7 Things LGBTQ+ People Should Know About Major Depressive Disorder

Life with major depressive disorder (MDD) (aka major depression or clinical depression) can be hard to navigate, and that’s especially true if you’re a member of the LGBTQ+ community.

Here, find out what you should know about MDD if you’re LGBTQ+.

Factors Influencing Depression Among LGBTQ+ People

High rates of hate crimes and legislative efforts to restrict the daily lives of LGBTQ+ people can lead to stress and depressive symptoms, even if the person doesn’t personally experience acts of hate themselves or live in a state with a hostile legislative environment, says Kristen Choi, PhD, a psychiatric mental health nurse practitioner and an associate professor of nursing at the University of California in Los Angeles who studies health services and policy approaches to mental health, health disparities, and trauma among children and other vulnerable populations.

“When people experience rejection, discrimination, lack of support, and lack of community related to their sexual orientation or gender identity, depression may be exacerbated, and some people may even experience suicidal ideation,” says Dr. Choi.

Given the unique stressors that can contribute to worsened mental health among LGBTQ+ individuals, it's crucial to know about how depression affects LGBTQ+ communities — and how to find the right treatment and support. Here are seven key things to be aware of.

1. LGBTQ+ Identity Does Not Cause Depression — Discrimination Does

An LGBTQ+ identity doesn’t make someone more susceptible to MDD on its own, says Lex Pulice-Farrow, PhD, an assistant professor of clinical and counseling psychology at Muhlenberg College in Allentown, Pennsylvania, who identifies as transmasculine nonbinary. “Being queer or trans doesn’t directly cause depression,” says Dr. Pulice-Farrow, who uses they and he pronouns.

“But the stigma, discrimination, worries about whether I can use the bathroom safely or whether I can access medical care can all increase the risk, and so can just anticipating these stressors,” they say. “Know that it’s not who you are that’s the issue.”

2. It’s Crucial to Find an LGBTQ-Affirming Therapist

It can be really hard to take the first step to get help when you have depression, and it’s even harder when you’re worried about whether a therapist will respect and understand your identity, says Choi.

Helpful resources for finding an affirming therapist include referral services like the LGBTQ+ Healthcare Directory, the Association of LGBTQ+ Psychiatrists, and OutCare’s OutList LGBTQ+ Affirming Healthcare Directory to find one near you. Psychology Today, which lets you search for LGBTQ-affirming therapists by ZIP code or city, is another good place to start, Choi says. These providers may note whether they have specific training in LGBTQ+ health, identify themselves as allies, share their pronouns and encourage others to do the same, or work for organizations whose missions and values align with affirmative care, Choi says.

3. It’s Key to Vet a Therapist Beforehand

Once you find a therapist who seems like a good fit, reach out and ask them specific questions about their experience with and treatment approach for LGBTQ+ clients before you book an appointment, says Megan Sutter, PhD, a health research scientist in Atlanta who researches LGBTQ+ health.

“It’s one thing to check a box on an online profile to indicate you can treat LGBTQ+ people, but the way someone speaks about their work is more telling,” says Dr. Sutter, who uses they and she pronouns. “There are unfortunately some providers who say they do gender exploration work and what they’re really talking about is being anti-trans or not acknowledging how gender-affirming care can be potentially lifesaving, especially for someone with depression.”

It’s a red flag, for instance, if a therapist doesn’t want to answer questions about their own pronouns or discuss their approach to supporting people who are exploring their gender identity or sexual orientation, Sutter says.

4. If Depression Treatment Is Affirming, You’ll Be More Likely to Stick With It

Care that’s affirming boosts your odds that you’ll keep up with it (and therefore better manage your depression), Sutter says. “If this means finding a new provider or finding new supports in your community, you need to prioritize that, because MDD isn’t really something you can fix all on your own.”

Also, don’t lose focus on mood-boosting lifestyle strategies like exercise, good nutrition, and plenty of sleep, Pulice-Farrow says. “This isn’t the sexy part of recovery, but it is necessary,” they say.

5. Stigma Can Keep LGBTQ+ People From Getting Help for Depression

“The stigma and discrimination that LGBTQ folks experience are unique, chronic stressors that they face over and over in addition to the everyday stressors that everybody in the general population faces,” Sutter says. This is especially true for people who have been made to feel like their sexual or gender identity is wrong or that it's causing their mental health problems, they say.

Try not to let fear of stigma keep you from seeking affirming care for depression. An affirming provider will acknowledge the added stressors and stigma that LGBTQ+ patients may experience, and can make addressing these issues a focal point of treatment, Sutter says.

6. Support From Friends In Person or Online Can Help, Too

“Finding community and solidarity is critical,” Choi says. “This is especially true for members of the LGBTQ+ community who might be experiencing mental health challenges.”

Just getting out of the house to connect with people who can support and accept your identity can boost your mood, Pulice-Farrow says. It might be an LGBTQ+ organization that offers a safe space to socialize or anywhere else that’s affirming. “Maybe for you it would be a gardening club, or meeting a friend at a brewery; even if it’s not specifically a queer space, it can help as long as you feel safe there,” they say.

Virtual communities count, too. In many instances, social media can be a supportive space for LGBTQ+ people, especially when they don’t live in households or communities that make them feel safe and supported, Sutter says.

“There are downsides to social media, but I know it can be a go-to place for the kind of connection and support that can be very positive for people with depression,” Sutter says. “It’s also safer if you can’t be out and you need to be anonymous.” One safe option for LGBTQ+ young people ages 13 to 24 is TrevorSpace, an affirming online community hosted by The Trevor Project, an LGBTQ+ suicide prevention and crisis intervention organization.

7. Watch Out for ‘Co-Rumination,’ Which Can Worsen Depression

If you’re fortunate enough to be part of an LGBTQ+ community where you feel welcome, there may still be a potential downside when it comes to your mental health: “co-rumination,” Pulice-Farrow says. That’s when a group of people who are all experiencing common stressors dwell on these stressors in their conversations. While these stressors are important to talk about, talking about them all the time can actually exacerbate symptoms for people with MDD.

“It’s understandable that this could be a really anxious space, given everything going on in the world,” Pulice-Farrow says. “It’s important to have the wherewithal to recognize when a negative conversation goes on too long and is impacting your mood, and take a step back and suggest a change of subject.”