"People tend to react strongly in one of two ways when I tell them that they have clinical depression," says Rakesh Jain, MD, director of psychopharmacology at R/D Clinical Research Center in Lake Jackson, Texas. "Many people experience extreme relief. It's huge. They know they're not crazy, weak, or stupid."
Others react with denial, he says. "People often want to fight it on their own. They fear looking weak more than they fear being ill."
A feeling of failure
Pat McEvily, 52, of New Rochelle, N.Y., ignored his depression for 18 years after being diagnosed by a psychiatrist. His Irish Catholic upbringing left him feeling that medication would be a cop-out.
"I was convinced that my depression was a moral failure, even though I had a priest friend who told me it wasn't," he says. McEvily finally sought treatment, but he says he still fights the feeling of having failed.
Experts say such stigma is not justs in patients' minds. "It's ridiculous to pretend that there aren't people who get fired or pressured if they're seeing a therapist," says Corey Greenwald, MD, a psychiatrist in Atlanta.
The payment problem
The insurance companies make the stigma even worse, says Dr. Greenwald. Mental health services are almost never covered as comprehensively as medical care.
In addition, he says, "your mental health benefit is administered by a different companysubcontracted out to some mental health care company. If you're sick, call this number. But if it's mental health, then you call some other number, another company. The whole idea that depression is something 'outside' or 'other'there's sick and then there's this stuff."
Diagnosis can bring relief
On the other side of the equation, Terrie Williams, 53, of New York City, was amazed at the transformation her diagnosis sparked. "Once I heard the words, 'You're clinically depressed,' I breathed a huge sigh of relief and thought, 'So that's what's wrong with me,'" she says.
Antidepressants won't change your personality
Some people are afraid of the mental health system or of the medications that a doctor may prescribe for depression. "Patients ask me if depression medications will change who they are as people. It's an understandable concern," says Jewel Shim, MD, assistant clinical professor of psychiatry at the University of California–San Francisco.
"Antidepressants target the symptoms of depression, not your personality," says George I. Papakostas, MD, assistant professor of psychiatry at Harvard Medical School. (Watch a video of a psychiatrist explain the potential benefits of antidepressants, and how they might work for you.) "People around you may notice a change in your demeanor during treatment, though. Patients may seem less sad, less anxious, less irritable or angry, more content."