All About Telehealth for Depression Telehealth allows psychiatrists and therapists to care for people virtually over a phone call, text message, or most commonly, video chat. Although some situations require an in-person visit, telehealth is a great option when you can't physically meet with your psychiatrist or therapist. If you're new to telehealth, here's what you need to know. Medicare will cover telehealth visits just like in-person visits, but state Medicaid programs and private insurers vary, so confirm your coverage in advance. With telehealth, even though you're not in the doctor's office, your private health information is still covered by HIPAA, so it will remain confidential and secure. You can't get all forms of treatment via telehealth, such as electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS)... but you can get prescription refills, quality care, and counseling, especially if you prepare in advance. Before your telehealth appointment:- List any depression symptoms, such as mood changes, sleep disturbances, physical pain, or changes in appetite-including dates and severity- Note any side effects from your depression medications or therapies- Document any new stresses or recent life changes- Compile a list of your health conditions and medications- Write down any questions you have for your psychiatrist or therapist- Charge your computer or phone- Make sure your internet is reliable- Download any telehealth apps your specific provider may require- Find a quiet, private space to conduct the call- Be prepared with pen and paper or a note-taking app Turn to Healthgrades to connect with the right psychiatrist or therapist to treat depression via telehealth. And share this video to help spread the word! National Suicide Prevention Lifeline1-800-273-8255Available 24 hours every day

Amelia: Having depression, there's no way to sugarcoat it, it is not fun. It's not just that you're not happy. It feels like you don't have the ability to be happy. Stewart: I focus my energy on doing things that unwillingly inside, I don't want to do. Doing mixed martial arts, writing poetry, listening to music. Amelia: It's counterintuitive. All you want to do is lay in bed but the more you do that, the more you don't want to get up. Meredith: Your brain is like a bike. If you stay in a negative place, your brain will just be like, "Yeah, let's keep doing these negative thoughts. Let's just keep going there." Joshua: Exercise really, really is big also. Veronica: Also it is true, the endorphins and just getting your body moving is super, super helpful. Kate: I definitely notice when I am consistent with exercise, it helps with symptoms. Amelia: I think, "Oh well, I can't do a full cardio workout and there's no point." But honestly just walking outside for 20 minutes has a huge impact, or being productive is really helpful to me and it can be a small thing, like if I can't do all of my dishes, doing one dish, it's just one dish less than you have to do later. Kate: I learned transcendental meditation. It's a great technique for if I'm starting to feel overwhelmed, take 20 minutes and try to meditate. Joshua: One of the things with depression is that you think you're alone. You think that the world doesn't understand, nobody understands, your family, your friends, no one is going to understand what it is you're going through. Amelia: But you are not alone, you're really not. Honestly, I've found communities online that really can relate. Joshua: Everyone has their own stuff. Whether it's worse than your situation, the exact same as your situation, or not as bad. You can learn from all those different things. Stewart: I was afraid to talk to people about it because I didn't want to be judged and that was the worst part of this whole journey. Veronica: So I try to be super, super honest with people. Amelia: In being open, I've found so many friends who are going through similar things. I had no idea. I can talk to those people about medications. I can talk about therapy with them. They just relate. Veronica: There is definitely a stigma around depression still. Meredith: But it's just like any other health issue. Amelia: This is an illness. You wouldn't let a physical illness go untreated. If you had a heart condition, you would not let that go untreated. Meredith: So seek help because it gets better when you do. Joshua: Do not, I repeat, do not engage in a permanent solution for a temporary problem. There is hope. There is a better tomorrow. You just have to open yourself up to that.

