Building A Bridge to Understanding Depression and Treatment

*This blog summarizes key points discussed during the May 2021 GeneSight Cares Webinar – Depression Disconnect: Building a Bridge to Understanding and Treatment

The panel featured:

	W. Carson Felkel II, MD, FAPA – a psychiatrist and system medical director at Bon Secours Mercy Health in Greenville, S.C.
	Crystal Nelson, MD, owner and CEO, Blueprint Psychiatry in Newnan, Ga.
	Ben Inventor, PhD, APN/CNP, director of the Adult-Gerontology Primary Care Nurse Practitioner Program, assistant professor at Rush University College of Nursing in Chicago, Ill.

Could life be easier if others understood how depression feels? According to a GeneSight Mental Health Monitor survey, 83% of those diagnosed with depression say yes.

Yet, for those who have not experienced depression, it can be hard to grasp just how debilitating its symptoms can be. So much so that getting help is almost too much to manage. This can create a feeling of disconnect between those suffering from depression and those who may not have experienced depression. Our panel of healthcare providers discussed this disconnect and ways to bridge the gap.

Depression Disconnect: Frustrations

Echoing the survey, Dr. Nelson shared that many of her patients feel frustrated that others, including some healthcare providers, don’t fully understand how depression makes them feel. She elaborated that many patients feel invalidated, to which she tells them: “It does not require someone to understand your feelings for your feelings to be real.”

This disconnect in understanding can be complicated by the wide variety of depression symptoms, according to Dr. Felkel. He elaborated that some patients with depression experience an increase in negative affect, meaning these patients may have feelings of anxiety, worry, pain and burden. Other patients experience a loss of positive feelings or an inability to feel happy anymore.

People with depression can also remove themselves from social activity, explained Dr. Inventor, which makes it even more difficult for others to understand how that person feels and can create even more of a disconnect.

Did Understanding of Depression Improve During the Pandemic?

While misunderstanding of mental illness is still common, some have suggested that increased attention to mental health issues due to pandemic-related isolation could be a silver lining for mental health awareness.

One way this could be true is in the understanding of depression as a disorder of the brain. For example, Dr. Felkel referred to a large study that showed one-third of people who survived COVID after infection developed a psychiatric or brain disorder within six months of infection, including depression, anxiety, brain fog, and fatigue. With so many people potentially experiencing the mental health impacts of the pandemic, there may be a better collective understanding of mental illness as legitimate as being an illness of the brain.

Understanding depression as an abnormality of an organ (the brain) normalizes the condition in the same way that other conditions, like asthma, are abnormalities of the body that need treatment, said Dr. Inventor. This normalization may help reduce the stigma that keeps people from seeking depression treatment.

Dr. Felkel recommends seeking care for anyone who has struggled to feel like themselves since the start of the pandemic. While he said it’s normal to have felt stress throughout the pandemic, feeling like you cannot get back to where you feel you need to be may be a sign that you have developed depression and that you may need to seek care.

Barriers to Understanding Depression

Stigma remains the most problematic barrier to understanding depression and seeking treatment, according to Dr. Inventor. Stigma can manifest in several ways, including:

• People with mental illness may be perceived as weak
• For men, mental illness may be perceived as a loss of masculinity
• Some cultures may not recognize mental illness as a part of life
• People may wrongly assume that depression is a normal part of aging

Additionally, both Dr. Inventor and Dr. Nelson agreed that access to professional mental health services can be limited for those who seek help. Additionally, as demand for mental health services increases, Dr. Nelson explained, so do wait times for patients to get appointments and many times, patients do not want to wait to get the care they seek.

Dr. Felkel called for better access to “excellent” mental healthcare. Offering care based on the latest science and evidence-based techniques is one area of improvement. Another, he explained, is that health systems can better support patients outside of their appointments, as providers only have a limited amount of time with the patient. He suggested that health systems work with faith-based organizations and community centers to bring mental health outside the doctor’s office.

Bridging the Depression Disconnect

Each panelist offered several suggestions to help healthcare providers, families and friends better understand what depression feels like.

One step for healthcare providers may simply be to ask and ensure that the patient’s concerns are being addressed. Primary care providers may want to include mental health questions as a routine part of visits, according to Dr. Nelson. Patients may not always mention mental health issues during an appointment, and other ailments could signal an underlying mental health issue.

Many of Dr. Inventor’s doctoral students have focused their graduate work on mental health. Through this work, he’s learned that one way to raise awareness for mental health issues could be to bring that research into local school systems, community health centers, and senior care centers through training and education programs.

Dr. Nelson said that depression is not something people can control or simply “try harder” to improve. Providers have a role in explaining to patients that their feelings are valid.

“Everything that we do, all the functions that we experience, this is happening in our brain. So, whether you thought it up or whether there was a malfunction in some genetic component, it was an experience that happened to you and that’s enough,” she said.

The panelists recommend establishing a common language or feeling to help patients reach an understanding with their loved ones. According to Dr. Nelson:

“Most people have felt just about every feeling that they’re going to feel by the time they are about 25. The intensity might change, but you’ve felt sadness, you’ve felt anger, you’ve felt confusion. So, when you’re talking to your loved one trying to explain it to them, ‘Maybe you can’t relate to me in exactly what I’m going through, but you know what sad feels like. Imagine your saddest day. I feel that every single moment of my day.’”

For more conversation about depression, treatment and managing mental health issues within unique family dynamics, view the full webinar.

For a better understanding of depression, its symptoms and treatment, explore our virtual experience created in partnership with the Depression and Bipolar Support Alliance at KnowMentalHealth.com.