Finding help for depression is not an easy task. The research you do and the decisions you make at this time will have a profound and lasting effect on your health and well being for the rest of your life. The very symptoms of depression make it difficult to seek help and those symptoms also make it difficult to discriminate between what makes us feel better in the short term and what will have a lasting therapeutic effect for the long term. I urge you to keep an open mind while reading this manuscript, especially if you are just beginning your search for help, or if you have been in the system for some time and have not found satisfactory relief.
In our sometimes frantic search to end the terrible pain of depression we tend to latch on to "causes" and "solutions" which may not have a basis in reality as much as there is a basis in our desperate need for relief. Many of us want the miracle to cure us, where the mystical therapist does their special thing and suddenly we are cured, or we pray for divine intervention, or all we need do is pop a pill and everything is instantly ok, but seldom does it happen that way. Depression in many ways can be viewed the same as the addictive process, where the very thing we feel we need or want most is the very same thing that is most harmful to us.
If our mind, because of our depression, works against our seeking help, and works against our being able to discriminate between what will be helpful and that which will do us more harm, then how are we going to be able to make decisions which will end this unrelenting pain? The answer is, most of us can not. That is why an intervention is needed, someone who will help us sort out the reasons we have ended in this depressed state, someone who will help us find realistic and lasting solutions which will end the pain, a skilled and caring therapist who will give us the tools and show us life skills which will eventually enable us to live our life in control of our emotions, with a more positive view of our future.
The truth is our depressed mind does not give us good counsel, our depressed mind seeks to relieve the pain by whatever means as long as it makes us feel better, without regard to the long term consequences and without regard to what will eventually end the depression. If we allow our depression to dictate what is and what is not therapeutic we run the distinct risk of worsening our depression and over time, ending the depression will become more and more difficult.
The information presented on this web site is not intended as a substitute for therapy by a trained mental health professional. My presentation is more explanatory and directive than most other web sites dealing with depression and suicide, for the sole purpose of connecting with depressed people and convincing them that therapy is beneficial. The mental health community says that they are able to help 80 per cent of those who seek help, yet the majority of those who are depressed do not see a therapist and of the 30,000 who commit suicide each year most had not been to see a doctor. These pages are an attempt to accomplish three goals. One, through benefit of my personal experience with depression I hope to convince many of those who would not otherwise seek therapy that they are not alone and that there is help available to stop the pain. Two, I intend, to the best of my ability to inform those who are depressed more about what they are going through, and how the mental health system works in order that their therapy has a better chance of being successful. Three, for those whom the system has been a failure and have dropped out, I hope to help them look at their therapy from a new perspective in order that they may yet end the pain of depression.
If you are convinced that medication is the only way to combat depression then this guide to finding help for depression will not benefit you. I suggest you begin your research at Dr. Ivan Goldberg's site, Depression Central.
If you are not sure what type of therapy would be best in helping you combat your depression, if you are taking drugs for your depression yet continue to be plagued by bouts of depression and suicidal thoughts, if your insurance has run out and you are still depressed, and if you would rather take responsibility for your own health and well being and not be dependent on drugs for the rest of your life, then I may be able to help point you in the right direction.
For those of you who are not comfortable with counsel from a non professional such as myself I suggest that you start your search for help at Mental Health Net. Dr. John M. Grohol, et.al. have constructed a web site which is unprecedented when seeking information about mental health, both on and off the web. From that site you will be able to link to anywhere on the web that is of any benefit concerning mental health. Don't forget to check out the many features such as self help, editorials, support groups, etc. If you feel you might benefit from the counsel of one who has been there, then read on.
If you are losing control of your life situation, if you cannot control your emotions, if you think that your situation is hopeless and will never improve, if you have suicidal thoughts, if nothing seems to give you joy anymore and you are constantly and oppressively sad, if you feel as though God has forsaken you and is punishing you, if you feel as though a black hole is sucking in all the good in your life or that a black cloud over your head follows you and causes bad luck, if you feel worthless and that you deserve to be punished, if you wake early in the morning for no apparent reason, if you think that all your problems are caused by other people or events you cannot control and that your situation can only improve if they change, if you have any or many of these feelings or thoughts, then there is a good chance that you are depressed.
There are differing types of depression, there are differing degrees of severity of depression, there are differing causes of depression, and there are differing types of relief from depression. Because there are so many variables, self diagnosis and attempts of self help before a professional diagnosis is given may be harmful. Depression may happen after a major catastrophic life event such as the loss of a loved one or a divorce or after financial problems. But such is not always the case as the symptoms of depression may creep into our life over a period of time so that we are not aware of the change, and it may be that those around us are first to recognize that we are clinically depressed (a depression that should be addressed with therapy because we are no longer in control).