Dr. Riley: For a patient to find the right treatment for depression, it can take some time or it can happen right away. Dr. Poole-Boykin: We will prescribe either a medication, a therapy, or sometimes we prescribe both. Dr. Karampahtsis: The first class of antidepressants is the selective serotonin reuptake inhibitor. Dr. Riley: Lower levels of serotonin have been implicated in major depressive disorder. Dr. Karampahtsis: The second class of antidepressants is something called SNRIs, which are serotonin norepinephrine reuptake inhibitors. Dr. Riley: There's also medications that work on the dopaminergic system, which increases the levels of dopamine in your brain. Dr. Tice: When someone really has not responded to medication such as an antidepressant, maybe augment the antidepressant with thyroid or a stimulant. Dr. Samton: We might add a small dose of an antipsychotic medication. Antipsychotic medications are synergistic with antidepressants. They really boost that response. Dr. Riley: In terms of psychotherapy, there are things called CBT, which is cognitive behavioral therapy. We are looking at how your thoughts, feelings, and behaviors all interact to cause lower levels of mood in your life. There's also psychodynamic therapy, which examines how your childhood and adolescence affects the way that you become the person you are today. There's also psychoanalytic therapy, which is that typical 'lying on a couch talking about your dreams,' and finally there is DBT, which is dialectical behavioral therapy. It shows you how to take control of your life, how to increase your frustration tolerance, and how to control any distressful situations that you might be going through. Dr. Samton: Unfortunately, there are times when patients really don't feel any improvement in their mood. We might turn to brain stimulation therapies. Dr. Karampahtsis: There's several brain stimulation therapies. The most common one being ECT, electroconvulsive therapy. Dr. Tice: It is a very good treatment for serious depression. Dr. Poole-Boykin: It actually sends an electrical current through the brain. It's like resetting different neural connections and pathways. Dr. Samton: The newest form of brain stimulation therapy is transcranial magnetic stimulation. This is a therapy that uses an electromagnetic current to increase the neuronal activity in the brain. Dr. Tice: Changing your lifestyle and depression is hugely important. I sit in a chair for a living. I make sure every day that I do a vigorous workout. Do I want to every day? Of course not, but exercise is medicine. Dr. Samton: Meditation, being on a regular schedule, improving sleep-wake cycle can benefit somebody's mood. Dr. Poole-Boykin: It's important to have a support system. Your family members or friends, or even work. Dr. Karampahtsis: Speak with your therapist. Sometimes, they do have group therapy that happens within different clinics, but also looking online. You'll be surprised that there's communities of people who suffer from depression all around you. You can connect and they can be very beneficial while you're seeking treatment. Dr. Tice: I think the best therapists are eclectic. It's not like strep throat where 99% of the time, we're going to give you penicillin and that's going to take care of it. Dr. Karampahtsis: I think it's just a matter of being patient and working with your psychiatrist to find the right combination for you.

Dr. Tice: We are lucky to be living in a time where there are a lot more depression treatments. Dr. Samton: The most recent treatment that's become available and is FDA-approved for depression is esketamine or intranasal ketamine. That is a nasal spray that actually induces ketamine into the brain. Dr. Poole-Boykin: This might be helpful for people who need something to work quicker than usual. Dr. Karampahtsis: Especially for those subset of patients with depression with suicidal ideations, esketamine could be a very good option to consider. Dr. Tice: Right now there's new research on psilocybin, which is psychedelics. They started out by treating terminally ill patients. It reduced their depression and changed their whole life outlook. Dr. Samton: The newest form of brain stimulation therapy is transcranial magnetic stimulation. Dr. Karampahtsis: This uses magnetic waves to impact that same neurocircuitry related in major depressive disorders. Dr. Tice: This therapy has changed depression treatment by giving us another viable option aside from ECT. Dr. Samton: What ECT does is it puts the patient under general anesthesia, and then you actually induce a very, very, small seizure in the brain. Dr. Tice: People do have issues with their memory after ECT treatment, even though it's very effective. With the magnetic stimulation, there are none of those side effects. There's no general anesthesia. There's no anesthesia at all. Dr. Samton: Other than a little bit of discomfort at the site where we apply the electrode, patients are able to return to work that same day. Dr. Tice: I do genetic testing. It's literally a cheek swab. It's very useful because it gives you a glimpse into someone's metabolism. Are they are rapid metabolizer? Do they need a higher dose? Do they need a lower dose? And also, it goes through a list of medications, which you're more or less likely to respond to. I've had several people come to me who thought they had tried everything, and we do genetic testing, and then we picked something on the list that they hadn't tried, and then they respond. So that's always, you know, a very gratifying experience.

