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Depression

This fact sheet is designed to help MBF members and their families be better prepared for their healthcare experience after a diagnosis of depression.

Not all of the information here will be applicable to everyone, so it is important to discuss your individual circumstances with your doctor and other healthcare professionals caring for you. Please, never hesitate to ask 'why' or to have something explained to you until you understand it. If, after you have been given an answer, you still feel as though there are unanswered questions, ask again or ask someone else. You can help the healthcare team to help you if you feel free to communicate your needs to them. Further research and reading (see 'More about depression and its management and treatment') will also help you make more informed decisions about your treatment.

About depression  

Almost one in five Australians is likely to experience some kind of depressive illness in their lives and depression is one of the most common reasons for visits to the GP. Many people are affected by some form of depression, either personally or through a friend or family member. In recent years, growing awareness about the prevalence of depression in our society has led to a significant improvement in, and understanding of, the best treatment methods. There has also been an increase in the number of reliable and helpful support and information agencies.

If you or someone close to you has been diagnosed with depression, then it is likely that you will understand that it is far more than a "low mood". Rather, clinical depression (as opposed to the label we sometimes give to the times when we are feeling "down" temporarily) is a condition that can profoundly affect your ability to effectively carry out everyday activities. This can in turn affect general health, personal relationships, workplace and professional life, financial decisions and more.

It is also important to understand that depression is not just "feeling down". The condition can also deprive you of your motivation to get out and do things, to relate to those around you, or even to work effectively.

You may experience only one period of depression in your life, perhaps linked to a particular event or series of events; or the depression may be chronic and recurring. Depression may also be accompanied by mild or severe anxiety disorder, it may be mild enough to respond well to lifestyle changes, or so severe as to require hospitalisation. Depression may also be associated with inappropriate use of alcohol or other drugs.

The symptoms of depression include weight loss, lack of energy, low libido, insomnia and even thoughts of harming oneself.

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Treatment and management options 

While the most appropriate treatment may differ from person to person, one thing is clear from the research: choosing to have treatment and sticking to a treatment regime offers the best chance of recovery.

Because one feature of depression can be a feeling of helplessness, being overwhelmed or powerless or not even caring about your health, you might need to get help from a friend or family member as you work your way through treatment, including perhaps asking them to come with you when you visit the doctor.

Treatment is likely to start with your GP who, depending on your condition and his or her experience treating people with depression, may in turn refer you to a psychiatrist to help confirm the initial diagnosis and recommend treatment, especially relating to medication. You may also see a psychologist. Depending on your individual needs, the psychiatrist may take over your ongoing care. In most cases, the GP will be your key carer, and the person best able to coordinate all the aspects of care you might need, including ongoing monitoring once your depression has been treated.

The type of treatment you have will depend on, among other things:

  • the severity of the condition;
  • what, if any, causes can be established - sometimes this can be quite clear, other times depression can develop for no apparent reason;
  • your age and general health - you may have other conditions that affect treatment decisions; and
  • how long you have had depression and what, if any, other treatments you have tried.

If you have just been diagnosed and your depression is not severe, your doctor may wish to take a gradual approach to find out which treatment plan best suits you. One or more of the following may be suggested:

  • lifestyle management can, in many cases, make a real difference in helping to overcome depression. It is especially important to have regular exercise, establish a regular sleep routine, to eat well and regularly, and avoid or reduce use of alcohol or other drugs;
  • psychological therapy provided by a mental health professional such as a psychiatrist or psychologist, to help you to learn how to overcome or control depression by thinking differently, break negative habits, and gain a greater understanding of the causes of your depression so you can try to address them;
  • hospitalisation may be recommended by your doctor if your depression is particularly severe;
  • community support options to help with needs such as accommodation and employment, and self help groups;
  • support organisations can help you with information, assist if you have a pressing need, provide support by others who have found themselves in similar positions to yourself; and
  • medication prescribed by your GP or a psychiatrist. This includes both anti-depressants and in some cases, tranquillisers or mood stabilisers (such as lithium).

The most important thing to realise and to keep in mind is that help and support are available from both your healthcare providers and from others in the community who simply want to help you through the tough times and keep you well. Don't hesitate to seek assistance.

