Depression is one of the most common medical problems affecting disability applicants. While sometimes causing severe functional impairment, depression is often unrecognized, undiagnosed and under-treated. Whether called dysthymia, major depressive disorder, or experienced as part of a bipolar disorder diagnosis, there are typical symptoms: increased sadness, anxiousness, irritability, hopelessness, and guilt; loss of interest in formerly enjoyable activities; increased fatigue and restlessness; poor concentration and poor memory; difficulty sleeping or sleeping too much; an inability to handle stress or make decisions; increased physical pain; isolation; and even thoughts of death. Depression can cause a person to miss days of work, perform poorly at work due to inattention or lack of motivation, and be the cause of conflict between the individual and his co-workers, family and friends.

One of the problems with depression (or its cousin, anxiety) is that the condition itself can create a barrier to getting help. Someone with a horribly painful back usually gets into a doctor because she knows that is the most likely place to get relief from that pain. Depression, however, affects the way we think about the challenges we are facing. When you are already having problems getting out of bed in the morning, brushing your teeth every day, getting dressed, or just finding the energy to make a meal, the effort required to set up a medical appointment with a medical provider is overwhelming. Depression may make you think that nothing can possibly help and that seeking help is a waste of time.

Complicating this picture is that it is often hard to acknowledge that you are suffering from depression. Many of us are raised to see depression as a personal or moral weakness. Depression can also be a secondary effect of another chronic illness or chronic pain condition (it is a rare person who is suffering from chronic pain who does not also suffer from some degree of depression or anxiety) and so we don’t realize we are depressed because of the bigger problem. Sometimes it is just difficult to know what is troubling you until family members or friends finally tell you that your personality has changed and urge you to seek help.

Social Security, however, demands that a person get consistent treatment to prove disability due to depression or just about any other mental health disorder. A diagnosis of the condition must be made by a trained medical professional (preferably a psychiatrist or psychologist, but a nurse practitioner or your own primary care doctor can make the diagnosis), with continued treatment by a mental health professional to document your symptoms and the severity of the impairment caused by your depression. Additionally, you need to take prescribed medication, reporting any side effects.

This may sound overwhelming. But you must start down that path. Talk to family or friends to see what they think. Ask for their support. Reach out to your doctor and make an appointment specifically to talk about your depression. Write down a list of your problems over the week before you go in. If you do not have a doctor, reach out to your local clinic or even to the county health and human services for a referral. Don’ t just see a doctor once every few months for medication management, but seek out more frequent mental health therapy with a psychologist, clinical social worker or licensed marriage and family therapist. Be honest in therapy. Do not minimize your problems or decide that an issue is too small to be discussed. Take your medications and report any side effects so that changes can be made. Hopefully, that effort will help you feel better and more functional. If not, the medical records created will help explain why you are not able to work.