4. Getting Help - Starting your Treatment

Starting your Treatment

What's the best way to approach your doctor about starting treatment?

Here's a helpful step-by-step guide. The following information has been re-printed, lightly edited, from the NIMH website. Much of this information was originally written to help people with depression, but in this publication, we've added references to anxiety when the advice applies.

Step 1: Visit your doctor or care provider
If you think you may have depression or anxiety, start by making an appointment to see your doctor or health care provider. This could be your primary doctor or a health provider who specializes in diagnosing and treating mental health conditions (psychologist or psychiatrist). Your doctor should do an exam and ask you about your health history to make sure that an unrelated physical problem is not causing your symptoms. Certain medications, and some medical conditions, such as viruses or a thyroid disorder, can cause the same symptoms as depression, for example. A doctor can rule out these possibilities by doing a physical exam, interview, and lab tests.

Making the appointment. If you still need to make an appointment, here are some things you could say during the first call: "I haven't been myself lately, and I'd like to talk to the provider about it," or "I think I might have depression (or anxiety), and I'd like some help."

Talking to your doctor. How well you and your doctor talk to each other is one of the most important parts of getting good health care. But talking to your doctor isn't always easy. It takes time and effort on your part as well as your doctor's.

Before your appointment, make a list of:

• Symptoms you've had, even if they don't seem related.
• When did your symptoms start?
• How severe are your symptoms?
• Have you experienced these symptoms before?
• If you have had these symptoms before, how were they treated?
• Personal information that might be related, such as major stressors or life changes.
• Medications, vitamins, or other supplements that you're taking, including how much and how often
• Questions that you want to ask

Find a doctor you can trust. If you don't have a primary doctor or if you don't feel comfortable talking with the doctor you usually see, this may be the time to look for a new doctor. Whether you moved to a new city, changed insurance providers, or had a bad experience with your doctor or medical staff, it's worth the effort to find a doctor you can trust.

Step 2: See a mental health professional, if needed
Your doctor may refer you to a mental health professional, such as a psychiatrist, psychologist, social worker, or mental health counselor, who should discuss with you any family history of depression, anxiety, or other mental disorders, and get a complete history of your symptoms. The mental health professional may also ask if you are using alcohol or drugs, and if you are thinking about death or suicide.

Finding a mental health professional. If your doctor does not refer you to a mental health professional or you feel your concerns were not adequately addressed, call or visit the website for your health insurance provider. You can also try searching the Substance Abuse and Mental Health Services Administration's (SAMHSA) Behavioral Health Treatment Services Locator (https://findtreatment.samhsa.gov/) or other resources listed on nimh.nih.gov to find one.

Starting Treatment. Depression and anxiety are treated with medicines, talk therapy (where a person talks with a trained professional about his or her thoughts and feelings, sometimes called "psychotherapy"), or a combination of the two. A healthy lifestyle can also help. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends that you trust for support. Remember: There is no "one-size-fits-all" treatment. It may take some trial and error to find the treatment that works best for you.

Choosing the right medication, dose, and treatment plan should be done under an expert's care and should be based on a person's needs and their medical situation. Your doctor may try several medicines before finding the right one.

You and your doctor should discuss:

• How well medications are working or might work to improve your symptoms
• Benefits and side effects of each medication
• Risk for serious side effects based on your medical history
• The likelihood of the medications requiring lifestyle changes
• Costs of each medication
• Other alternative therapies, medications, vitamins, and supplements you are taking and how these may affect your treatment
• How the medication should be stopped (Some drugs can't be stopped abruptly and must be tapered off slowly under a doctor's supervision).

Antidepressants are medicines that treat depression, though they can also be helpful for treating anxiety disorders. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts. It is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose.

About Talk Therapy (or Psychotherapy)
Psychotherapy can be an alternative to medication or can be used along with other treatment options, such as medications. Choosing the right treatment plan should be based on a person's individual needs and medical situation and under a mental health professional’s care.

Even when medications relieve symptoms, psychotherapy and other interventions can help a person address specific issues. These might include self-defeating ways of thinking, fears, problems with interactions with other people, or dealing with situations at home and at school or with employment.

Talk Therapies for Depression
Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression.

For mild to moderate depression, psychotherapy may be the best option. However, for severe depression or for certain people, psychotherapy may not be enough. For teens, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the chances of it coming back.

Cognitive Behavioral Therapy (CBT) can help an individual with depression change negative thinking. It can help you interpret your environment and interactions in a positive, realistic way. It may also help you recognize things that may be contributing to the depression and help you change behaviors that may be making the depression worse.

Interpersonal Therapy (IPT) is designed to help an individual understand and work through troubled relationships that may cause the depression or make it worse. When a behavior is causing problems, IPT may help you change the behavior. In IPT, you explore major issues that may add to your depression, such as grief, or times of upheaval or transition.

Problem Solving Therapy (PST) can improve an individual’s ability to cope with stressful life experiences. Using a step-by-step process, you identify problems and come up with realistic solutions. It is a short-term therapy and may be conducted in an individual or group format.

Talk Therapies for Anxiety
Psychotherapy or “talk therapy” can also help people with anxiety disorders. To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs.

Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.

Cognitive therapy and exposure therapy are two CBT methods that are often used, together or by themselves, to treat social anxiety disorder. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful or distorted thoughts underlying anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises and/or imagery.

The symptoms of mental disorders can have a profound effect on quality of life and ability to function. Seeking help is not an admission of weakness, but a step towards understanding, and relief from distressing symptoms.