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Taking Medication 

Because there are many available anti-depressant medications which aid or affect different people to different extents, a trial and error approach is sometimes needed before the right type of drug and dosage is found. It is also very important to understand and remember some basic principles regarding anti-depressant medications:

  • you may need to take the medication for some time (often a few weeks) before you notice an improvement;
  • it may cause side effects. If you are experiencing side effects from your medication or symptoms you feel might be caused by taking the medication, contact your doctor as soon as possible. Some side-effects can be managed, while others warrant a change of drug, but this should always be done in partnership with your doctor.
  • suddenly stopping the medication for any reason without consulting with your doctor may result both in serious withdrawal effects and the recurrence or increased severity of depressive symptoms. This can be a real hazard if you are either very depressed or think you feel well enough that you don't need medication any more. Both you and those close to you should know that taking your medication regularly and according to instructions is vital, and that even more special attention needs to be paid to this during episodes of depression;
  • you may also have to be careful about mixing the medication/s you are on with other medications and especially alcohol.
  • it is extremely important to continue taking your medications as prescribed by your health care providers, even if, and maybe even especially if, you are feeling well. It is a common cause of relapsing back to the beginning when people stop their medication as soon as they feel a little better and then their symptoms come back gradually and often without their realising. It is usual for medication to be continued over a full year in the case of first time treatment. If you have recurring depression, you may need to continue medication for much longer;
  • your medication should be reviewed regularly - every six months or so - by your doctor (either your GP or psychiatrist) to make sure it is still the most appropriate choice for you.

As outlined previously, the best results usually occur with ongoing treatment, even when symptoms disappear. This type of day-to-day management can help dramatically reduce or even completely eliminate depression. See 'Questions to ask your doctor' to help you prepare for conversations with your doctors regarding your medications.

Questions to ask your doctor 

Your decisions about the treatment and management of your depression will depend very much on your individual case. It can be very helpful to ask a friend or family member to be with you so you can go through the questions with the doctor together.

To the GP/referring Doctor:

  • If you feel I have depression, do you think I should be referred to a psychologist or psychiatrist, or is there any point when we might reconsider that?
  • If you have, why have you chosen to refer me to this psychiatrist or psychologist?
  • Could you please explain to me what medication you have recommended and how it might help me? Would you mind explaining this to my friend/family member so that they can assist me if I need help? Are there any side-effects that I should be aware of?

To the specialist doctor or treating GP:

  • Can you explain what depression is and your reasons for this diagnosis?
  • Are you certain about the diagnosis, or may it change over time?
  • Will you or my GP be handling my ongoing care?
  • Can you explain, in simple terms, what you think is the best treatment option in this case and why?
  • What are the likely outcomes of my treatment?
  • What can I expect in the long term?
  • What other treatment options are there and how effective are they?
  • What are the chances that the outcomes will be good, with this treatment or with the alternative options?
  • Are you associated with a comprehensive mental health team? Are there others that would be part of my care team?
  • How can my family & friends help?

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Questions about medication

Always share a list of the drugs you are currently taking with your health care provider, including your pharmacist, when discussing your medication options and discussing this list of questions. Write a complete list of all the current drugs you are taking, including the name of the drug and the dosage (typically stated in mg). Remember to include those drugs prescribed by doctors and drugs and supplements you buy over-the-counter without a doctor's prescription, even if you take them occasionally.

  • What changes in my lifestyle (exercise more, better nutrition) could I adopt in order to better manage my mood swings?
  • What are my medication options?
  • Why are you prescribing this particular medication? How does it compare with other available types?
  • What side-effects may occur? If I have any side-effects, who should I contact?

If your doctor recommends hospitalisation (also see What MBF pays toward my treatment)

  • Do you charge a gap that Medicare or my health fund won't cover for inpatient services?
  • Do other doctors that may be associated with the likely hospital treatment charge a gap? If so, how much should I expect that to be?
  • Do you know how long the hospital stay is likely to be? Under what conditions will discharge occur?
  • What sort of monitoring and follow-up treatment should I expect once my initial treatment is over? Is there a community care organisation that could help me and/or my family with ongoing support? Or other groups that may be able to help?
  • How long after I leave hospital do you think I might need to have:
    • counselling;
    • medication; or
    • psychological therapy

Living with depression 

If you, or a friend or family member, have depression, it's especially important for everyone concerned to be very aware of the signs and symptoms of its onset and, in some cases, triggering factors (such as lack of sleep, stress, or alcohol or other drug use). It may sometimes be possible to avoid or reduce the impact of these factors in your life. Factors such as exercise and regular sleep can, in many cases, be of help in reducing symptoms.

Similarly, your doctor may be greatly helped by a close friend or family member providing insights into your general wellbeing. This can help everyone concerned gain a better understanding of how severe your condition is, how well the treatment is working and how best to manage it over time.

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What MBF pays toward treatment  

Understanding how the healthcare system works can be confusing. Most of your treatment will not be in a hospital setting as an inpatient, so it is likely your medical bills will be reimbursed in part by Medicare, and some non-medical services you receive may be from a public health service provider. However if you require admission to hospital, always check with MBF before you go. This brief summary outlines what MBF pays toward mental health treatment.