SUICIDAL THOUGHTS
Certainly the most important indicator that you need therapy is if you are having
suicidal thoughts. This is especially true if you have begun to think that there are
no other options left and that suicide is the only way to end this pain. If you have
formulated a plan on how or when you will kill yourself, I urge you to seek help
now! Make an appointment with a therapist as soon as possible or go to your
local hospital, if the crisis is severe call a crisis help line and let them help you
make it through the night, seek help in the morning. Suicidal thoughts and
depression are episodic, in that you will have periods which are worse than at other
times, but the intense feelings will abate if you give yourself time and seek
counseling.
LOSING CONTROL
If you are no longer able to control your anger, if you are no longer able to control
your periods of despair, if it seems that your life situation is no longer under your
control and you are entirely at the mercy of someone or something else, if your
interpersonal relationships are falling apart and your are at odds with members of
your family and your co-workers and you are losing friends, if these things are
happening to you there is a good chance that your depression is beginning to take
control of your emotions and it is taking control of your life situation. If you do not
make the decision to intervene and seek counseling your depression will worsen
and regaining control will become more and more difficult.
ARE YOU GOING CRAZY?
You may have the feeling that you are going crazy. This is not an uncommon
thought when a person first experiences the symptoms of depression. Without
defining what the term "crazy" means, a person who is actually going crazy
probably does not have a complete realization of what is happening to them and
will most likely blame their problems on someone or something other than
themselves. They many times think that they are sane and it is the rest of the
world that has gone "crazy". The automatic thought "I think I am going crazy"
arises due to a reaction to the symptoms of depression. The confusion, the loss
of memory, the anger, the despair, the ups and downs (especially for manic
depressives), and the loss of control of our emotions, all are perplexing when we
first become depressed. This feeling that we are losing our minds happens as our
depression begins to take control, it is also a very good indicator that intervention
is needed and that it is time to seek therapy.
DOES THERE NEED TO BE A CRISIS?
Most of us only begin to consider that we need therapy when there is a crisis, where our life
has come to a point where we are no longer in control, or we are having strong suicidal urges.
Yet our depression does not have to reach a crisis stage before we seek therapy. One of the
main reasons I am writing this article is to help people recognize the warning signs of depression
so that they begin to work on healing before the depression reaches a crisis stage. In fact my
ultimate goal is to inform enough people so that most of us do not even need therapy, but
are able to recognize that we are depressed and use improved self help methods to avert a
crisis and heal ourselves. Of course these are lofty goals and at my present site visitation
rate, my goal of reaching ll million depressed people will take approximately 2,752 years.
I am a manic depressive and have seldom been accused of setting my goals too low.
Anyone who knows or suspects that they are depressed would be wise to first have a complete medical evaluation in order to determine if there is a possible organic cause of the depression. It is possible that certain medical disorders such as hypothyroidism are the cause, especially if the onset of depression is sudden or cannot be explained by reaction to environmental influences. The problem may also be caused by an adverse reaction to prescription or illegal drugs such as amphetamines. If you begin your therapy by going to a psychiatrist (who is also a MD) he/she will give you a medical evaluation, if you do not start with a psychiatrist then a complete physical by an internist or family doctor is recommended. While I do urge you to rule out any possible organic cause by seeing an MD, I do have reservations about beginning your therapy choices with a visit to an internist or family doctor. My concerns will be covered in the section on drugs and again in the section on pitfalls later in this article. I caution you not to become overly optimistic and fixate on the possibility that the depression has an organic origin because for most of us this is not the cause, but it should be investigated.
One of the first considerations when we are trying to heal or improve our mind is with our physical body. If we abuse or neglect our physical body, our mind will be adversely effected. Whether or not our depression has been caused by the abuse or neglect of our physical body, or if our depression can be cured by stopping the abuse or neglect is not what I am addressing at this time. The point is that if we abuse and neglect our physical body and we are depressed, the depression will be worsened and our efforts to heal our mind will be more difficult and take a longer period of time. This is true even if the method of therapy is drugs only, because if we are physically fit our body can more readily assimilate the drugs and possible side effects will have less of an impact.
If you determine that you are depressed, I do not suggest you undertake a rigorous program of physical exercise for the express purpose of ending the depression, especially if exercise is the only method used to combat the depression. It is not uncommon for a depressed person to begin an exercise program by buying an expensive pair of shoes, an exercise machine or sports club membership, and a new exercise outfit, only to find that within a short time the symptoms of depression make it impossible to follow the regimentation, commitment, and motivation needed to insure the success of the exercise program. There is a good chance that I will be buying your expensive exercise machine for ten cents on the dollar at a garage sale next summer. On the other hand, I do highly recommend that you start a mild program of physical exercise consisting of walking, stationary bicycling, or mild aerobics, for 20 to 30 minutes a day, five days a week. This will help clear your mind, it will help you focus while investigating your mental health care options, and mild exercise will help with motivation and commitment when first beginning your therapy.
As far as abuse of the physical body is concerned, I also do not recommend you take on a commitment of stopping an addiction for the express purpose of ending your depression. There is a good chance that the depression will sabotage your efforts and sap your motivation, with a final outcome of worsening your depression and delaying your needed therapy. There is one thing that you do not need at this time, and that is another failure in your life.
