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In a culture that embraces the mantra “never let ’em see you sweat,” it can be hard to admit—to yourself or to anyone else—when you’re not on top of your game. But when you’re blue and you don’t know why, or you’re in a funk that you can’t quite pull yourself out of, it’s important to talk to a health professional.
Granted, it’s not always easy to start the conversation—or even to know if you should. Feeling consistently sad or pessimistic, anxious or empty, guilt-ridden or worthless, irritable or restless can all be signs of depression. So can less obvious symptoms like insomnia, inexplicable fatigue or lack of energy, a change in appetite, mysterious and persistent aches and pains, and being unable to concentrate for more than two weeks. (And, of course, if thoughts of suicide so much as flicker across your mind, you should seek help immediately.)
Without medical intervention, whether it’s therapy, medication or both, many cases of depression either don’t improve or get worse. Yet a recent national survey of more than 15,000 adults across the United States found that few people with major depression receive any sort of treatment. Sometimes a person who’s depressed goes without help simply because she doesn’t recognize the symptoms in herself, but all too often it’s because she doesn’t know whom to turn to or what to say.
“The hardest part is getting started; remind yourself that talking with someone who can help you will put you on the path to feeling better,” says psychologist Christopher Beevers, Ph.D., director of the mood disorders laboratory at the University of Texas at Austin. “Once you get that dialogue going, it will get much easier.”
How to break the ice
Start with your regular physician, and just be direct, as if you were relaying the details of a virus or other physical ailment. Describe your primary symptoms, when they started and why they’re unusual for you. “Explain how they’re preventing you from living your life the way you want to,” says Dorothea Lack, Ph.D., a psychologist in private practice in San Francisco. “Tell your doctor what you think the problem is and describe how it’s affecting you.” For example, you might say, “I’ve been feeling unmotivated and I’ve lost interest in my usual activities in the past month. Could these be signs of depression?” Or, “I’ve been getting stressed out more easily and I think I could benefit from some kind of counseling. Is there someone you’d recommend?” It’s also worth mentioning whether there was an event that could have triggered the change, as in, “A good friend of mine died a few months ago and I’ve been feeling stuck in sadness.”
Based on what you tell him, your doctor should be able to suggest a good therapist or two; it can also help to get recommendations from close friends who’ve had good experiences with a particular counselor. When you get a referral for a counselor, ask about the person’s credentials—he or she should have a Ph.D. in psychology, an M.D. in psychiatry, a Psy.D. (doctor of psychology), an L.P.C. (licensed professional counselor) or a master’s degree in social work, Lack says. Find out what the therapist’s approach is, whether it’s cognitive-behavioral therapy (which focuses on changing maladaptive beliefs and thinking patterns into healthier ones) or interpersonal therapy (which focuses on becoming more comfortable with social roles and improving relationships). Consider whether that approach is likely to help you.
Getting comfy on the couch
At your initial session with a therapist, don’t worry about being put on the spot. The counselor will likely lead the conversation by asking questions about your current situation and your physical and emotional history. Be prepared to discuss any prior bouts of depression you’ve had, or if depression, anxiety or other mental health conditions run in your family. Describe how your feelings are affecting your relationships and your ability to function, and what your goals and expectations are for treatment, including your thoughts about taking antidepressants, if appropriate. Don’t be afraid to share how something you’ve done might be contributing to your symptoms. Counselors are used to that and they won’t be judgmental.
“What’s most important is that you feel comfortable—that you feel safe, not intimidated—with the counselor,” Lack says. “It needs to be someone you can open up to.”
Above all, be patient with the process. “It’s a little like trying to find a good mechanic—it can take a few false starts before you find someone who is a good fit for you,” Beevers says. So, if you don’t click with the first therapist you meet, try another—until you find one you can talk to openly and freely: That ongoing dialogue will be the key to dealing with your depression.
In a funk? Try these easy mood boosters from emotional wellness expert Gail Saltz, M.D.