Someone’s Mistakes Make Their Life Filled With Depression

Mental illness is difficult to treat, in no small part because patients’ thought processes are affected significantly. With depression, patients have distorted and unhealthy views of themselves and their illness, which can impair smart decision-making and get in the way of finding and following a proper treatment plan. As a result, many patients make mistakes about their disease and what they should do about it.

U.S. News asked two psychiatrists to list some of the more common errors they see their patients making. Dr. Peter D. Kramer is emeritus clinical professor of psychiatry and human behavior at Brown University. Dr. David Mischoulon is an associate professor of psychiatry at Harvard University and director of the Depression Clinical Research Program at Massachusetts General Hospital. Here are their top 10 mistakes.

1. Suffering in silence. Depression typically doesn’t go away on its own, and left untreated it can worsen and progress to a point where a person can become disabled and potentially suicidal. Seeking help is key to getting out of depression, Mischoulon says. “The motto in my psychiatric residency program was ‘don’t worry alone.’ If you are depressed, tell someone about it rather than suffering in silence.” Patients can start by telling a friend or relative, or their primary care physician. “This could represent your first step toward getting the help that you need,” he says.

2. Self-medicating. There are numerous over-the-counter products that claim to treat various psychiatric and emotional symptoms, Mischoulon says. “Many people will try these rather than seeing a practitioner. While some of these therapies have evidence to support efficacy, they have to be used with the same care as prescription medications, and preferably under the supervision of a clinician.” He adds that “self-medication” includes using alcohol or recreational drugs to alleviate depression symptoms. Also a bad idea. “While these may induce a temporary feeling of well-being, over the long term they tend to worsen depressive disorders as well as present a risk of addiction,” he says.

3. Staying wedded to a treatment that is not working. “Sometimes a patient will be intent on relying on alternative treatments, like exercise or yoga, which is fine if the practice brings substantial or decisive relief,” Kramer says. But, “if a given treatment is not working, it will make sense to switch, often to a standard, well-tested approach, like psychotherapy or medication.” Patients may be reluctant to try these, perhaps on idealistic or ideological grounds, he says. That’s a mistake, he explains, because “depressive episodes are harmful to mind, brain and body, and longer episodes are more destructive. We want them to remit.”

4. Choosing the wrong clinician or treatment option. There are many different approaches to treating depression, including but not limited to antidepressant medication; somatic therapies such as electroconvulsive and transcranial magnetic stimulation therapies; and various kinds of psychotherapies, such as psychoanalytic and cognitive behavioral therapy. “While all of these are supported as effective by research studies, they don’t all work for every single individual,” Mischoulon says. “A licensed psychiatrist, psychologist or psychiatric nurse practitioner is in the best position to recommend the right treatment for the right person.”

5. Not staying vigilant. Residual symptoms may occur as an episode of depression resolves or recur at the onset of a new episode. “A great problem with depression is insidiousness,” Kramer says. “It can slip up on you. And because depression brings an altered perspective, you may believe that you have always been a certain way, you deserve to feel bad, the situation is hopeless or entertain similar thoughts.” A spouse, relative or close friend can be of use, he says, if that individual is allowed and encouraged to let the patient know that he or she is slipping back into depression.

6. Not understanding insurance coverage. “Managed care today is very complicated, and insurance plans differ a great deal from each other in terms of what they will cover,” Mischoulon says. He suggests that patients work with their doctor’s office to learn what is covered under their plan, including which antidepressants, what kinds treatment and how many visits within a certain period. “This can prevent you from getting saddled with unexpected bills that your insurance refuses to cover,” he says.

7. Not following doctor’s orders. As with any other doctor, a psychiatrist or psychotherapist can only offer a course of treatment. It is up to the patient to follow instructions regarding how to take medications and how often to see the doctor. “For example, antidepressants should be taken daily and at certain doses, whether or not you are feeling depressed on that particular day,” Mischoulon says. “When you don’t take the medications as prescribed, they don’t work as well, and recovery can be delayed. Likewise, for psychotherapies to work, regular visits are paramount, and every effort should be made to see your therapist with the recommended frequency.”

8. Losing touch with a therapist. “I like to see patients with persistent or highly recurrent depression maintain a relationship with a mental health professional and check in at regular intervals – as a patient with diabetes might,” Kramer says. “The mistake would be in not recognizing that sort of depression for what it is, a chronic ailment. Why should we not need our doctors here as elsewhere?”

9. Not “doing it anyway.” People with depression often feel unmotivated about their work, leisure or social activities. Those who push themselves to remain active despite the depression often find that participating in those activities can actually lift their mood, at least temporarily, and provide a reprieve from depression. “If you are depressed, make every effort to stay engaged in your activities as much as possible, because this can have positive effects on your mood,” Mischoulon says.

10. Ignoring or hiding suicidal thoughts. People with depression may at times feel that life is not worth living or that they may be better off dead. They may think about killing themselves. Don’t push those feelings aside. “If you are depressed and having these thoughts, talk to someone,” Mischoulon says. “If you already have a doctor, talk to him or her about it. Or tell a trusted friend or family member who can assist you in getting the help that you need.” And those friends or loved ones who suspect that someone may be suicidal should be direct and ask about it. “Contrary to popular belief, asking about suicide will not encourage a person to do it,” Mischoulon says. “In fact it may prevent them from harming themselves.”