If you feel depressed and think you may need therapy or medication, you're not alone. But there are numerous factors to consider when seeking treatment. Is therapy the right answer? Will your insurance cover therapy and medication consultations?
Are You Clinically Depressed?
Are you experiencing brief mood swings that leave you feeling blue for a short time, or is your condition lingering and hard to shake? If the answers to any of the following questions are "yes," it may be time to seek professional help:
- Have you had several acute periods of depression (not just an isolated episode or two of feeling "glum")?
- Are the symptoms affecting your sleeping and eating habits?
- Have you experienced a recent loss or major life stressor?
- Do you have suicidal thoughts or plans?
A Good Counselor or Therapist
Let's start with the essentials: find a qualified therapist. A good counselor or therapist is an invaluable resource. Valerie Raskin, MD, author of When Words Are Not Enough, explains, "Unlike medication, psychotherapy can heal deep-seated emotional vulnerabilities for many people...Successful psychotherapy can be somewhat of a vaccine, boosting immunity to stressful circumstances."
The term "psychotherapist" refers only to the fact that one is engaged in the professional practice of psychotherapy. It does not refer to any particular educational discipline or training. A psychotherapist should hold a professional degree in the field of mental health and be licensed by the state. Psychologists, clinical social workers, and psychiatrists all diagnose and treat mental health disorders; only psychiatrists, however, can prescribe medications. But that doesn't mean you shouldn't see a psychologist or social worker if you think you might need medication; they can both provide referrals to a reputable psychiatrist if medication is needed.
Essential Information for Your Therapist
Whether you have a history of depression or are seeking help for the first time, it helps to have a therapist with whom you can share your problems and symptoms. You are more prone to mental health troubles if your family has a history of depression or anxiety, and you'll need to share this information with your therapist. Keep a record of your feelings and moods, including how long the episode lasts and the circumstances (if any) that may have caused you to feel depressed.
Cost of Therapy
Raskin explains that the cost of psychotherapy varies, depending upon the counselor's credentials: "Psychiatrists charge the most for psychotherapy; psychologists are usually next; and social workers generally charge the least amount."
It's wise to contact your insurance company and find out what type of mental health coverage you have, prior to making your final therapist selection. If you don't have health insurance, many therapy providers work on a sliding-scale basis. Fees are usually calculated based on your annual income. If cost is an issue for you, check out community mental health centers and colleges to see if they offer services for uninsured or lower-income families.
The First Session
Your therapist will interview you and administer a Mental Status Examination (MSE). This is basically a series of questions designed to help your therapist learn more about you. The questions will focus on your symptoms and your work and social life. Try to provide the most accurate information possible, as this will help your therapist to formulate an accurate diagnosis and treatment plan.
If Your Therapist Recommends Medication...
Don't panic if your therapist suggests medication. Ask her to provide a referral to a reputable psychiatrist. Request that your therapist coordinate your treatment with the psychiatrist as needed. This allows him or her to stay in contact with the psychiatrist throughout your care. A coordinated team approach is always best, since both parties are working together towards the same goal: helping you to feel better.
Medication cannot heal deep-seated emotional issues but it can pick up where therapy is incomplete. Dr. Raskin explains, "Some people think of emotional recovery with an all-or-none mentality. Either you take psychotherapeutic medication or you go into therapy for a pure talking cure. It just isn't so. In fact, oftentimes the medication is necessary in order for psychotherapy to proceed. Other times, the treatments complement each other."
Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram); Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants
Seeing a Psychiatrist
If you need to see a psychiatrist, find someone that is compatible with your specific needs. "The importance of good rapport between doctor and patient is nowhere as critical as in psychiatry," Raskin says. "Developing trust and mutual respect is essentially important when it comes to mastering the do-I-or-don't-I-take-medication dilemma."
In your first appointment, your psychiatrist will ask for a detailed account of your symptoms and a description of your feelings and moods. This meeting generally lasts 45 minutes to an hour. Once your psychiatrist establishes a regular medication regimen (and this may take a while), you will still have to be seen at regular intervals. Don't be discouraged if your doctor changes your medications and dosage before you feel a noticeable improvement in your mood.
Medications Are Improving
The latest medications have helped millions of people to manage their symptoms while keeping unpleasant side effects to a minimum. Pharmaceutical companies continue to investigate newer, better and fast-acting medications that have few or no side effects. "If you or someone you love is suffering from clinical depression, obsessive-compulsive disorder, premenstrual depression, anxiety attacks, or other emotional symptoms, you couldn't be alive at a better time in history," says Dr. Raskin.
A Combination Is Your Best Bet
Studies show that often the best management for psychiatric issues comes from a combination of talk therapy and medication. Dr. Raskin adds, "It's like taking muscle relaxants and undergoing physical therapy for back strain; the two treatments work together to get you back on your feet."
Finally, don't be timid about asking questions about any aspect of your treatment. Be assertive in managing the overall process. If you feel uneasy about any part of treatment, share this with your healthcare provider. If your concerns are met with resistance or a refusal to consider your ideas, it may be best to get a second opinion.
RESOURCES:
Anxiety Disorders
National Institute of Mental Health
http://www.nimh.nih.gov/
Depression
National Institute of Mental Health
http://www.nimh.nih.gov/
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