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January 25th, 2011
08:30 AM ET

Where can I get help for depression relapse?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Megan of Alabama:

Hi. I am 18 years old. In the past, I have been treated for depression, among many other things. My problem now is I am feeling the same way I used to before. I am feeling very depressed. I want to go to counseling because it could help, but I don't have insurance and I do not know any low-priced place. No one knows what's going on, and I am not telling my parents. What can I do? I want counseling. I want help, but there is nowhere to go at the moment.

Expert answer:

Dear Megan,

If you regularly read these postings, you'll know that I addressed a very similar situation a few weeks ago. Situations like yours really distress me, because I know that the care you desire would really help you. And I know that the limited access to such care is a reality not just for you, but for so many people in our country who are in need and who could be helped.

OK, we have to get practical. I can't tell from your question whether you live in a city or the country. In general, it's harder to find counseling in the country than in the city. I also do not know all the places you've tried, so forgive me if I suggest things you've already tried.

The first thing I'd do is see what services are offered by your county's mental health system. I'm often pleasantly surprised by the level of care that can be available at county clinics. Because these facilities are not as bound by the need to make money, they sometimes offer more than what all but the higher-priced clinicians provide. On the other hand, some county clinics are terrible. And some counties don't really have any facilities at all.

If your county system does not offer what you need, you might think of turning to the church. Again, this varies widely by denomination and from one region of the country to another, but many people in the ministry have at least basic training in counseling and can be quite helpful in my experience. This is especially true for the pastoral staff of mainline denominations.

But let me qualify this suggestion by telling you loud and clear that you need to avoid anyone who would view your depression as anything other than a mind-body disorder that needs treatment. Avoid those who would see depression as a punishment from God or as a sign that you don't have enough faith. And of course, if you are not involved in a church, this whole suggestion won't be of much value.

Finally, if you can't identify counseling that you can afford, let me encourage you to consider seeing your primary care doctor to be evaluated for potential antidepressant treatment as a "stop-gap" measure.

Most antidepressants come in generic form now and thus are inexpensive. It is really important that you don't let the depression linger without treatment. We know now beyond a shadow of a doubt that depression inflicts physical damage on the brain and the body, and the longer a person is depressed, the more damage is done.

So please consider medication treatment if counseling is really impossible in your current situation.


soundoff (70 Responses)
  1. Suse

    I would also add that at 18 years old, if she is also a student in high school or college, her school will have counseling services. A high school counselor will be able to refer her to free/low-cost options, and a college should offer those services for their students.

    January 25, 2011 at 08:40 | Report abuse | Reply
  2. Jorge

    Poor girl, Living in a place like Alabama with parents she can't trust, as if that weren't reason enough. Honey, distract yourself with making it your main mission in life to get a degree that will let you get a career so you can move to a more fulfilling place among nicer people...

    January 25, 2011 at 09:11 | Report abuse | Reply
    • Been There

      Jorge, I know that you mean well, but a good career is probably not the answer. There are many successful, professionally fulfilled people who still suffer from severe depression. Getting to the underlying cause of the depression is what will help. There is no quick fix, and it is a long, difficult road, but she can get through it with help. It is doubtful that finding the right job is going to take care of long term depression.

      January 25, 2011 at 09:50 | Report abuse |
    • SmarterthanyouJorge

      Jorge,
      You sound like a complete idiot.

      January 25, 2011 at 17:09 | Report abuse |
    • Bill

      Ha!!! The problem is Alabama where the people are not nice. Trying living in northern New Jersey, you'll wish you were back in Alabama.

      Seriously, look in the Yellow pages under doctors, psychiatry. Call one of the phone numbers and tell them you have depression and no insurance. Ask then to give you the name of the local mental health center.

      January 25, 2011 at 17:21 | Report abuse |
  3. sbulcroft

    You might encouraged her to start mindfulness meditation practice as this has been shown to not only alleviate depression but helps in improving working memory, and focus. It doesn't work as quickly as a pill but over time it is much more effective as it doesn't cost anything. There is a lot of information on the web for mindfulness. Try it for at least a month and you will feel the results. Then again if you want to see a licensed counselor the new health care reform makes her eligible to be on her parents insurance regardless of whether or not she is in school until she is 26 so bring your parents into the loop. Don't be so alone in your depresson.

    January 25, 2011 at 09:55 | Report abuse | Reply
    • you

      so its more effective because it doesnt cost money? what kind of help is that? bubble gum is cheap. is that a good treatment?

