Clearing the Hurdles: How to Overcome Obstacles in Depression Treatment

We sometimes tend to sabotage our efforts to get better. Knowing the warning signs may help you avoid self-inflicted problems.

Depression treatment often involves a combination of talk therapy, medication, lifestyle changes and other approaches aimed at improving your outlook. The process can be time-consuming, demanding vigilance and patience on the part of the individual and his or her family.

But because of the commitment required for a positive outcome and the wide range of possible therapies to assist you, it can be easy to go off track. You may stick with an ineffective treatment for too long or give up on a treatment plan that could have helped you. Or, as is often the case, people with depressive symptoms may never even seek out the help they need.

“Some individuals are, by their nature, resistant to making necessary changes for their lives to improve, and this can often undermine a therapy,” says David Mischoulon, MD, PhD, director of the Depression Clinical and Research Program at Massachusetts General Hospital. “Change is difficult and takes time to make. This is a very common problem in the psychotherapeutic setting.”

Sometimes, however, making the right changes to overcome depression is made harder by our own missteps. Identifying self-imposed pitfalls, both deliberate and unintentional, may make your treatment faster, smoother, and more lasting. Consider whether any of the following issues are torpedoing your best efforts to feel better.

Putting Off Therapy

You may have acknowledged that what you’re feeling could be depression or other emotional disorder. But instead of seeking out the help of a mental health professional, you’re hoping you can get better on your own or that those symptoms will just disappear one day. These are dangerous assumptions.

“People often start to feel that there is something wrong psychologically before they know for what to actually seek help,” Dr. Mischoulon says. “For example, they may notice depressive symptoms, or see a story in the news about depression that leads them to recognize themselves. Still, many may face obstacles to getting proper evaluation and help. They may be worried about stigmas around psychiatric illness, e.g. that depression is a sign of personal weakness. This is common in many cultures. They may feel that this is a temporary condition and will pass on its own. They may procrastinate, which is a common symptom of depression. Even if they take action, they may not know how best to go about finding a proper treater.”

He adds that mental health providers may be difficult to find in a person’s geographic area, either because there are few of them or because waiting lists are long. Also, people may not be sure whether their insurance (if they have it) will cover mental health treatment.”

Before you assume that you can’t find or afford mental health care, exhaust all your options. Talk with your insurance provider, your primary care physician, and your local public health department. Your community may have reasonably priced services that simply aren’t well publicized.

Selecting the Wrong Treatment

You may think you’re doing the right thing simply by starting therapy. But it’s not enough just to talk with a therapist regularly, take prescribed medications, and hope for the best.

The key, Dr. Mischoulon explains, is to start with a therapist who is trained in depression treatment. He suggests getting an evaluation from a mental health professional qualified to make psychiatric assessments.

“These include psychiatrists, psychologists, and psychiatric nurse practitioners,” Dr. Mischoulon says. “Primary care physicians can also make an early determination of depression and refer the patient to a qualified mental health clinician, or they may decide to initiate antidepressant treatment in the office prior to making the referral.”

When choosing a treater, you need to consider what particular treatments the clinician is qualified to provide. For example, psychiatrists can prescribe antidepressants, but psychologists cannot. “Personality styles may also affect how compatible the patient and the doctor may be,” Dr. Mischoulon says. “Sometimes, particularly when considering psychotherapy, people will meet with one to three different therapists to make sure that the one they pick is the most compatible with them from a standpoint of personality and approach to treatment. A good general psychiatric evaluation can help guide you to the right kind of treater and treatment.”

Continuing Ineffective Treatment

You may have started therapy out on the right track, but a lot of things can derail a good start. Dr. Mischoulon says in many cases, people stick with treatments that aren’t working because they may not know about other approaches. Or an individual may not know how to leave one therapist and move on to another.

“They may be embarrassed to ask their treater, or worried about offending them,” Dr. Mischoulon says. “One common problem is that patients often do not see their treater as frequently as they should, and this prevents the doctor from determining how well the patient is doing and whether, say, adjustments in antidepressant doses are needed. Some patients get very attached to a certain treatment, e.g. a certain medication regimen that once worked but no longer does, and they may be reluctant about changing.”

He adds that those same concerns apply when a person has worked with a therapist for a long time and may have trouble admitting that they are no longer compatible or that the therapist’s approach is no longer the optimal one for their situation. “If you feel your treatment is not working well, tell your doctor so that they can determine the proper next step,” Dr. Mischoulon says.

Giving Up on Treatment

While sticking with ineffective treatment is problematic, a potentially more harmful choice is to quit therapy too early. Dr. Mischoulon says people make this choice, typically, because they grow impatient about results or they don’t like the nature of their treatment.

“Most psychotherapies are meant to produce change over long-term periods, and seldom provide quick results,” he says. “Some people may become disillusioned when they don’t start to see improvement right away, or may find it difficult to stick with weekly therapy sessions, which represent a large time commitment compared to, say, a monthly medication visit.” He recommends the therapist and the patient discuss these issues early on before they embark on a long-term therapy course.

It can also be a very helpful exercise for anyone seeking treatment to review with a therapist the pitfalls that may lie ahead to help avoid any self-imposed obstacles in the way of improving symptoms.


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