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

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.

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.

Diana Keough: By the time she was in high school, I was already married and staring to have children, and I lived far enough away that I'd only see her two or three times a year. So there were things that were going on in her life. Kevin Keough: I would occasionally hear things about Claudia that maybe in retrospect should have raised red flags. Diana Keough: Had I been closer, I probably would have noticed, but I wasn't. Kevin Keough: The defining moment happens in, I think it's the summer of 2009. Diana Keough: We would get a beach house and my siblings and I and our kids would gather at the beach. Kevin Keough: There was clearly something wrong with Claudia from the very first day. Diana Keough: I had brought probably half a case of white wine and half a case of red wine for the beach. And the next morning I got up, and there were over three bottles consumed. The thing with mental illness, especially when you have someone that is really in a high mania state, is that there's no instruction book on what to do. Kevin Keough: In the fall of 2011, right around Thanksgiving, Claudia essentially incarcerated and put in a couple of different facilities in Virginia but needed permanent help. Diana Keough: There was a point where my older sister and I were having a discussion about the fact that we had to let her go. And I remember saying to her that nothing's going to happen to Claudia on my watch. Kevin Keough: Diana really was able to work a connection that got Claudia into Skyland Trail. Diana Keough: There's two institutions in this entire country that actually do what's called a dual diagnosis program, where they treat the mental illness as seriously as they would the addiction. Kevin Keough: Well, the person that went into Skyland Trail went there because others wanted her, if not forced her, to do it. It certainly wasn't her decision. It wasn't something she was asking to have done. The person who came out of the Skyland Trail had gone to a point of being broken, with a rebuilding process that had started but not been completed. Diana Keough: Most people that are as sick as she is with bipolar, they don't come back. You hear of them wrecking their cars at 100 miles an hour. You hear of them jumping off bridges, or they don't get well. She has worked so hard and I'm phenomenally proud of her. I think if I had anything to say to somebody else, another family that's going through this, remember that the person that you know and you love is in there, so don't take personally what they say to you. Don't take personally what they're doing, do all you can do to get them help, and don't give up.

I had a business, and it was a graphic design firm, and so I thought my mind racing and those kind of racing thoughts were just because I was an artist, so I exercised a ton to keep my mind focused, but then that didn't work anymore, so I started drinking white wine, at least a bottle a night, just to keep my mind from racing. It wasn't until I was in my 30s, where I was breastfeeding my third child, and I was drinking martinis, and that progressed into partying too much, that progressed into leaving the kids when I shouldn't have, that progressed into having an affair with a drug dealer. I couldn't really stop myself. I was with these people that I just met at a bar at a hotel. They talked me into going back to their hotel room to smoke pot, a guy and a girl, and so I did, and it was laced with something, and then when I walked out the door, I'm like, "What? What am I doing? Who am I? Why am I in this situation?" At the time, it really scared me. When I got to treatment, I knew, "okay, I can't get out of this place without support from my family." I did get support from my family, and I accepted it and knew that they wanted the best for me. I think a huge trigger would be drinking. So that's why I don't drink. I see a doctor every other month, take my medication every day. The lifestyle stuff, eating at the same time or trying to every day, and not getting too tired, not getting too stressed. Not getting too stressed is hard sometimes. You have to go to the right doctor that you're comfortable with. You have to get the right cocktail, and you have to be extremely honest about how you feel. I feel like I'm mostly happy. It's just being stable. It's telling the truth, where, before, maybe I would have told a half truth. With this disease, you have to push yourself. It's basically getting up every day and being disciplined enough to do what you have to do even though you don't want to do it.

I had all these interests. The joke is that I love buffets. I want the red cake and the lemon meringue, and the chocolate pie and all this. I just love it all. Life is a big buffet. And that was great, because we live in a society that validates that, that celebrates that. It was really menopause, I believe, that unhinged me. I had no executive function. I couldn't control myself. I was impulsive in my behavior. I couldn't stop saying things that I knew, perhaps, were inappropriate. Instead of always living up here, I had a drop and began to feel very anxious. And then, also, I was more fidgety. Felt that the ground--there was no solid ground under me, that it was just yanked out from under me. Instead of something that you inside, internally, say, "Gee, I'm really contributing to the world. I'm all things to all people," you realize you're nothing to anybody, and you're nothing to yourself. That's part of what I began to feel very, very deeply. But I thought that I could deal with it myself through a combination of journaling and meditation and talking to my friends and going deep inside or going for long walks, or running, perhaps even a drink every night, or maybe two or three. And then other people began to bring it to my attention. "What's happening to you? You were always so optimistic." It was my sister, when I was out visiting her at her ranch in Texas--after my trip there, she called me almost within a day or two, and said, "I insist that you get a psychiatric evaluation." My psychiatrist looked at me and said that she felt that all I had told her was very clear case of bipolar disorder. I burst into tears. And I finally, for the first time, felt heard. I see how much I have been blessed to accomplish and do in the year and change since I've been diagnosed and started medication. I just love to laugh, sing at the top of my lungs. The simple act of breathing. There is that sense of, well, shake it off, you can do it, step up, it's just a matter of your willpower. It's important to ask for help when you need it, rather than to think that you are a complete failure because you yourself were incapable of accomplishing great things. I always was someone who saw the connection between people and, as a result of my mind being calmer, I can actually feel that on a deeper level, and that I can act on that in a more thoughtful and mindful way.