      January 25, 2011 at 17:10 | Report abuse |
  4. Jason

    When I was in college I had a friend direct me to the school's health services for counseling. This was a "free" service (it was included in tuition) and was an excellent group of counselors.

    I've also found that, far from being a "stop-gap measure," medications have helped me tremendously. A counselor once explained to me that depression can sometimes be determined on a scale with "situational" (death of a family member, divorce, etc...) on one end and "chemical" on the other. I fall much further on the chemical end of the spectrum. I don't really have events in my life to lead to my depression; I just have a strong family history from both sides of clinical depression. Not to say that counseling hasn't helped me, it's just that medication, in my case, has helped more.

    January 25, 2011 at 10:31 | Report abuse | Reply
  5. Sarah in Texas

    I developed depression when I was 17 and never sought proper treatment until now, ten years later. I urge any teenagers dealing with this to seek treatment and counseling now. Dealing with depression on your own is painful and dangerous, and can negatively affect your school, work, friendships, health and relationships. Reach out to your parents and ask them to help you get the care you need. Good luck, and when you are feeling down remember that you will not always feel this way. There are many bright days ahead for you.

    January 25, 2011 at 12:43 | Report abuse | Reply
    • x_megz

      i'm 20 years old and i'm also suffering from depression, along with some other mental health issues, and like you, i just started getting treatment after 10 years of trying to deal with it on my own. i just wanted to let you know that your comment is exactly what i needed to see right now. i've recently lost hope in ever feeling normal, but you've made me feel a little bit more optimistic. thank you.

      January 25, 2011 at 22:03 | Report abuse |
  6. PleinJane

    Megan, do not overlook your parents as a source of help. You say that you were treated earlier for depression; I am assuming they know about this. These things are not easy to talk about; unless you tell them otherwise, they may think - or just hope - that you are doing fine now. Even though you're 18, you should still be covered under their insurance if they have it. If they don't, enlist their help in finding free or low-cost answers. I know from experience that depression can make you feel like everything is an uphill fight. It's important to have at least one person on your team who can make finding help not so much of a struggle. Reach out to them - and to others. I wish you the best.

    January 25, 2011 at 13:01 | Report abuse | Reply
    • Philadelphia

      Amen to this. Excellent advice.

      January 26, 2011 at 01:00 | Report abuse |
  7. Ted B

    Anyone suffering from depression or anxiety needs to read the story of Jack Drefus the lion of wall street. You can get a lot of information at from the website remarkablemedicine. He was fortunate to find a cure for his anxiety and panic attacks and tells his story. He spent the second part of his life trying to get the word out about the drug that helped him.

    January 25, 2011 at 18:37 | Report abuse | Reply
  8. aleppo1091

    I began to suffer from depression at age 13 .My parents knew it, but didn't "believe in" such nonsense. I'm glad you're 18. There's good advice here about possible access to counselors. I would suggest that you start easy if you're still in high school... they're more likely to be interested in college applications & financial aid. Please be open to (so called stop gaps) medication – & don't quit as soon as you begin to feel better. I began to get better when I combined meds from my family doctor with talking with a college counselor around age 19.

    January 25, 2011 at 19:03 | Report abuse | Reply
  9. katie

    I have certainly been where you are, and I commend you for putting forth effort to get help. The support of my parents increased greatly when they learned they didn't need to pay for it. I first started counseling in college, and have now found a psychotherapist that is very helpful. Although money/insurance are issues, it is important to find someone that can get to the root of your depression. I have been to many health professionals, and was significantly overmedicated for a problem I didn't have. I am now being treated for ADHD with minimal medication and counseling, and feel more well adjusted than at any other point in my life. My point is that you need to advocate for yourself, and explore all of your options.

    January 25, 2011 at 21:28 | Report abuse | Reply
  10. Larry Lupus

    Go phuck yourself Spam azzwhole

    January 25, 2011 at 22:09 | Report abuse | Reply
  11. Bob

    Why is that Drs do not warn people regarding side-effects of Anti-depressant medication. People need to be better educated to the risks and benefits of drugs esp. parents of children and teens.

    January 25, 2011 at 22:10 | Report abuse | Reply
    • Tempered

      And more people need to be made aware that for severely/chronically depressed people, the side effect for NOT taking medication is hurting themselves or even suicide. I'd take side effects over that pain any day. (And have, for 19 years.)

      January 26, 2011 at 00:44 | Report abuse |
  12. Michelle

    I've had depression since I was a child. I am a young adult now.

    Anti-depressants DO WORK. So does counseling and the combination of the two work better than either one alone, for most people.