Your hospital costs 

All levels of MBF hospital cover help pay for in-patient treatments for depression provided that:

  • they are provided to you while you are formally admitted to a hospital;
  • they are treatments for which Medicare pays a benefit;
  • they are not an Excluded Service on your level of cover; and
  • you've met all the standard conditions of your membership (like serving the relevant waiting periods).

Your MBF hospital cover will help pay for the following treatments and services so long as you are formally admitted to the hospital and the above conditions are met:

  • shared accommodation (or private room if available),
  • drugs supplied as part of your inpatient hospital treatment, and
  • rehabilitation and associated therapies such as psychology, occupational therapy, dietetics, and social work as part of your inpatient hospital treatment.

The cost of participating in clinical trials and experimental drugs are not covered by private health insurance.

Remember, if you are not in an MBF Network Hospital and/or public hospital, you may incur substantial out-of-pocket expenses for your hospital charges.

Please note that doctors' charges will be part of your medical costs.

Your medical (doctors') costs 

If your doctor thinks you may need to go to hospital for care, ask your doctor to explain the costs of your inpatient care including their own fees, any fees that other doctors might charge, and any other expenses involved. If there are any gaps for you to pay, ask for a written cost estimate. This is known as 'informed financial consent'. Obtaining this information is extremely important before any planned hospital admission.

Remember, there may be more than one doctor involved in your care. You may not meet them all in person.

Each doctor will charge separately for his or her services and may or may not charge a gap.

Key things for you to know about medical costs and your health cover are:

  • MBF will pay benefits toward your doctors' charges for the service you receive:
    • when formally admitted as an in-patient in hospital or day surgery, and
    • when the service relates to treatment included under your level of cover, and
    • when you are entitled to a Medicare benefit for the treatment.
  • The Medicare Benefits Schedule Fee ('MBS') is the amount determined by the Commonwealth Government for the purpose of paying Medicare Benefits. For eligible in-patient services, Medicare pays for 75% of the MBS; MBF pays the remaining 25%.
  • Many doctors charge above the MBS, creating a 'gap' - an amount the patient has to pay.
  • MBF does not pay any amount charged by your doctor above the MBS unless there is an agreement in place between your doctor and MBF. This agreement is known as the MBF Medical Gap Cover Scheme.
  • MBF has created the MBF Medical Gap Cover Scheme to help reduce gaps paid by members. Doctors who participate in this scheme have agreed to accept the MBF benefit as full payment for your treatment. If a doctor has agreed to treat you under the MBF Medical Gap Cover Scheme there will be no 'gap' to pay for that doctor's charge.
  • It may be that not all doctors involved in your hospital treatment are 'no gap' doctors. So you may have to pay a gap for some doctors' services, but not others.

Remember, doctors are independent of MBF and can decide whether or not to treat you under the MBF Medical Gap Cover Scheme.

Click here for a list of 'no gap' doctors or call MBF.

Other costs relating to your treatment and recovery  

If you have selected MBF extras cover, MBF may also help with the cost of a number of other healthcare providers or community-based services that may assist with the treatment and management of depression. These are not payable during a hospital admission.

Depending on your level of MBF extras cover, limits of your cover and waiting periods these may include:

  • occupational therapy, to help you re-establish your usual living or working routine;
  • psychology, such as Cognitive Behavioural Therapy (CBT), group therapy, and counselling for you and family members included on your cover;
  • pharmacy (for drugs not listed on the Pharmaceutical Benefits Scheme);
  • dietetics provided by a Registered Dietitian to help establish good eating habits;
  • Living Well Programs to help pay for things like gym membership fees or yoga classes (restrictions apply); and
  • complementary therapies such as remedial massage.

MBF extras benefits are only payable for services provided in Australia by an MBF Recognised Provider. MBF Recognised Providers are health service providers that meet MBF guidelines. Call 131 137 to confirm whether or not your provider is a MBF Recognised Provider.

You can enjoy higher benefits on all preventive and general dental services and selected physiotherapy, optical, pharmacy and gym membership services (restrictions on claiming apply) by using the growing MBF MemberCare network of service providers. With our MBF MemberCare network of providers, you are guaranteed of receiving at least 70%-90% of the charge back on selected services depending on your level of cover, up to the annual limit of your cover. Find an MBF MemberCare service provider.

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More information about depression and treatment  

More about going to hospital, MBF Network hospitals, no-gap doctors, and MBF MemberCare providers 

As well as calling MBF, you can find plenty of useful information about your health cover and what to expect when you go to hospital right here on this website.

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Last updated: 05-06-07

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