I've always been very outgoing, everyone says I'm very happy and spunky and sparkly. But that spunkiness seemed to be spiraling out of control. Wrecked my car, driving fast, talking fast. The inability to focus on things, and not in an attention-deficit kind of way. But complete inability even to complete an entire sentence. I did do a lot of paintings. I painted on anything I could get my hands on. And I'd think, okay, what's next, what's next? What can we do next? It's like this little wind up toy was just bouncing against the walls and sort of leaving a mess of art things in its wake. I guess I had what they call a break. And I went and saw a psychiatrist. I really wasn't sure if it was just a phase. And I was diagnosed bipolar. There was some medication that I was prescribed, that did make me, what my family and myself say, "I was a bit of zombie." It just made me flat. So there's the perky flower, and then the one that droops. And I was like this. And I needed to be Marcy again. And it was the right medication. Over the years, there have had to be fine tuneups, small tweaks. It's a matter of eating right, sleeping right, and exercising--taking care of myself. I would not take the mania. Because it is so addictive. I think that is why so many people who are bipolar do relapse. Or they don't take their medication properly. Because they're afraid they'll lose their creative edge. They'll lose the high. They'll lose the feeling that they're totally hot and sexy, and own every room when they walk into it. I don't miss that time. I don't miss it at all. Because it was so destructive. And it was so hard on so many people around me. I could not have made it through without my friends and family. My daughter, my family, my friends help me maintain. When someone is in a depressive cycle, or in a manic cycle, they don't necessarily realize where they are or know where it is that they need to be. But the best thing a family member can do is stand by them and help them stay alive. Bipolar is part of me, but it's not going to break me. It doesn't make me. It is just part of who I am.

Bipolar disorder has two different types of moods involved with it. One can be the depressed side, and the other can be the upside where people may experience an increase in energy, an elevated mood, or euphoria. Patients will describe feeling really energetic. Sometimes they can go for several days in a row without sleeping. They have a lot of ideas. Sometimes their thoughts go through their head so fast that they can't even keep up with them. Creativity is often elevated during episodes of mania with bipolar disorder. Really, what defines bipolar disorder as a disease is the fact it is a chemical imbalance in the brain, and so it can cause problems with relationships, it can cause other problems in functioning with jobs or school. It interferes with your ability to live your life the way you want to and that it can be prolonged, and that's really what defines it from the normal ups and downs that everybody goes through. A lot of people in the manic phase of bipolar disorder will be very impulsive, which means they do things without considering the consequences of their actions. A lot of times we see alcohol or drug use as part of that impulsive behavior, and also people who are going through mania will be hyper-sexual. In psychiatry, the unfortunate thing is that doctors don't have tests that they can run to make a diagnosis. When a new patient comes to see me, I interview them for at least an hour on their first visit. I ask them lots of different questions about their behaviors, about their moods, about their functioning, and there are some targeted questions that I ask to try to determine whether or not the patient may have bipolar disorder or a depressive disorder. Most of the time, patients in the manic phase don't even recognize that anything is wrong, and because they have such a positive outlook on life, they don't want any help. It's very important to encourage patients to come into treatment because the longer the manic episode goes untreated, the more risk there is of the patient harming themselves. With the right medication and the right treatment program, symptoms can be controlled, and a lot of people can live very normal lives with bipolar disorder.

Schizophrenia is deeply misunderstood and widespread stigma of the mental illness makes it hard to learn what it's really like to live with it. When you think of schizophrenia, you may think of characters from movies and TV who are paranoid and act erratically. But those stereotypes are part of the reason why we need continued education about the disorder. This is the real story about common schizophrenia misconceptions. Myth #1: If you have schizophrenia, you hear voices in your head. Schizophrenia is a complex condition that may cause a variety of symptoms. Many people with schizophrenia experience hallucinations like hearing voices or seeing things that aren't really there, but not everyone has this symptom. And it may change over time for those that do. Myth #2: People with schizophrenia can easily recognize their hallucinations or delusions. For people with schizophrenia, hallucinations and delusions feel very real, no matter how smart someone is, or if evidence proves them wrong. That's why treatment is necessary to control symptoms and help people manage their illness. Myth #3: The only treatment option for schizophrenia is medication. Antipsychotic medication is a crucial first step. But once symptoms are stabilized, psychosocial treatments like cognitive behavioral therapy and support groups can empower people with schizophrenia to deal with the everyday challenges of the condition. Myth #4: A general practitioner is qualified to treat schizophrenia. Your primary care physician can be your first stop, but he or she will likely refer you to a psychiatrist, a medical doctor who specializes in diagnosing and treating mental health issues. By using Healthgrades' Guided Physician Search, it's easy to find a psychiatrist who's the best fit for you and your schizophrenia. Myth #5: All schizophrenia medications come in the form of daily pills. If you're prescribed antipsychotic pills, then yes, it's incredibly important to take them every day. But some antipsychotics come in the form of a long-acting injection that's given at your doctor's office once or twice a month. These injections can be easier to manage than remembering to take a pill every day. Myth #6: Treatment for schizophrenia isn't really effective. While treatment won't cure schizophrenia, it can greatly reduce how severely and how frequently someone experiences symptoms. It may take some time to find the best approach, but with the right treatment plan, people with schizophrenia can lead full and productive lives. Talk to your doctor to get on the treatment path that's right for you. It's easy to find the right doctor at Healthgrades.