Depression: Are You Honest With Your Doctor?

From the WebMD Archives

When you're depressed, everything can seem difficult -- getting out of bed, going to work, even talking with your doctor or psychiatrist. You may not be sure how depression treatment -- or anything -- can possibly make you feel better. Can talking about how you're feeling really help? And if you take medication, will it make a difference?

"There is no question that psychotherapy and medications work for depression and anxiety," says George Papakostas, MD, associate professor of psychiatry at Harvard Medical School in Boston. But for treatment to work effectively, doctors and patients need to communicate openly, he says. If you hide your symptoms or don't take your medication as directed, it makes it harder for your doctor to help you.

Are you being as honest and open as you can be? If not, why not? Learn some of the barriers to open communication -- and what you can do to overcome them.

Depressed? Me?

It can be hard to admit you have depression at all -- let alone talk about it. Many people still feel a stigma about seeking help. In fact, according to the National Institute of Mental Health (NIMH), only about 51% of people in the U.S. with major depression receive treatment.

Part of the problem, says Rajita Sinha, PhD, a professor in the department of psychiatry at Yale University in New Haven, Conn., is that there's a knowledge gap. "I don't think people realize that there's help out there for the kinds of things they're feeling," says Sinha. "You've got people who think, 'Oh no … I get out of bed and I'm not that bad.' So if you manage to struggle out of bed, and you still go to work but you really can't concentrate and you have to take days off -- that's the working miserable," Sinha tells WebMD.

It can also be difficult to realize that you can't handle your feelings on your own. "People can chalk it off to, 'Oh well I should cope with it better,' or 'I'll just figure something out,' and ignore it," says Sinha. "It doesn't help to ignore it at all. In fact it just makes things worse. It makes the symptoms worse."

Continued

Why is it Hard to Talk About Depression?

If you're struggling with depression, but haven't been open with your doctor about your symptoms, think about what's holding you back.

"Being stoic is common in depression," says Papakostas. Often people underreport their symptoms because they're afraid they won't be taken seriously, or they don't want to come across as alarmist, he says.

Others may have unrealistic fears about what may happen to them if they voice their feelings. Some people worry that their doctor might think they are crazy. They fear that they might be hospitalized or treated against their will, Papakostas tells WebMD.

There's no question that talking about painful feelings -- and facing those feelings head on -- isn't easy.

If you're seeing a therapist for depression, keep in mind that he or she sees many patients who struggle with painful feelings. It's your therapist's job to help you work through these feelings and regain a sense of hope. And in order to move past them, you have to get them out in the open.

Why Do Some People Stop Taking Antidepressants?

Antidepressant medications can be very effective for many people with depression -- if they are taken as directed. If your doctor or psychiatrist prescribes antidepressants, you need to take them for at least 6 to 9 months for them to work properly.

Unfortunately, according to the Agency for Healthcare Research and Quality, more than 50% of people taking depression medications stop taking them before 6 months. This increases the risk for relapse. Common reasons for not taking antidepressants as directed may include:

  • You have troublesome side effects. Many people are afraid to bother the doctor or psychiatrist about side effects -- they don't want to sound like they're complaining, says Papakostas. So they stop taking the medication without finding out if another drug might work better.
    There are many different types of antidepressants available -- so the first one you try isn't your only option. If you are having bothersome side effects, tell your doctor or psychiatrist. He or she will work with you to find the most effective drug with the fewest side effects.
  • You're concerned about medication interactions. It's important to be aware of potential interactions between the drugs you take. But it's also important to ask your doctor or psychiatrist whether an interaction actually applies to you before you stop taking a drug.
  • You feel better -- and forget to take your medicine. Another common scenario is that the antidepressants work and the symptoms go away. You're happy, you're no longer depressed, you're catching up socially and professionally -- it's normal for people to forget, says Papakostas. We do that all the time with other illnesses. Having a pounding headache is a great reminder to take a pain reliever. But when the pain goes away, you don't think about taking the medicine.

Continued

Problems can occur if you stop taking antidepressants abruptly. While not habit-forming, many depression medications can have withdrawal symptoms. Some patients confuse these symptoms with a return of the illness, says Papakostas. "It can even result in a relapse."

Don't feel ashamed or embarrassed to tell your doctor that you haven't been taking your medication as you should. Your doctor just wants to understand why, says Papakostas, because then he or she can work with you to put a better treatment together. "Physicians know that a 5-minute phone call can really save patients and clinicians from a lot of work down the road if it comes to a full relapse and recurrence."

Depression Treatment: Staying Positive

Your attitudes and beliefs are also important when it comes to depression treatment. Papakostas explains that a person who believes that medication and therapy can work has a higher chance of healing than someone who doesn't have the same positive attitude. This is true in other medical fields as well.

Some people believe things that just aren't backed by the evidence, he says. That's another reason why it's important to share any doubts; you may have heard something about depression treatment that just isn't true. "Having beliefs that are very pessimist and unrealistic -- and not feeling comfortable discussing them with one's doctor -- may, in fact, get in the way of treatment," says Papakostas. Your doctor can explain the facts and help you understand how and why treatment can work for you.

WebMD Feature Reviewed by Louise Chang, MD on May 29, 2012

Sources

SOURCES:

George Papakostas, MD, associate professor of psychiatry at Harvard Medical School in Boston.
Rajita Sinha, PhD, a professor in the department of psychiatry at Yale University in New Haven, Conn.

S.Rupke. American Family Physician, January 2006.

Science Daily" "Doctor-Patient Communication Has a Real Impact on Health."

G. Swaminath, Indian Journal of Psychiatry, July – September 2007.

National Institute of Mental Health: "Major Depressive Disorder Among Adults."

Agency for Healthcare Research and Quality: "Antidepressant medication management (effective continuation phase treatment): percentage of members 18 years of age and older who were diagnosed with a new episode of major depression, and treated with antidepressant medication, and who remained on an antidepressant medication for at least 180 days (6 months)."

National Alliance on Mental Illness: "Cognitive Behavioral Therapy."

Medscape Education: "Confusion and Complaints: The True Cost of Noncompliance in Antidepressant Therapy."

C. Warner. American Family Physician: "Antidepressant Discontinuation Syndrome," August 2006.

J. Aikens. Annals of Family Medicine," Jan. 1, 2008.

© 2012 WebMD, LLC. All rights reserved.

Pagination