Is it necessary to involve my family in my treatment?

Anne's comment:

When one family member is experiencing depression, the entire family is affected. In our situation, when both of our adolescent children were in crisis with their bipolar disorders, the stress caused my spouse to begin to recede into a depression, and I had to struggle to maintain a healthy perspective with so many ill family members to care for. Being involved in each family member's individual therapy and having regular family therapy sessions were essential to keeping a family in crisis together.

Although the decision about the level of involvement of a family member in the evaluation and treatment of depression is generally up to you, your clinician may request (and in certain circumstances insist) that an involved family member be brought in as part of the evaluation process. Depression typically affects a person's cognitive abilities and can be so severe that the ability to make decisions becomes impaired. The involvement of a family member helps to clarify symptoms, relationship and work difficulties, as well as family history. The involved family member may have certain insights as to recent stressors that triggered the onset of the depressive episode. Most importantly, your family member can be an important supportive figure during the initial phase of treatment and the recovery process. Sometimes depressed persons only seek treatment at the insistence of their loved ones. Because of effects on motivation, self-esteem, and feelings of self-sufficiency, a depressed person may not engage fully in the treatment process. The person may need reminders to take his or her medication and keep appointments. Even more important, if you are having suicidal thinking, an involved family member may be an important factor that your clinician uses in determining your ability to be safe. A family member can monitor for suicidal behaviors. If a person is alone and without any support network, he or she is at higher risk for complications of depression, including suicide. Thus a clinician may insist a family member be involved in the treatment if it is believed a person's personal safety is at risk.

Should I worry about my employer finding out about my treatment?

Many employers are actually paying the medical bills through contracts established with health insurance companies. As a result, they may feel entitled to know what they are paying for. Additionally, if you take time off work for depression you may be concerned about what will be released to your employer to justify the time off. Finally, in many job application forms the issue of a mental disability comes up as part of the application process. All these issues may lead to concern that your employer will gain knowledge of your illness and that negative consequences will result from such knowledge. Although all these issues are of concern, paying the bill does not give an employer the right to specific information beyond the minimum amount necessary. They are on a "need to know" basis. They have no right to know your diagnosis, whether it is medical or psychiatric, for either payment or time away from work. An employer may request information on whether the illness will impact on job performance in any way to know whether you should remain out of work or return with a change or reduction in workload. Finally, any application for employment should ask only if you are suffering from a mental disability that would impair your ability to perform your job. Depression is a treatable mental illness and is not in and of itself a disability. The obvious answer to such a question then is "no." The vast majority of people treated for depression can expect a full recovery to their previous functional capacity. You do not need to disclose to a potential employer that you have been treated or that you continue to receive treatment for depression.

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