Obstacles to Treating MDD

Letters to Strangers
4 min readJan 30, 2022
Photo by christopher lemercier on Unsplash

This article was written by Sanjana Shaji.

The global prevalence rates of Major Depressive Disorder have risen by approximately 68 million people from 2000 to 2019.

According to the DSM 5, it is one of the most common disorders in the world and is characterized by persistent feelings of sadness and a lack of pleasure in daily activities . For an individual to be diagnosed with Major Depressive Disorder (MDD), they must present those symptoms along with at least 5 other symptoms, such as fatigue, for two consecutive weeks.

After a diagnosis is made, individuals are presented with treatment options like Cognitive Behavioral Therapy (CBT) or antidepressants. These treatments aim to help individuals cope with the disorder and improve the quality of their life. Therefore, it is important that both mental health professionals and patients work together to ensure that the patient receives the most effective treatment option for them.

If a patient is provided with a treatment that is not suitable for them, they may feel as though they will not be able to cope with their disorder. This is known as low self-efficacy, which is the belief that one has the ability to implement the behaviors needed to produce a desired effect. Some research has shown that self-efficacy is an important predictor of the outcome of treatment. If the treatment option appeals to the patient and they believe that they will be successful in their recovery, the treatment is more likely to be effective.

For patients to be provided with the most suitable treatment option, factors like affordability, treatment period, lack of information, and stigmas that may affect the effectiveness of the treatment are often considered.

Affordability is often the first factor that people consider when they choose whether to seek a particular treatment. It is important to note that healthcare may be more affordable for individuals in certain countries or who work for companies with more accommodating insurance plans.

That said, healthcare costs may still take up a large portion of a person’s income, resulting in many people being forced to decline treatments that are too expensive. What is more, the average income earner may struggle with the high costs of antidepressants or therapies.

For those who struggle to afford the only treatment they have access to, the pressures of paying for care may adversely impact the effectiveness of the treatment as well. This additional stress might exacerbate the feelings of hopelessness or general inability to function normally. While working to address these costs may be difficult, it is important to understand that treatment might also help individuals manage this stress overtime.

Therapies for MDD can also be time-consuming, varying from inpatient treatment centers to regular therapy sessions. Inpatient hospitalization in a psychiatric facility, for instance, may seem infeasible for some patients, especially those who work the normal 9:00 am to 5:00 pm weekday schedule and cannot take an extended period off of work. For others, the regular 45 minute to hour long therapy sessions weekly or biweekly may also seem unattainable for the way they conduct their lives.

Taking time off work for therapy may seem even less worthwhile for individuals who experience feelings of hopelessness and fatigue. Those who are paid hourly may also recognize that they have less income to pay for the treatment since they have to take that time off. That said, telehealth has made it easier to obtain and schedule appointments for individuals who do not have the ability to commute from work to therapy. Instead, they can receive treatment remotely from anywhere with internet access.

Every person must look at the costs and benefits for each treatment plan they are considering. While it is more costly and time consuming for some to obtain therapy, it is crucial to understand that overcoming or learning to cope with MDD may be more beneficial in the long run, yielding benefits like greater energy and motivation to work and live a healthier lifestyle.

Unfortunately, some organizations do not accommodate for mental health treatments, either by not including mental health care in the insurance plans or by not allowing time off for therapy.

The reason that some workplaces do not accommodate mental health and its treatments is largely stigmatization. The stigmatization of mental disorders such as MDD negatively impacts a person’s access to treatment, their decision to seek treatment, and their belief in the effectiveness of treatments for the disorder.

The stereotype that depression is “only in someone’s head” and that it is not a true malaise can make a person feel uncomfortable when considering treatments.

More broadly, stigmas can also interfere with the therapeutic process itself, such as when patients do not actively participate in the session, thereby reducing the effectiveness of the treatments. Stigmatization can also lead to patients skipping medication or sessions simply so that they do not have to tell someone else about their diagnosis and treatments.

Despite what some may think, MDD is a legitimate mental illness that deserves to be treated appropriately. It is estimated that the total economic burden of MDD is $210.5 billion per year. These costs are based in absenteeism, reduced productivity, medical costs, and other expenditures related to suicide.

If employers or healthcare systems supported individuals more seriously, this burden would not be so great.

It’s important to consider that it is not just one factor that can impact the effectiveness of care, rather it is more often an interaction between factors that acts as a barrier to effective treatment. Overcoming these barriers can help individuals receive better care. When someone is given the chance to actively engage in mental healthcare without the pressures of costs, limited time, and stigmas, they are far more likely to reap the benefits.

That is why, we must promote mental health by advocating for a widespread societal change in terms of healthcare, attitudes and equality.

For everyone deserves to lead a fulfilling and joyful life.



Letters to Strangers

Global youth-run NGO seeking to destigmatize mental illness and increase access to affordable quality mental healthcare. Join us!