Depression: How to Get Treatment If You Can't Afford It or It Isn't Covered

THE GOOD NEWS ABOUT depression: It's treatable, and the majority of patients who are treated do well. The bad news is that only one-third of those diagnosed receive treatment, according to the Anxiety and Depression Association of America. And the reason for that is often the cost of care.

Those lucky enough to have good health insurance still have limits on what that coverage will pay for and copays or deductibles that must be met. Those with inadequate or no coverage are looking at prescription drug and psychotherapy costs that may be prohibitive. “It’s like if you had cancer and no insurance,” says Dr. Jerrold Rosenbaum, professor of psychiatry at Harvard Medical School and psychiatrist-in-chief at Massachusetts General Hospital.

“Depression is a mean disorder, not only in mental suffering but in real morbidity: decreased functions, impacts on all aspects of life, increased risk of self-harm – and that is only the half of it. It is not a trivial disease, so having no access to care is as disturbing as saying you have a lesion on your arm and nowhere to go.”

What can you do if you or a loved one is in this situation? Fortunately, there are low- and no-cost options for treatment. But they take a bit of work to access.

Self-Help for Mild Depression

For mild depression, the best thing anyone can do is free: exercise. “The effects on the brain of daily exercise are as potent as antidepressants in inducing neurogenesis, the birthing of new neurons that are associated with recovery,” Rosenbaum says. Just 20 to 30 minutes a day will benefit mood, cognition and sense of well-being, he says.

For seasonal depression, he recommends an inexpensive light box to simulate daylight during the dark winter months. And at any time of year, try to fill your life with the things you enjoy. “Even if you are not motivated, do your own well-being therapy,” he says. “Go to a movie, hang out with friends, drive yourself to do things that give you pleasure.”

Mindfulness exercises also help, he says, and the internet offers abundant sites and apps to teach you how. “I recommend Dan Harris’ ‘10 percent happier,’” he says.

Dietary changes may also lift mood. “Move from an inflammation-inducing diet to an anti-inflammatory diet – no red meats or refined sugar,” he says. “A Mediterranean diet potentially can help you recover.”

These are all proven strategies for mild bouts of depression. As depression worsens, however, motivation may become a problem. “The tricky part is that depression takes away the motivation to do the things you need to do to get better,” he says.

Options for Costly Treatment

If you or a loved one suspect a mental health issue, the first step is to sign up for some form of health insurance, says Dr. Harsh K. Trivedi, a psychiatrist and president and CEO of Sheppard Pratt Health System, a leading mental health system based in Baltimore.

But do it with eyes wide open. “It is true of all health care but particularly in accessing mental health services that most people don’t think about their coverage when they sign up for a plan,” he says. “We all expect insurance to cover us, but it is not the same with mental health coverage.”

Plans may list providers who really aren’t on the plan or can’t take new patients. Copays and deductibles can add up quickly. So he recommends doing sound research. “Asking specific questions and doing your homework at the front end is most important,” he says. Enlist the help of family and friends if depression prevents you from accomplishing this.

If coverage is not sufficient, there are options for treatment at lower costs:

Medication. The Partnership for Prescription Assistance has a website that offers access to more than 475 public and private programs, including about 200 programs offered by biopharmaceutical companies, to people get prescription drugs for free or at very low cost.Big-box retailers like Walmart and Target also have programs for low-cost medications. And military veterans may have access to better benefits through the VA.

Psychotherapy. Depending where you live, you may be able to find psychiatric training programs that offer low-cost treatment from students, under supervision. “Major teaching institutions in urban areas often are affiliated with public hospitals – Bellevue Hospital in New York City, for example, has an affiliation with New York University – and most training programs have trainees offer low-cost or sliding-scale therapy,” says Dr. Sue Varma, a psychiatrist and clinical assistant professor at NYU Langone Medical Center. Trivedi notes that Sheppard also does this through its psychiatry residency program.

In addition, therapists looking to build their practice may be willing to lower their fees, Varma says. She also recommends group sessions as a low-cost alternative. “Doing a short-term course of cognitive behavioral therapy can be very effective,” she says. “Courses in relaxation therapy, meditation and mindfulness all can be low-cost ways for stress management that I use as part of a comprehensive treatment plan.”

Other Resources

The website offers a variety of low-cost health care options broken down geographically.

The National Alliance on Mental Illness, or NAMI, has numerous state organizations and affiliates that can help locate low-cost resources in your community.

The key to beating depression often is getting treatment early. “A big issue is there is still a lot of stigma with accessing mental health care,” Rosenbaum says. “When you add the financial burden to that, people put it off and wait 'till it gets worse, but getting good care is just as important for mental health as for any other health condition.”

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