel sad all the time. It's not stupid.
posted by Krop Tor at 5:06 AM on August 12, 2014 [2 favorites]

If you like your regular doctor then start there. Most primary care doctors are more than happy to throw anti-depressants at you. Follow up with a therapist or a psychiatrist, or start with a psychiatrist and follow up with a therapist.

Something to watch out for- if you have been clinically depressed for a good bit of time, the medication may lift you out of your funk to a place where you will feel all the pain that you have been not dealing with. This is why therapy is important- you will need help at this time. It may hurt but you can get better.
posted by myselfasme at 5:58 AM on August 12, 2014 [2 favorites]

If your workplace has an Employee Assistance Program (EAP), that can be a good place to start, as it's free, confidential, and can serve as a bridge/referral to treatment plans.
posted by jackbishop at 6:07 AM on August 12, 2014 [1 favorite]

It is 100% okay to go to any of these places and say "I'm sad and I don't know why, I need help with that." Pick whichever one you're most comfortable doing - comfortable enough that you'll actually do it. Once you start, people will keep helping to point you in the right direction.

I went straight to a psychiatrist when I first got serious about getting help*. He checks in with me each time I visit to see if it would make sense for me to add a therapist to the mix (so far I haven't, but he'd be able to point me to someone).

*If the reasons for that matter - my primary care is just the campus health center, since I'm a graduate student, and I had a hilariously unhelpful experience with their therapy center that made me give up on seeking help for an additional two years or so.
posted by pemberkins at 6:22 AM on August 12, 2014

I agree with jackbishop on the EAP route being an option as well, if you work for an employer that offers one--my depression hit a crisis stage this year and that was the route that I took because at the time it was the least complicated route and the only one I had the strength for. It was a relatively easy way to get placed with a therapist that was guaranteed to accept my insurance. (And I see that you're in the US, so you're presumably subject to the byzantine insurance bureaucracy that we all have to deal with here...)

I would definitely suggest trying it if your PCP doesn't have any recommendations, or if the recommendations you get aren't accepting new patients, which is what happened with me when I asked my PCP.
posted by Kosh at 6:24 AM on August 12, 2014

"I feel sad and I don't know why, my life is basically perfect, I have no reason to be sad"

External appearances have pretty much nothing to do with internal reality.

If you're sad all the time, you're sad all the time. If it's causing you distress, which it obviously is, then it's time to start speaking to professionals. Start with your PCP and ask for recommendations of therapists and psychiatrists (I'd lean towards psychiatrists in case medication is a therapeutic modality that is indicated) who are good with depression and are currently taking on new patients.

Or to put it another way: would you feel stupid about going to the doctor upon stubbing your toe and possibly breaking it? Of course not. You'd go and get it checked out to make sure it's not serious. Mental illness is no different at all than physical illness, and needs to be treated accordingly.

You seem to have internalized the idea of depression as something silly, or not worth wasting anyone's time with. That's most likely partly due to the stigma around mental illness, and is also partly your depression lying to you. "It's not that bad, you're stupid for wanting help," etc. Remember: depression lies. All day, every day. Whether what you're experiencing is something transient or something more long term makes no difference: your brain is lying to you, and it's time to cut through that.

So. Go to your PCP and say "Doc, I'm depressed all the time. I need some help figuring this out, who would you recommend I speak to?"

Antidepressants are very useful (ask me how I know!) but they come with side effects and take 6-8 weeks on average to reach therapeutic levels in the bloodstream. So you definitely want a specialist you're seeing on a regular basis to be helping and monitoring you through that period, and adjusting/changing medications as necessary. There's also the saying that "pills don't teach skills," which is true, but they can give you the safe space to learn skills in. Most PCP will just write a scrip for an antidepressant or something and leave it at that; depression pretty much always needs a two-pronged approach, pharmaceutical coupled with some form of talk-based therapy. CBT is usually the most effective.

Best of luck. You're not alone.
posted by feckless fecal fear mongering at 7:12 AM on August 12, 2014 [4 favorites]

Or a combination - the most recent time I needed it, I talked to my PCP, who prescribed medication to tide me over, and recommended consulting my EAP for practitioners on my insurance plan.
posted by The Underpants Monster at 7:31 AM on August 12, 2014

Start with your PCP. Your insurance might require that you get referred from her/him anyway. It's also usually quicker to get into see a PCP than a new patient appointment with a psychiatrist, so your PCP can start you on an antidepressant while you want.

Depression is a biochemical illness. Just like you can have a perfect life and still be diabetic you can have a perfect life and still be depressed.
posted by Jacqueline at 7:51 AM on August 12, 2014

Hi. Long time depression sufferer. I didn't seek treatment until my mid 20s for similar reasons to you - it felt stupid saying "I'm sad all the time". I finally did go to my doctor and said something like "I'm sad all the time and I have no reason to be." I told her about the different ways my sadness manifested (fits of crying a few times a week, sleeping WAY too much, complusive eating, etc). I was never suicidal, but I felt like my friends were no doubt just hanging out with me to be polite, not because they actually liked me, and that surely everyone I worked with knew I was a waste of time. It didn't take long in to the appointment for me to start sobbing.

