It’s something that Dr. Luana Marques, Director of Community Psychiatry PRIDE at Massachusetts General Hospital (MGH), Associate Professor of Psychiatry at Harvard Medical School, and President of the Anxiety and Depression Association of America (ADAA) has witnessed herself. She says that by the end of March 2020, she saw telehealth use increase by 150%. And it’s not just something that’s been helpful during the pandemic. Dr. Marques adds that for many, “the convenience of telehealth reduces barriers to accessing treatment like transportation, childcare, and taking time off from work, allowing more people to get care when and where they need it.” Telehealth certainly has its benefits, and as it turns out, it can provide specific gains to those who have been diagnosed with depression. If you or someone you love suffers from depression, read on to discover how to make the most of telehealth appointments and what you need to know.
What to know about telehealth if you suffer from depression
“Telehealth can be an extremely helpful and effective form of treatment delivery for those with depression,” says Dr. Craig Sawchuk, psychologist and co-chair of the Division of Integrated Behavioral Health at Mayo Clinic in Rochester, Minnesota. He says that significant literature already exists from before the pandemic regarding the effectiveness of behavioral therapy for depression delivered via telehealth. It’s no surprise that the greatest number of telehealth visits during the pandemic has surrounded mental health. There are many reports that share the high incidences of mental health struggles that have occurred throughout the pandemic, such as one from the CDC that says that from August 2020 to February 2021, the percentage of adults with recent symptoms of anxiety or depression increased from 36.4% to 41.5%. “The largest and most consistent users of telehealth or virtual care during the pandemic have been those seeking behavioral healthcare, with depression among the most common reasons,” says Lee H. Schwamm, MD, Vice President of Virtual Care at Massachusetts General Brigham, Director of the Center for TeleHealth at Massachusetts General Hospital, and Professor of Neurology at Harvard Medical School. “At our hospital system, over 90% of behavioral healthcare visits since the pandemic have been conducted over video, and there’s no evidence that trend is changing.” If you haven’t been participating in telehealth appointments for your depression, there are some things to consider. First of all, it’s important to check with your insurance provider to see if telehealth visits are covered. Many insurance companies have made exceptions during the pandemic by covering telehealth appointments. Secondly, while telehealth appointments can greatly benefit those with depression—Dr. Schwamm explains that for patients with severe depression who are unable to leave home easily or for whom travel is burdensome, video visits can be a great help—there is a caveat. Dr. Schwamm cautions, “Staying cooped up at home for days or weeks on end is not healthy either, so it is important not to assume that all of our needs can be met by jumping on a computer screen. A healthy, balanced life includes social interaction, exercise, and healthy eating. Make sure you get all those.” Dr. Sawchuk says that one challenge with treating depression via telehealth is “we have to be careful about ensuring patient safety, especially during times of worsening suicidal ideation and thoughts of not wanting to live.” He adds, “The concern for safety is even more compounded when they are isolated and living alone. Being able to see people in person during these times is very important from a treatment planning and safety standpoint. Additionally, especially when considering and/or monitoring medication management and response for depression, it can be helpful to see people in person to further assess vitals and perform additional laboratory testing if indicated.” The moral of the story? While telehealth has been a lifesaver for patients throughout the pandemic, and it continues to be helpful in a variety of ways, ideally, a mix of telehealth and in-person appointments is really best when it comes to one’s mental health. Perhaps your clinic is not allowing in-person visits quite yet, so this is something to keep in mind for the future if you prefer to stick with telehealth appointments as much as possible.
Differences between telehealth and in-person appointments
Each expert notes key differences that exist between telehealth and in-person appointments. Dr. Sawchuk says that while teletherapy “is actually very comparable to in-person therapy” since the technology is straightforward and user-friendly, even for those who may not be especially tech-savvy, you can run into connection issues and glitches, “which can interrupt the rhythm and flow of the appointment.” He says, “It may take a bit of getting used to, conducting your healthcare in this way, but the learning curve is very quick. Many people do find that the time saved from commuting, cost of gas, and the portability of doing video visits from almost anywhere are great benefits.” Dr. Schwamm says that for some people, it is harder to engage emotionally during a video call and may take extra effort or attention. He elaborates, saying, “It may feel very different to share personal information or to cry while sitting alone in a room elsewhere, removed from the therapist, though for some patients it might be easier to share deeply personal feelings or thoughts if they are not sitting in the same room as the therapist.” Dr. Marques says that during telehealth visits, “things like body language and gestures” may not “translate as well across the screen.” But even with these challenges, there is still a great deal of benefit that results from teletherapy, and it’s something that’s been confirmed for a while. Dr. Marques says that one study published over 15 years ago compared treatment outcomes between two groups of veterans, one receiving in-person treatment and one receiving teletherapy. The results found that depression levels in both groups improved significantly and harmoniously, seeing no difference between those who received therapy in-person or virtually.
