I have been diagnosed with depression. What do I tell my family and friends?

Anne's comment:

Because of the stigma surrounding depression, we have been careful with whom we share the facts of what we are dealing with. It has been essential to have the support of family members, and we have found it extremely important that the family members living in the household with the depressed individual work with a therapist so that they can have a comprehensive understanding of depression and be a part of the healing process.

Anthony's comment:

I have preferred not to discuss my struggle with depression with friends or family. I have found that family members may become needlessly frightened, and friends are more apt to shrug it off with comments like "who isn't depressed?" or "you're just stressed out." Be careful in whom you decide to share with. In spite of extensive media coverage of depression, there remain doubts about depression and what it is about. People may not give you the reaction that you want, which can cause further problems as well, as you may question the

Stigmatization results when people hide shamefully behind what bothers them. It is easier for people to hold on to their biases if they believe that they do not know anyone with depression or any other mental illness. Close family and friends are more apt to be supportive than you may believe.

sincerity of your friendships. Unless in borderline need of hospitalization, it may be better not to say anything, depending on the situation.

Although there is a greater understanding in society about depression, stigmatization continues to exist, and there can be concern about what to share about the condition with your family and friends. The decision to share information about your diagnosis can be fraught with more worries as to how others will perceive you than, for example, if you had to inform them of an infectious disease, a heart condition, diabetes, or even cancer. As with any other illness, you have a right to your privacy in terms of disclosure. Certainly, the more you can open up about your depression, as with any illness, to people close to you, the more support you can garnish in your time of need. It is reasonable to use discretion in sharing anything personal about yourself; the same holds true regarding your depression. However, if you do not discuss it with people closest to you, you may be more apt to feel shame about it and inhibited in obtaining help and remaining on the treatment plan that you need. Stigmatization results when people hide shamefully behind what bothers them. It is easier for people to hold on to their biases if they believe that they do not know anyone with depression or any other mental illness. Close family and friends are more apt to be supportive than you may believe. Question 92 addresses the issue on family involvement further.

Who is qualified to diagnose and treat depression?

Many clinicians of various educational backgrounds are qualified to diagnose and treat depression. The choice of practitioner type in part depends on need for therapy, medication, or both. Your internist or family practice doctor can diagnose and treat depression, as can a nurse practitioner. They may wish to refer you to a mental health specialist, however, if therapy is needed or if a more in-depth evaluation is warranted. Most insurance plans have participants who can provide mental health services, although sometimes the choices available on a given plan are limited. Geographic location also may dictate choice of practitioner, because shortages of certain clinicians exist in some areas of the United States (e.g., child and adolescent psychiatrists). Mental health specialists who can evaluate for and treat depression include

• Social workers

• Psychologists

• Psychiatric nurse specialists

• Psychiatrists

In seeking a mental health specialist, it is important to choose someone with proper credentials and training. Anyone can call himself or herself a psychotherapist without having specialized training or a degree. It is appropriate to ask the therapist about his or her training and background in the assessment and treatment of depression. Credentials for the previously noted mental health specialists follow.

Social workers provide a full range of mental health services, including assessment, diagnosis, and treatment. They have completed undergraduate work in social work or other fields, followed by postgraduate education to obtain a Masters of Social Work (MSW) or a doctorate degree. An MSW is required to practice as a clinical social worker or to provide therapy. Most states

It is appropriate to ask the therapist about his or her training and background in the assessment and treatment of depression.

require practicing social workers to be licensed, certified, or registered. Postgraduate education is 2 years with courses in social welfare, psychology, family systems, child development, diagnosis, and child and elder abuse/neglect. During the 2 years of coursework, social work students participate in internships concordant with their interest. After completion of the master's program, direct clinical supervision is usually required for a period of time to apply for a license, which may vary from state to state.

Psychologists have completed undergraduate work followed by several years of postgraduate studies to receive a doctorate degree (PhD or PsyD) in psychology. Graduate psychology education includes study of a variety of subjects, notably statistics, social psychology, developmental psychology, personality theory, psychological testing (paper and pencil tests to help assess personality characteristics, intelligence, learning difficulties, and evidence of psychopathology), psychotherapeutic techniques, history and philosophy of psychology, and psychopharmacology and physiological psychology. After the coursework, a year is spent in a mental health setting providing psychotherapeutic care and psychological testing under the supervision of a senior psychologist. Psychologists must demonstrate a minimum number of hours (usually approximately 1,500) before eligibility to sit for state psychology licensure exams.

Psychiatric nurse specialists have completed undergraduate work, typically in nursing, and have obtained postgraduate education in nursing at the master's or doctorate level. Master's programs are 2 years with coursework consisting of study in physiology, pathophysiology, psychopathology, pharmacology, psychosocial and psychotherapeutic treatment modalities, advanced nursing, and diagnosis. The training includes clinical work under supervision. Licensing varies from state to state.

Psychiatrists are medical doctors with specialized training in psychiatry. They have completed undergraduate work followed by 4 years of medical school. Medical education is grounded in basic sciences of anatomy, physiology, pharmacology, microbiology, histology, immunology, and pathology, followed by 2 years of clinical rotations through specialties that include medicine, surgery, pediatrics, obstetrics and gynecology, family practice, and psychiatry (as well as other elective clerkships). During this time medical students must pass two examinations toward licensure. After graduation from medical school, physicians have a year of internship that may include at least 4 months in a primary care specialty such as medicine or pediatrics and 2 months of neurology. After internship, physicians must take and pass a third exam toward licensure to be eligible for licensure (and subsequently practice) in any state. Psychiatrists in training have 3 more years of specialty training in residency, the successful completion of which makes them eligible for board certification. After residency, many psychiatrists pursue further training in a fellowship that can last an additional 2 years. Such fellowships include child and adolescent psychiatry, geriatric psychiatry, consultation-liaison psychiatry, addiction psychiatry, forensic psychiatry, and research. To become board certified, psychiatrists take both written and oral examinations. Certain psychiatry specialties also have a board certification process. Board certification is not a requirement to practice and may not be obtained immediately after completion of residency, although many hospitals and insurance companies do require physicians to be board certified within a specified number of years to treat patients in their facility or to receive reimbursement.

In addition to seeking a private practitioner for mental health services, different types of facilities/programs are available to obtain an evaluation and treatment, in which various mental health specialists work. These facilities/programs include community mental health centers, hospital psychiatry departments and outpatient clinics, university-affiliated programs, social service agencies, and employee assistance programs.

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