She listened, asked some questions, inquired at my family history (in my case there are family member with depression), and after some discussion we started me on antidepressants. It took a while for them to kick in and when they did it wasn't a sudden "Holy crap, life is awesome!" thing. I just slowly stopped having so many sad days, I slowly started to feel like a worthwhile person, I slowly became more interested in doing things out with other people, etc. My life is so incredibly different from how it had been before I got my depression treated. I'm not 100%, I still have the occasional "cry day" as I call them, but things are so much better.

Go talk to your family doctor. Be honest. Don't downplay or exaggerate. Just tell them exactly what has been going on, what is worrying you, what you want to change. See what they say.

Good luck. This is a very common disease, but it CAN get better. Congrats on wanting to take the first step towards feeling better.
posted by PuppetMcSockerson at 8:08 AM on August 12, 2014 [3 favorites]

Response by poster: Thanks everyone. These are all helpful answers. Unfortunately my employer does not offer an EAP. But, I will call my PCP and make an appointment now.
posted by Librarypt at 8:18 AM on August 12, 2014 [4 favorites]

There is no right or wrong way.
PCP first is probably easiest (and you may not even need to go to a psychiatrist then for meds), and you can get a feel for the options out there.

And if you ever want to talk, there are services out there like the Samaritans, and you don't have to be suicidal to talk to them.

I think about my depression like the weather (borrowing from Stephen Fry's metaphor). You are going to have rainy days in life. And sometimes, it starts storming and it feels like it won't end. You can get some help with the weather (medication), and then get help in developing an umbrella (counseling). In the end, no one should be left out in a storm alone. You deserve help.
Good luck with everything.
posted by troytroy at 8:35 AM on August 12, 2014 [2 favorites]

PCP is a great place to start. It's not the easiest conversation for many, but it's the first step.

Since no one else brought it up, I recommend NAMI. They have all different kinds of support groups. It helps to know you're not alone and there are other people out there that share the same thoughts you do. I've been lucky to be in a great group on and off for more than 10 years.

Good luck. Update if you can.
posted by kathrynm at 8:58 AM on August 12, 2014

Going to the doctor because "I feel sad all the time" seems so stupid. Should I start with a psychiatrist appointment?

I found it was helpful to just call my insurance first to see what was covered. With some kinds of insurance you don't need a referral to get psychiatric care and you can just make an appointment. With some, there is a narrower range of what insurance will cover. But absolutely "I feel sad and I don't know why" is a perfect thing to see a doctor about. If, for some reason, the doctor is dismissive about it, it's totally okay to press. Usually the key phrases are "This is disrupting my life" (that is affecting your work, sleep, family life, quality of life) which is what it seems like is happening. Take care of yourself like you are sick and especially be kind to yourself as you work through this. Congratulations for taking the first step. Being sad sucks and is something you can work on.
posted by jessamyn at 9:12 AM on August 12, 2014 [1 favorite]

I just want to commend your problem solving/creative thinking skills - you nailed it when you mentioned "Going to the doctor because you feel sad all the time." That IS a legit way of getting help for depression! Doctors know about depression and what lab tests can check for physical aspects like hormone levels, iron, environmental contaminants, etc. They know about meds and can help you find a therapist.

You figured out where to start. You're awesome and you know how to get help. You can do this, and a ton of people on the green have got your back.
posted by cadge at 9:59 AM on August 12, 2014

Going to the doctor because "I feel sad all the time" seems so stupid.

It's really not at all stupid.

1. Sometimes depression / chronic mental pain / whatever are problems that have a medical component. This is not at all unusual. It's entirely reasonable to bring this up with your doctor.

2. Even if your particular stuff, whatever it may be, is not medical in nature, your doctor is a health professional who knows other professionals doing work that is orthogonal to physical health. You aren't the first patient your doctor has referred to a therapist or psychiatrist or counselor, not by a long shot.

3. One of the big lies that depression tells its victims is that it's not depression; it's totally normal to feel this way and you're just not tough enough, you should just man up and stop being so weak. That's a lie that depression tells you because depression wants to keep existing, so it doesn't want you to get help and it doesn't want you to talk about it. It thrives in your silent suffering. It's not stupid to talk about it, but your depression will try its damnedest to make you feel like it is stupid. Don't listen to it.

I'm not saying anything anybody else hasn't already said, and I'm glad you're taking steps to address this. You should be proud of yourself and know that you are strong and that it is not stupid to ask for help if help is what you need or want.
posted by gauche at 11:48 AM on August 12, 2014 [3 favorites]