Social stigmas, discrimination, and access to drugs have exacerbated the presence of mood disorders in LGBTQ communities.
Studies have consistently shown that people in the LGBTQ community are three times as likely to suffer from anxiety disorders, depression, and other mood disorders — a fact that has resulted in higher rates of self-harm and substance abuse in the community. This is indicative not only of the unique pressures and instances of discrimination that LGBTQ individuals face on a daily basis, but also of the dearth of health resources available to the community as a whole.
We sat down with Matt Buttigieg, a nurse practitioner who specializes in psychiatry, to chat about the root causes of mood disorders in the LGBTQ community, and the potential benefits of a joint therapy-medication regimen.
What’s Driving the Disparity?
When asked what contributes to the higher rates of mood disorders in the LGBTQ community, Buttigieg notes an oft-cited factor known as minority stress. This refers to the damaging impact that recurring discrimination and hostile environments can have on the mental health of minority communities.
Most individuals also suffer from some degree of internalized homophobia. “In general, the coming out process can be very scary and stressful,” says Buttigieg. “Family rejection, potentially becoming the target of violence and hate-crimes, etc., can take an enormous toll.” Depending on where someone comes from, he continues, “cultural or societal forces can be hugely detrimental and contribute to elevated levels of stress and anxiety.”
Others are dealing with addiction — usually as a form of self-medication. “Many substances are easier to get in the LGBT community through hookup apps, parties, and friend groups, so it’s become more normalized,” Buttigieg says. “Since there’s a history of healthcare providers discriminating against LGBTQ patients, it can be much easier to illegally acquire drugs within the community.”
There isn’t any one lone factor responsible for the widespread mental health disparities, but the inherent stress, discrimination, discomfort, and resulting dependence on substances have a huge — and interconnected — part to play.
The Challenges of Finding Care
“Many of my clients, especially ones who are coming from places other than New York City, have encountered discriminatory behavior upon revealing their gender identity in healthcare settings.” says Buttigieg. “And it doesn’t just happen with primary care doctors, but also with therapists, and even specialists like dermatologists.”
Some discriminatory behavior is less overt, but just as harmful. Buttigieg notes the frequency with which microaggressions come into play: “many providers will simply use insulting language because they don’t know better,” he says. “Because most med schools don’t teach enough about LGBTQ-specific terminology and health issues, most providers don’t even know they’re being offensive.”
“That’s why I think resources like Lighthouse are so important — not just for therapists but for all health providers. It gives patients a place where they can search for people who allow them to feel comfortable disclosing who they are as a whole person.”
Navigating Misconceptions about LGBT Depression
Because of the history of mental health professionals treating homosexuality as an illness, Buttigieg points out that there’s a lot of mistrust surrounding medication and therapy within the LGBTQ community:
“Many of my clients worry that medication for anxiety or depression will fundamentally alter who they are. Others worry that it will hinder their ability to connect with others. And many of my clients simply worry that there will be unforeseen side effects,” Buttigieg explains.
“I never try and convince my clients to do something they’re uncomfortable with,” he continues. “Instead, I focus on education — letting my clients make their own decisions, but alerting them to the consequences of those decisions, and to other options.”
Striking a Balance Between Prescription Regimens and Therapy
Studies on LGBT depression and mood disorders have shown that the first line of treatment should almost always be therapy — unless there’s risk associated with not immediately using medication. But many patients are not able to manage their mood and anxiety symptoms solely with therapy. “Generally, there’s a combination of biological factors and environmental factors that together lead to depression, anxiety, or another mood disorder,” says Buttigieg. “Medication in conjunction with therapy can help address both of these problems simultaneously.”
Finding the Right Care for LGBT Depression
If you’re struggling with depression or anxiety, it’s never a bad idea to find an affirming provider who can help you tackle these issues head on — whatever that might look like for you. “If you don’t feel like yourself, are dealing with ongoing anxiety or depression, or feel like your general happiness is declining, it’s always a good idea to go see a healthcare provider,” says Buttigieg.
Getting help doesn’t have to mean years of therapy or medication. It can be as simple as talking to someone for an hour, or as complex as finding the medication best-suited for your biological makeup. Finding an LGBT-friendly doctor who understands your specific needs is an important step for many people to work through the issues causing your depression.
“There is someone out there to support you,” says Buttigieg. “You just need to find them.”