Depression affects people of all races and ethnicities. But depression that doesn’t respond easily to treatment, known as treatment-resistant depression (TRD), may take a bigger toll on racial and ethnic minority groups like Black and Hispanic people, whose depression symptoms are often serious, long-lasting, and harder to recover from.
There isn’t a lot of research on how different types of depression affect different racial and ethnic minority groups. But here’s a breakdown of what we know about how treatment-resistant depression differs for Black and Hispanic adults.
Different Depression Symptoms
When you have a diverse racial and ethnic background, you may experience or talk about depression in less typical ways. As a result, doctors may not recognize your TRD right away. This can lead to delays in diagnosis and treatment.
For example, researchers found that Black and Hispanic people are less likely to bring up symptoms like low mood or hopelessness when they have depression. Instead, you may report physical problems like tiredness, aches and pains, dizziness, fainting, or even episodes of sleep paralysis.
According to one study on Black women with depression who recently gave birth, they were more likely to tell their doctors about symptoms such as:
- Sleep disruptions
- Self-criticism
- Crankiness
- Less interest in sex
- Not being able to feel pleasure
And instead of talking solely about your sadness, when you’re Hispanic/Latinx and have depression, you might say you:
- Feel nervous
- Have a headache
- Are fatigued
You might not get the best treatment if your doctor mistakes your depression symptoms for another mental illness like schizophrenia or another mood disorder, and they don’t pick the right medication or therapy at first. Mental health conditions like TRD are likely to linger the longer you go without proper care.
More Risk Factors for Depression
Depression is diagnosed most often in White Americans, but if you’re Black or Hispanic, you’re more likely to report being at risk for a depressive disorder. That means you’re more likely to have things in your life that raise your odds of getting depression.
For instance, stressful life events are a known risk factor for TRD. These challenging experiences are more common among people who come from racial and ethnic minority groups.
Some examples of stressful life events include:
- Racism and discrimination
- High levels of chronic stress
- Immigration
- Lower education and income
- Community violence
- Living in a single-parent household
- Early trauma (also called adverse childhood experiences)
Depression can also be harder to treat if you have other medical conditions. Some that often affect people of color and raise the odds of TRD include:
- Obesity
- Heart disease
- High blood pressure
- Diabetes
- Kidney failure
- Cancer
Studies show that Black people are often diagnosed with multiple psychiatric conditions, and depression can be harder to treat if you have other mental illnesses. Some examples are:
- Agoraphobia
- Anxiety or panic disorder
- Obsessive-compulsive disorder
- Posttraumatic stress disorder
- Social anxiety disorder
Barriers to Mental Health Care
There’s no single reason for disparities in TRD among Black and Hispanic people. There’s likely a complex mix of things going on stemming from cultural, social, and economic differences and inequities.
Mental health care hurdles for Black and Hispanic populations can include:
Lack of health insurance. Due to things like systemic racism, when you’re Black or Hispanic, you’re less likely to be insured or have the financial means to pay the out-of-pocket costs for depression treatment. You’re also less likely to have mental health resources in your community.
Language barriers. You may have a harder time communicating with your doctor if English isn’t your first language. And you might not take antidepressants long enough to recover from treatment-resistant depression if your doctor isn’t able to ease your concerns about medication or other treatments.
Lower income. Your odds of depression go down as your income goes up. But people who are Black or Hispanic are more likely to have lower household incomes and more financial barriers, compared to other groups.
Social stigma. There tends to be a greater negative view, or stigma, around mental illness and seeking mental health treatment among racial and ethnic minorities. And you may not ask for outside help to manage your depression, or you may not be open about your symptoms when you do.
Lack of diversity in doctors. You may feel more comfortable seeking care from someone who shares your race or culture. But if you’re Black or Hispanic, you may have more trouble finding a doctor you trust or who doesn’t hold negative racial stereotypes or biases.
Treatment response. If you’re Black or Hispanic, you may be less likely to use medication or stick with drug treatment for depression. Your genes may affect how you respond to antidepressants. Racial and ethnic minority groups are underrepresented in clinical trials that test how well depression medications work. There’s ongoing research in this area.
Misdiagnosis. If you’re Black or Hispanic, your doctor may mistake TRD for another mental illness or personality disorder such as schizophrenia, conduct disorder, or bipolar disorder. This can lead to delays in diagnosis and treatment.
How to Get Support for TRD
Despite its name, there are ways to treat TRD. But you’ll need to work closely with your mental health care team to find what works to resolve your symptoms. Ask your doctor to go over all your treatment options, including new medications, procedures, or clinical trials you may qualify for.
If you’re open to talk therapy and prefer to see a therapist of color, these groups may help narrow your search:
- Black, Indigenous, and People of Color Mental Health
- Black Mental Alliance
- Black Emotional and Mental Health Collective
- Clinicians of Color
- Therapy for Black Girls
You can also search provider directories through groups such as:
- National Queer and Trans Therapists of Color Network
- Melanin and Mental Health
- Latinx Therapy
- Therapy for Latinx
- Inclusive Therapists
Some health providers offer a free one-time consultation. Use this get-to-know-you session to find out how to get free or low-cost services based on your income level. Your doctor may also be able to point you to mental health resources in your community geared toward Black and Indigenous people, and People of Color (BIPOC).
Show Sources
Photo Credit: DigitalVision//Getty Images
SOURCES:
CDC: Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013-2016.
Keith Carter, DNP, APRN, PMHNP-BC, psychiatric nurse practitioner, Relief Mental Health, Orland Park, IL.
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NYU Langone: “Depression May Look Different in Black Women.”
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