Common reasons people avoid treatment and expert advice on how to get past them.
By Mary Anne Dunkin
Reviewed By Joseph Goldberg, MD
Are you struggling with depression? Are you getting treatment for it? If not, you’re not alone. About two-thirds of people with major depression never seek appropriate treatment, and the consequences can be devastating: personal suffering, missed work, broken marriages, health problems and, in the worst cases, death.
The World Health Organization ranks depression as one of the world’s most disabling diseases. Yet with treatment, 80% of people with clinical depression improve, usually in a matter of weeks.
So what keeps us from seeking help? “It’s hard to find out from folks why they are not coming [for treatment], because if they are not coming, they can’t tell us,” says Kate Muller, PsyD, director of psychology training and assistant professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine at Montefiore Medical Center in Bronx, N.Y. “But when they do finally get to our offices, they can certainly speak about the things that might have kept them from coming initially,” she says.
Major Depression: Reasons Why People Avoid Treatment
Therapists’ interviews with people who seek treatment, as well as community surveys, provide some clues as to why people don’t get help for depression. If you feel depressed and are trying to deal with it on your own, see if any of these reasons ring true to you. If they do, then follow the experts’ advice to get the help you need.
If I give it time, I’ll snap out of it. Although a case of the blues passes with time, clinical depression may linger indefinitely if not treated, says Erik Nelson, MD, associate professor of clinical psychiatry at the University of Cincinnati Academic Health Center and staff psychiatrist at the Veterans Administration Medical Center in Cincinnati. People can’t just snap out of being depressed. Often, in fact, depression has a biological origin. And like other medical conditions, it often requires treatment to control or heal it.
Waiting for depression to simply pass can be harmful for a number of reasons. For one, depression that goes untreated may become more severe, says Nelson. The longer the delay in treatment, the more difficult it may be to control, and the more likely it is to recur when treatment is stopped. There also is growing evidence that untreated depression can contribute to or worsen other medical problems. “Heart disease is the one that has been most linked to depression, but research also suggests a link between depression and metabolic issues such as obesity, diabetes, and diseases such as Alzheimer’s and cancer,” says Nelson.
Expert advice: Don’t allow depression to linger. Speak to your doctor. If you find it difficult to seek treatment for a mental disorder, remember that depression can have a biological origin and treatment for it may help prevent serious health conditions like heart disease.
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I don’t want to take antidepressants. “Sometimes I think what keeps people from coming in to see us is that they’re afraid they’ll have to take a pill,” Muller says. “They think, ‘I don’t want to take a pill for the rest of my life.’”
Although antidepressants are effective against depression, treatment for depression doesn’t always involve medication. “We have psychotherapies these days that are as effective, so if you are depressed, medication may not be the only option,” Muller says.
“Cognitive-behavioral therapy is a form of talk therapy that focuses on the here and now -- helping you look at your emotions, thoughts, and behaviors to try to improve your quality of life and reduce your depression,” she says. “We know that it may work as well as medications in the short term, but may also last longer.”
Expert advice: See a therapist (psychologist, psychiatrist, or social worker) as well as your regular doctor. If you do need a medication, it most likely won’t be for life. Learn all you can and don’t rely on stories you have heard from others who have taken antidepressants, Muller says. Every person reacts a little differently to them.
I don't feel sad all the time. Why do I need treatment for depression? You don’t need to feel sad or cry all day to be clinically depressed. Often people with depression see their primary care physicians for problems such as muscle pain, sleeping difficulties, or fatigue, not knowing those are signs of depression, Nelson says. Sometimes these symptoms accompany sadness; other times they don’t.
“There is also so-called ‘masked depression’ -- when, for whatever reason, people don’t feel in touch with a sense of sadness or abnormal mood,” he says. “They may be more likely to report something like apathy, blunted mood, or not feeling like themselves.”
In these cases, a doctor may diagnose depression based on other symptoms, particularly decreased interest in or loss of pleasure from favorite activities.
Expert advice: If you are experiencing symptoms such as fatigue, muscle pain, or loss of interest in once-loved activities, don’t rule out depression as a cause. See your doctor.
I’m embarrassed to talk to my doctor about it. “The shame of having a mental health problem keeps folks from seeking help or even talking about suffering from depression,” says Bob Livingstone, a psychotherapist in private practice in the San Francisco area and author of The Body Mind Soul Solution: Healing Emotional Pain through Exercise (Pegasus Books, 2007).But depression is nothing to be ashamed of. It is a medical condition, much like diabetes or high cholesterol, which requires treatment.
It is also a very common condition. Depressive disorders affect nearly 19 million people in the U.S. every year -- regardless of gender, age, race, religion, sexuality, or socioeconomic status. So there’s a good chance your doctor won’t hear anything from you that she hasn’t heard many times before.
Major Depression: Reasons Why People Avoid Treatment continued...
Expert advice: Remember that virtually everyone experiences depression at some point, and your doctor will not divulge confidences that you share during an office visit. Still, if speaking to your own doctor is embarrassing, find out if your insurance company has someone you can speak with first by phone. If you don’t have insurance coverage for mental health, check out mental health services in your community.
I’m afraid of having to talk about painful subjects in therapy. “Depressed people avoid treatment for fear of having to undergo a probing examination of their psychological pain,” says Joe Wegmann, a licensed clinical social worker and board-certified pharmacist in Metairie, La.
“They have a fear of opening it all up – ‘I don’t want to go there,’” Muller says. Unfortunately, in some cases, getting into painful discussions is necessary for healing, she says. “But in other cases, it doesn’t have to be as deep or scary as you might think. A good therapist understands what is like for someone to open up to a stranger and will guide you through that process. He won’t push you to open up too quickly or at a level you are not comfortable with.”
Expert advice: Find a therapist you feel comfortable with and ask him as many questions as he asks you, Muller says. Find out what therapy will be like. Although painful discussions may be necessary in time, your therapist cannot force you. What you reveal is up to you.