Please do not misinterpret my comments, I am not suggesting anyone stop a 12 step program or even delaying enrolment, but if one attempts to go it alone by making a commitment to stop smoking or stop drinking alcohol or quit an illegal drug, and begins an ambitious physical exercise program in order to end depression, for most of us the depression will win. It is best to seek therapy for depression, begin to stabilize the symptoms of depression, and then work on the addiction and our physical improvement from a position of non depressed strength rather than from a state of depression.
Your method of payment for any possible therapy should be determined before you begin to
investigate actual therapists. Your insurance coverage or income bracket may well determine
the type of care you have available to you. Many insurance plans have certain restrictions
you need to be aware of before you make your decision on treatment.
Here are payment options that may be available to you:
Your company insurance plan
Managed care - HMO's
Medicare, Medicaid, CHAMPUS
A sliding-scale cost based on income bracket and financial situation.
Financing plans available through providers
Once you determine what is available to you, call them, ask questions:
Is your coverage limited to a medical necessity, how is this decision made?
Is there a list of approved providers, or can you choose on your own?
Is it possible that your coverage may be denied, or stopped for any reason?
Is there a limit on the number of sessions?
Will they pay the full cost, are there annual or lifetime maximums on payment.
Are there restrictions on types of therapists or on their license and degree?
Do they dictate type of therapy concerning drugs, outpatient or inpatient treatment?
Following is a list of places to investigate depending on your payment restrictions:
Private practice psychiatrists, psychologists, and master's level therapists.
Psychiatric hospitals
Psychiatric units of general hospitals
University outpatient clinics
Church with a minister that has a masters level degree in counseling
City or county community mental health centers
If you have limited insurance coverage or no insurance, be sure to ask all the above if they have financing plans and/or sliding-scale fees based on financial ability to pay.
Now that you have a better idea of what type of therapist your insurance will allow
or what you can afford, we can take a closer look at choosing a therapist that will
best fit your needs. There are three basic categories of therapists:
Psychiatrists, they are also MD's and can prescribe medication, perform psychiatric
evaluations and give medical exams. Their services are usually the most expensive.
Psychologists, are either Ph.D's(emphasis on research) or Psy.D's(clinical emphasis),
and cannot prescribe medications.
Masters level therapists, with differing designations such as MS, MSW, MFCC, CCSW, LCSW,
LPC, depending on schooling or specialty.
Psychologists and masters level therapists usually work closely and consult with a psychiatrist
when it is determined that medication is needed. Hospitals and many clinics have resident or
consulting psychiatrists if more extensive psychiatric evaluations are needed.
The quality of care you receive does not depend as much on what degree your therapist has,
as it does on their innate ability to connect with you and help you gain insight into some of
the reasons you have ended in this depressed state. Their knowledge of modern counseling
techniques is important and some of the masters level programs have more counseling requirements
than might be required of a psychiatrist in a program which concentrates on medications.
During the initial contact with prospective therapists ask them their views on medication and
what counseling technique or philosophy they follow. If they say that their approach is eclectic
and the methodology will be suited to your particular case, press them to be more specific. Most
therapists will adhere to some known method of therapy most of the time and you need to know more
about what type of treatment you will receive. This is your mind, this is your life, this will
effect the rest of your life, and you deserve to know more about how you will be treated. Their
reaction to this minor confrontation and how they make you feel may well be indicative of how
your relationship will progress and also give some hint at the final outcome of your therapy
with this individual.
Types of therapies will range all the way from someone with a lay back-I'm your best friend attitude, using simplistic relaxation exercises and/or ineffective tranquilizers, and a counseling technique taken directly from their psych.234 class and used on every patient who walks through their door. At the other extreme you have the drug only therapist who thinks most depression is genetic, that we have no control and that environment has no effect, their approach is lacking empathy, and they are arrogant (I know more than you, I have more education than you, I am smarter than you, therefore I know what is best--do as I say). Somewhere between these two extremes we should be able to find a therapist who can help us to overcome our depression.
Again, finding a competent and caring therapist the first time around is extremely important as
most of us cannot afford to waste our insurance allotted therapy sessions and our money on inept
therapists. Try for a free first half hour meeting with prospective therapists, if this is not
possible then I suggest that on your first contact you not be passive but ask questions about the
average number of sessions which are usually needed, what happens if your benefits run out and your
therapy is not complete, do they have a financing plan? This interaction will allow you to better
judge if you can work with this person and how they make you feel.
After all of this your final decision will come down to making an informed choice based on your gut
reaction. INFORMED is the key word here. I realize that it is difficult to interview and screen
prospective therapists at a time in your life when it is so very hard to concentrate and stay
motivated. That is one of the reasons I earlier suggested that you begin a program of mild
exercise so that you might have more energy during this difficult time.
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