How to get the most out of telehealth therapy
Since telehealth is a different arena than in-person therapy, there are some ways you can prepare for your virtual appointments so you can experience the best possible care for your depression. Our experts share the following tips:
Find a space where you have privacy and feel comfortable. Avoid anywhere that requires you to whisper.Minimize distractions as much as possible.Make sure you are prepared by practicing the technical steps necessary to connect over video.If you have any homework, make sure it’s ready to go to share with your provider.Complete self-report measures of depression to help track your progress across time. This is when a mood diary app may prove helpful.Take notes.Always make sure you understand the plan before hanging up, since you won’t have the chance to knock on the door after the visit to ask clarifying questions about medicines or the plan going forward.Get information from your therapist. Dr. Schwamm says that most forms of therapy can be delivered over video, but it’s important to discuss this with your therapist to be sure. Also, not every visit might be amenable to video. This is when it’s key to learn about the office’s COVID guidelines and practices if you do need to go in person.
How to navigate telehealth appointments with your primary care provider
Even though a sizable portion of your depression treatment plan involves regular appointments with your therapist, psychologist, or psychiatrist, you’ll also need to discuss your depression symptoms with your primary care doctor, which also could take place via a telehealth visit. Our experts share additional tips around meeting virtually with your doctor:
As with your therapy telehealth appointments, ensure that you have good connectivity ahead of your virtual visit.Again, minimize distractions and locate a quiet place.Try to log into your video appointment 10 to 15 minutes ahead of time in case you need to complete self-report questionnaires and/or need to meet with a nurse or other healthcare professional to get additional information prior to meeting with your doctor.Write down any questions—ask your doctor if you can send them in advance.Have your medications close by in case your healthcare provider needs to ask you specific information about what you are taking and what dose and discuss any side effects you’re experiencing.Be honest with how you are feeling and the symptoms you are experiencing, both with what’s improving and what you are struggling with. Dr. Sawchuk adds that it can be helpful to organize your symptoms into emotional (e.g., sad, down, apathetic, irritable), physical (e.g., sleep, appetite, energy), thinking (e.g., rumination, thoughts of not wanting to live, difficulties with attention/concentration), and behaving (e.g., withdrawal, avoidance, substance use).End the visit by summarizing what you heard and any plans going forward or changes in your medicines. Dr. Schwamm also recommends “asking a listener to join you for the visit and help take notes,” which is “often a good step as long as you are comfortable having medical information in front of them.”
Virtual appointments have been widespread during the pandemic, but it also has become a new standard form of care for people, including those with depression. Dr. Marques observes, “Prior to the pandemic, insurance was a huge barrier to receiving telehealth treatment, as many insurers did not cover virtual appointments. In the past year, the rapid increase in demand for virtual healthcare led many insurers to begin offering coverage for telehealth treatment. Because of the increasing mental health need and convenience of telehealth, for patients and providers, I do think virtual healthcare options will continue to be widely available.” To conclude, Dr. Schwamm says that even a pandemic shouldn’t pose barriers to one’s depression treatment. This is just one example of how telehealth can prove to be incredibly beneficial to those dealing with depression. He says, “Depression is a very common and very treatable disease. It is not a form of human frailty or due to old age, a lack of effort, or grit. Depression, when left untreated, kills many people young and old alike whose deaths might have been avoided. If telehealth can help make it easier for patients and providers to connect regularly for treatment, then it may be one of the best things to have come out of COVID.” Next up, discover 101 quotes about depression to help you not feel alone.
Sources
Dr. Luana Marques, Director of Community Psychiatry PRIDE at Massachusetts General Hospital (MGH), Associate Professor of Psychiatry at Harvard Medical School, and President of the Anxiety and Depression Association of America (ADAA)Dr. Craig Sawchuk, a psychologist and co-chair of the Division of Integrated Behavioral Health at Mayo Clinic in Rochester, Minnesota.The Centers for Disease Control and Prevention (CDC): “Trends in Use of Telehealth Among Health Centers During the COVID-19 Pandemic — United States, June 26–November 6, 2020”The Centers for Disease Control and Prevention (CDC): “Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care Among Adults During the COVID-19 Pandemic — United States, August 2020–February 2021”
