Depression: Obstacles to Treatment

I apologize in advance for the length of this post, which I just added to with this warning sentence, but there was a lot of information I wanted to cover that it wasn’t logical to split up into two.  I hope you make it to the end and find it worth your time.

The Biggest Problem

I started this post several times over the course of the last couple of days, but I just couldn’t figure out how to begin.  I knew the main point I wanted to make, and the minor points that I wanted to cover, but I couldn’t figure out how to tie it up into a neat little package that anyone would be able to read from beginning to end.  I especially couldn’t figure out how to package it so that the information would actually help anyone.

This made me realize something, though, and it kind of reinforced my point when I thought about it beyond how frustrated I was.  More than any external obstacles we face, the biggest problem we have is ourselves.  We get in our own way, mucking up things that we know and understand and turning them into messes.  Being depressed, the biggest obstacle to treatment is the depressed person him/herself.  Even if, like me, they have plenty of knowledge and understanding on the subject, they still can’t make it work for them.  Having the knowledge is only the first step; the next is being able to make use of it, which is where we usually mess up.

Being depressed is, at its core, a warped thought process.  There can be several reasons for this – genetic, chemical, learned behavior, etc. – but the result is the same.  A depressed person will look at life events, mis-evaluate them, and then act on this flawed thinking.  This fundamental aspect to depression can prevent a lot of people from getting treatment, or if they are getting treatment, keep them from fully benefiting from it.

I’ve done this myself, and even realized that I was doing it in that “two people, one brain” mentality.  I tell myself all sorts of things that I know aren’t true and get in my own way when it comes to management and recovery.  Here are some examples, and they may sound familiar to you.

• It’s all in my head.
• It’s not THAT bad; I can handle it alone.
• The doctor wouldn’t help me anyway.
• They’re going to think I’m crazy.
• This is my fault, so I should have to deal with it.
• I’m doing well enough to manage; I don’t need any more help.

This kind of flawed thinking is the biggest obstacle to treatment, more than anything else society can throw at us.  We sabotage ourselves.  Essentially, the main thing that stands in the way of a depressed person getting treatment is the fact that they are depressed.

Unfortunately, This Isn’t Everything

While the fact that I shoot myself in the foot when it comes to treatment is a BIG problem, it’s not the only one.  Even when I get myself past my own thoughts and into the doctor’s office, I will still face obstacles that will be both discouraging and handicapping.

1.  Treatment is expensive. Doctor’s visits aren’t free, and neither are the medicines that you’ll be picking up at the pharmacy.  Fortunately, most of these medicines are covered under insurance, both public and private.  If you’re on Medicaid, you won’t be forced to pay out of pocket.  Well, if you go to your primary care doctor, anyway.  At least in California, if you’re an adult, mental health is not covered, so any trips to a psychologist or psychiatrist you’ll be paying for without assistance.  This can easily discourage someone from seeking or continuing treatment, because they simply can’t afford it.

2.  Family practice doctors aren’t experts in mental health. If you go to the doctor instead of a mental health professional, and there are lots of reasons to do this including the one I mentioned above, they may or may not know a lot, or anything at all, about depression.  Even if they do have some knowledge, they aren’t going to be well-versed in the subject, and this poses obvious problems.  They may not be aware of all treatment options or medication options available.  They may not even think of depression as being a cause of your symptoms, leaping ahead to disease of some kind instead.  You get the idea.

3.  Treatment is trial and error. Odds are, when the doctor puts you on a medication, it will need adjusting or changing altogether.  What works for one person may not for another, and you may end up going through several different medications and combinations before settling on the right one for you.  This can be time consuming, frustrating, and expensive (every time you get a new prescription, you pay again, even if you didn’t finish the one before).  Not everyone has the time available to go to the doctor as frequently as necessary until this is worked out, and not everyone can take time off work.  This can cause you to give up and settle for second- or third-rate treatment, taking a medication that only helps a little, to avoid having to go back to the doctor every month.

Help, Please

I know that knowing the three things I talked about in the second half of this post probably isn’t going to help anyone beyond making them more informed.  It may even discourage them even more than they already are.  I feel this way a lot about the information.  But I hope that understanding the way we get in our own way will help a least a couple of people get onto the road to treatment.  If you’re suffering from depression yourself, keep this idea in mind when considering whether or not to seek help.  And if someone you’re close to is suffering from depression, realize that they are likely holding themselves back from getting the help they need, and give them a hand (or a kick in the ass, whichever is more effective).  Above all, remember that you’re not alone, there is help to be had, and even though the road is bumpy and full of detours and roadblocks, you’ll eventually get to where you need to go.

Articles In This Series

• Depression: What It Looks Like In Real Life
• Depression: When Treatment Isn’t Working
• Depression: The Confusion of Being Two People At Once
• Depression: Obstacles to Treatment

Related posts:

1. Depression: When Treatment Isn’t Working
2. Depression and the Medication Merry-Go-Round
3. Anger and Depression, Two Sides of the Same Coin
4. Upcoming Depression Series
5. Depression: What It Looks Like In Real Life