An expert's view: Treating hidden illness has multiple benefitsDr. Michael Trangle

Depression can hide in plain sight. 

“It’s invisible in many ways, said Dr. Michael Trangle, a psychiatrist and associate medical director for Behavioral Health at HealthPartners. “It’s not like somebody broke their femur and you see them in a cast or crutches.” 

Consider a patient who first saw Trangle because his wife pushed him to tackle his irritability, sleep problems and stress. 

“He wasn’t subjectively even feeling sad,” Trangle noted. “Generally he was not in touch with his feelings unless he was angry. He felt hopeless, pessimistic, and irritable and angry. Depression made him feel so stuck that nothing in his life was going well.”  

The man began using antidepressants and improved some, but he was still quite anxious, Trangle said. Using a second medication and talk therapy helped to change his patient’s outlook and habits. 

“As he got better he was fretting less, and he could consciously leave work earlier and focus on his family interactions more. He started to get more exercise, which helped his anxiety and sleep,” Trangle said. 

That patient understood the impact of his depression more as he recovered. “He wasn’t even aware of it (before treatment), and it was majorly impacting his marriage, his enjoyment of being a father, and his career,” Trangle said. “He says his life is so much better today.”

This patient’s experience is not unusual, Trangle said.

“Depression is very, very common. It often grows imperceptibly and can ruin people’s lives in ways that are so subtle and un-dramatic that it is almost like a silent disease. Even when people do recognize it, we need to improve attitudes, so people realize depression is a disease and treatable. One barrier to treatment is the unhealthy and inaccurate idea that people should just ‘buck up’ and use their willpower to get over it. It’s wrong. Depression is not a sign of weakness or moral failure. These attitudes must shift so more people get adequate treatment and get into remission,” he said. 

A proactive team of providers and engaged patients makes a powerful partnership to fight depression. Triangle helped develop the Help & Healing Toolkit to share useful materials with providers and patients. 

Under the less effective, old paradigm, the doctor-patient relationship was more like a mechanic-car relationship – the attitude was that the patient could just passively wait for the doctor to perform the tune-up. Now that more clinics are implementing best practices for depression care and using the “Patient Health Questionnaire-9,” or PHQ-9, patients and providers can easily jointly monitor symptom severity and improvement, Trangle said.  

“That changes the whole paradigm. The patient is more likely to be an equal, active participant,” he added. 

Help and Healing can put useful, patient-centered materials and tools in patients’ hands. Trangle recommends both patients and providers access the resources to determine what may be most useful for an individual patient. He recommends that patients partner with their provider and, depending on their situation, might focus on managing sleep, exercise, increasing pleasant activities, and decreasing caffeine and/or alcohol. It’s also wise to prepare for their provider visit ahead of time.  

“There’s evidence to show that patients who are more engaged and active in their own treatment tend to have better outcomes,” Trangle noted. “Engaged patients are more likely to reach remission from their depression and also to stay in remission. Using the contents of the toolkit makes it easier and more likely that patients will succeed.”

Addressing depression can also have additional benefits, especially for patients with complex conditions. Patients with diabetes, recent heart attacks and strokes, cancer, chronic pain, substance abuse and dependence all have higher rates of depression and significantly worse outcomes if the depression is not treated,” Trangle said.  “Community standard is that most medical or specialty clinics treating these conditions do not routinely screen for depression. A few do, and most should. People with depression deserve for this to be recognized and treated as much as any other disease.”