Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Megan,

If you regularly read these postings, you'll know that I addressed a very similar situation a few weeks ago. Situations like yours really distress me, because I know that the care you desire would really help you. And I know that the limited access to such care is a reality not just for you, but for so many people in our country who are in need and who could be helped.

OK, we have to get practical. I can't tell from your question whether you live in a city or the country. In general, it's harder to find counseling in the country than in the city. I also do not know all the places you've tried, so forgive me if I suggest things you've already tried.

The first thing I'd do is see what services are offered by your county's mental health system. I'm often pleasantly surprised by the level of care that can be available at county clinics. Because these facilities are not as bound by the need to make money, they sometimes offer more than what all but the higher-priced clinicians provide. On the other hand, some county clinics are terrible. And some counties don't really have any facilities at all.

If your county system does not offer what you need, you might think of turning to the church. Again, this varies widely by denomination and from one region of the country to another, but many people in the ministry have at least basic training in counseling and can be quite helpful in my experience. This is especially true for the pastoral staff of mainline denominations.

But let me qualify this suggestion by telling you loud and clear that you need to avoid anyone who would view your depression as anything other than a mind-body disorder that needs treatment. Avoid those who would see depression as a punishment from God or as a sign that you don't have enough faith. And of course, if you are not involved in a church, this whole suggestion won't be of much value.

Finally, if you can't identify counseling that you can afford, let me encourage you to consider seeing your primary care doctor to be evaluated for potential antidepressant treatment as a "stop-gap" measure.

Most antidepressants come in generic form now and thus are inexpensive. It is really important that you don't let the depression linger without treatment. We know now beyond a shadow of a doubt that depression inflicts physical damage on the brain and the body, and the longer a person is depressed, the more damage is done.

So please consider medication treatment if counseling is really impossible in your current situation.