    Having had depression for more than 20 years, I can definitively say that I would rather tolerate mild side effects (slight drowsiness in the evenings, jittery sensations when you first start taking them) than suffer with one of the most debilitating chronic conditions that can be experienced.

    I really hate it when people dismiss antidepressants as ineffective or try to scare people off by inflating the severity of side effects that most people don't experience or easily tolerate because they are usually mild.

    January 25, 2011 at 23:42 | Report abuse | Reply
  13. josie

    I would definitely seek mental health treatment asap. Be careful about antidepressants unsupervised – these are VERY powerful drugs. They shouldn't be handed out willy-nilly by primary care physicians on a 5 minute appointment. You may get a good fit. Great. However, if the drug isn't right for you, bad things (not just side effects) can happen, and if depression isn't the correct diagnosis (for example, you really are bipolar), a SSRI could push you into a manic state and cause all kinds of other problems. If you need psych treatment, you should be seeing a psych doc, even if that means the ER. Screw the money – just get treatment somehow – anything is better than suicide, which kills 15% of all depression sufferers.

    January 26, 2011 at 00:11 | Report abuse | Reply
  14. bhagwat saraf

    i am 62yr old, from surat, gujrat ( india ), have biopolar depresson since 1980, taking medicine on advice of MD Dr,

    now my family do not help, isolated, not get regular meal, want to die,

    bhagwat saraf 09374517587

    January 26, 2011 at 01:42 | Report abuse | Reply
  15. AA

    Megan,

    I agree with the recommendation to tell your parents. They might be able to help you find a therapist who practices cognitive behavioral therapy which has shown the best success rate for treating depression.

    I am not anti-meds but personally, I think other options should be tried first. One reason to see a physician is to get your vitamin D level tested as low ones could be contributing to your depression.

    I would also try fish oil that has a high EPA to DHA ratio. Studies have shown this can be be very helpful with depression. It doesn't work right away but meds don't either.

    Other things to try are sAME as recently studies came out that showed that can be very effective with depression.

    I personally found St. Johns Wort to be effective when I suffered suicidal ideation from stupidly cold turkeying Prozac. If you go this route, make sure you purchase a high quality brand like Kira.

    If you do decide to go the meds route, I would advice you to start low and go slow. According to Dr. Jay Cohen, a psychiatrist, who is not anti-meds, many of the side effects develop from pushing the dose up way too fast.

    I would then work like heck to develop the coping skills so you can plan to eventually come off the meds. The problem is that when many people go on meds, they end up on them for life when they should have been off of them years ago.

    Make sure you develop an active plan with your doctor for a constant reevaluation of whether the meds are needed.

    Good luck. While I know from experience that depression sucks big time, I know from personal experience it can be overcome.

    You can do this.

    January 26, 2011 at 04:45 | Report abuse | Reply
  16. Robert Long

    Hello, I googled your website and wanted to introduced myself. My name is Robby Long, I'm an Ambassador with a company called Visalus Sciences. We work with alot of churches and Non Profits around the country promoting our Community Challenge. In these tough economic times we know that donations are down. We have a program that raises money for your church and feeds hungry kids with our meal replacement shake. Last year we donated over 500K meals to kids in need. Our program is very simple. The reason I'm contacting you is we are looking to partner with a few more local churches and organizations. The great thing about our program is 100% of the money donated is given to the kids. Our company sends your organization a separate check for you to buy books, clothes or whatever you like. Please visit our website at http://www.robbylong.visalusgiving.com
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    January 26, 2011 at 07:36 | Report abuse | Reply
  17. John

    There has been a fair amount of research using an omega-3 fatty acid called epa (also referred to as e-epa) derived from fish oil. The latest research indicates that it can be effective for people with depression alone, but not those who also have anxiety disorders along with their depression. You can check out a relatively large recent study at this link:

    http://www.sciencedaily.com/releases/2010/06/100621111238.htm

    It's important to choose a good fish oil supplement high in epa. There are two brands that are identical and which have both been tested in clinical trials. The brand OM3 was used in the study I listed, and is sold in CVS and Rite Aid. Omegabrite is the other brand, and can only be bought online at omegabrite.com. I wouldn't recommend taking more than the recommended dosage because at higher doses EPA can lose its effectiveness. Taking more likely won't yield any further benefits. Give it about 6 weeks to see if it's working (you may see benefits before then).

    I saw someone advising using SAM-E, but this has the potential to worsen conditions in som people. EPA, if it works, is a much safer option. It's been studied for a wide range of mental illnesses (and shown positive results for many of them) including schizophrenia, without having caused any major side effects.

    January 28, 2011 at 12:01 | Report abuse | Reply
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