Dr. Poole-Boykin: A lot of people don't think depression is a disease because you can't really see it. Dr. Tice: But this illness is as real as stage 4cancer. Dr. Poole-Boykin: Long-term treatment-resistant depression could be defined as depression that did not respond to at least two medication trials. Dr. Samton: Don't be too afraid by the name. It's more just a generic term that informs us that we might need to get a little creative with the different treatments. Dr. Poole-Boykin: There could be multiple causes. It could be a medical cause which should be ruled out as soon as you go to the psychiatrist. Dr. Riley: I always check them for hypothyroidism because that can mimic depressive symptoms of low energy, low mood, weight gain, and difficulty sleeping. I also tend to check their vitamin levels, such as B12 and folate, just to make sure that all of their micronutrients are doing well in their body. Dr. Samton: One of the first things that we do when a patient hasn't been responding is we try to make some changes with the medication. Dr. Riley: You can add on another antidepressant. People also have added on atypical anti-psychotics, a very low dose, and that has been found to be an effective treatment for treatment-resistant depression. Dr. Tice: When someone really has not responded to medication such as an antidepressant, maybe augmenting the antidepressant with thyroid or a stimulant, getting them moving and exercising every day, cleaning up their diet, if none of this works, then I really recommend they look into a treatment such as TMS. Dr. Samton: Transcranial magnetic stimulation uses an electromagnetic current to increase the neuronal activity in the brain. Dr. Tice: ECT, which has a lot of stigma attached to it, is a very good treatment for serious depression. Dr. Samton: When an individual is experiencing treatment-resistant depression, we often recommend that he or she does not just take medication but also seeks psychotherapy or support. Dr. Riley: When I'm talking to people who have long-term treatment-resistant depression, often I actually liken it to type 1 diabetes. In type 1 diabetes, your body is just not making enough insulin. In long-term treatment-resistant depression or even just major depressive disorder, your body just isn't making enough serotonin. Dr. Poole-Boykin: It doesn't necessarily mean that there's no hope. It just means that we haven't found the right treatment yet, and we can do that as long as the doctor and the patient work as a team.

It felt really isolating. It was scary and it was lonely and I didn't know how to ask for help. My dad died and he was a really severe alcoholic and after he passed away, I started to have these weird feelings. I thought a lot about death. It wasn't until I was living with my now-husband, I really fell into a pretty deep, deep depression. It was hard to get off the couch. It was hard to just do anything really to the point where my husband was traveling for work and he was like, "Maybe you should come with me." He was just really worried about me. I felt a lot of guilt. I found a psychiatrist. I felt like I sounded crazy, like, "Oh my god, they're going to just lock me up in an institution immediately because I'm having these crazy images of death. What's wrong with me?" But I just felt like I had to be brave and say what was happening. As soon as I told this doctor, he prescribed an antidepressant and weekly therapy sessions with a psychologist. And that combination, I mean I did a 180. Being a working mom and managing mom and work and my mental health and my relationship with my husband, it's a lot to juggle, but I can juggle it and I credit that to a lot of different things. I am on an antidepressant. I also go to therapy. I think it's important to say, too, that if the support that you have been seeking isn't quite working, that's okay. Try a different therapist, ask friends, call friends. Having that support has been really great, and my husband is a very hands-on parent. Everything is 50-50. I definitely wouldn't be able to probably hold it together if he wasn't in 1000% as much as I am. So I often find myself saying, "Mommy needs to just go into the bedroom for a minute. You're going to just sit and watch this cute show." They can hang out for a minute if you need to go do 10 minutes of deep breathing. I think about my dad a lot and his depression and anxiety, and I don't even know what he was struggling with because he didn't have a chance to be diagnosed. Unfortunately, it got handed down to me, but I found ways to work with it and to live with it.

It feels very lonely because you feel like everyone else around you is normal and you're the only one who can't deal with these normal problems of life. When I first started experiencing my depression, I found myself just kind of by myself a lot, in my room, tired, not wanting to get up, usually crying, just constantly all throughout the day, and not getting work done or taking two hours to do something that would normally take me a half hour. I wasn't going to act on inflicting harm on myself, but the thought popped into my head like, "Wow, this would be so much easier if I didn't have to deal with this." That really got me nervous, and so my counselor at the time referred me to a psychiatrist, and he officially diagnosed me with chronic anxiety and depression. So I was prescribed an antidepressant and an anti-anxiety and I thought that this was all going to kind of be over. And I guess I thought that it was a momentary thing that I was dealing with, as opposed to a chronic illness, which is what it is, like diabetes or asthma. But because it's our mind and the way we're thinking and functioning, people assume you're just kind of making it up. I mean my dad said that to me at one point. He was like, "You can control how you think, and you just want to be home and coddled." And you know, I was in bed all day and just crying and my mom would even turn to him and be like, "Who would want to feel this way?" My mother was pretty adamant. She made me get up. She made me have a schedule. It's going to feel weird, but it totally helped me, and I try to keep active, exercise. It is true, the endorphins, and just getting your body moving is super, super helpful. The big thing to remember is it's case by case. One thing that worked for even your family member is not necessarily going to work for you, and that can be so, so frustrating. And you're like, "I've tried all this stuff and none of it is going to work." It is going to work, but you do need to give it time. It is definitely manageable and treatable, and you're able to be high functioning. It's not something that needs to hold you back from anything you want to do.