Laura Rosen, Ph.D., is author of When Someone You Love is Depressed. She has her own private practice in psychiatry, in New Jersey.
What roles and responsibilities can family members and friends take on to help someone with a depressive disorder?
Good relationships and social support can act as a buffer against depression. Support from family members and friends can make treatment more effective. So, if you care about someone who is depressed, the first thing to do is to let them know that you care. Try to provide a warm, supportive environment. Help the depressed person get into treatment and help him follow the doctor's instructions. And lastly, try to be sensitive. Treat the person as normally as possible, but don't try to act like nothing is wrong. The depressed person will usually appreciate that you are not denying the depression and that you are willing to help in any way that you can.
What shouldn't they do?
The most important thing is not to expect the person to just "snap out it." Depression is an illness. It is not willful and people can't just "pull themselves up by their bootstraps." Unfortunately, it's not that easy. Be careful not to criticize or blame the person for the depressed behavior. And don't take the depressed person's negativity personally. Part of being depressed is seeing the world and other people in a negative light. So, be aware of that and try not to take things personally and overreact. This is also not a time to make any major life decisions. If possible, focus instead on little steps to help the depressed person get better.
Do clearly defined roles and responsibilities help improve communications?
Absolutely! If family members can pitch in and take care of some of the depressed person's responsibilities, that can be a big help. For example, if the depressed person just isn't up to doing the weekly food shopping and a spouse can do it instead, that can be a big relief. However, it's important to keep the lines of communication open and check in with the depressed person about what would be helpful. You want to help out, but not so much that the depressed person feels like an invalid, like no one relies on them. Talking is one of the most important ways of expressing and understanding each other's needs. Planning out who will do what and how much help the depressed person might need will go a long way to prevent the person from feeling isolated and alone. The more you can talk about it, the better it will be. Sometimes family members tell me that they don't want to "bother" the depressed person by discussing plans or responsibilities at home, but not talking about these things can actually result in more misunderstandings and miscommunications.
What are helpful ways family members and friends can talk to someone with a depressive disorder?
Be direct. Make eye contact. Target the problem and talk specifically about what the issue is, rather than using words like "never" and "always" that make everyone feel discouraged and overwhelmed. Use "I" statements. For example, "I feel disappointed when you don't want to go to the party" is much less accusatory than "You never want to do anything. You're just not any fun anymore!" Instead, say what you think, feel, and want clearly in a compassionate way. Reflect back what you've heard. Show that you have really have been listening by attempting to state the feeling that the other person has expressed. Check in with each other to make sure you got it right. And lastly, be willing to compromise and give each other credit for trying to collaborate on something.
Do you have any guidelines for families on how they should communicate with each other to avoid conflict?
The number one rule would be to not blame the depressed person for the depressive symptoms. Avoid statements like "You should snap out of this already" or "You're just not trying hard enough." Second, don't yell or shout. Try to remain calm and talk in a normal tone of voice. If you can keep the discussion calm, you are more likely to really hear what is being said and really be heard as well. Third, avoid bringing up past issues. For example, if your discussion is about money, stick to that topic. Don't bring up old issues about who does more housework or who gives more emotionally. Family and couple therapists call that "kitchen sinking." It's when you throw everything into the argument, including the kitchen sink. And lastly, avoid calling the person negative names. If you are angry, express your feelings, but don't negatively label your loved one as "lazy" or "selfish." Instead of helping get your point across, it will only offend or insult the person, causing him or her to tune out everything else you say.
Should people have family meetings or regular check-ins and if so what should they discuss?
Family meetings are a great idea for all families, but particularly if one member is suffering from depression. It provides a time when everyone is present and all distractions, such as phones and computers, are ignored. It gives everyone a chance to share their concerns and hear what others have to say. A great format is to have a "go around" in which each person gets 3-5 minutes to check in and share what they've been thinking about. Then each person in the room can briefly respond to that person and the whole family can do some brainstorming of possible solutions. Topics to discuss should include how the depressed person is feeling, whether the doctor/therapist needs to know any additional information, and if there is any way that family members can be helpful that they might not be aware of.
What is your advice to families?
Don't get discouraged. Depression can be a devastating illness, but the good news is that it is treatable and that there are many treatment options these days. As family members, it's important to be hopeful and believe that your loved one will get better. Be sure to work together with the depressed person to follow the doctor's advice. At the same time, it is important to have realistic expectations as well. It can take time to recover from depression and it's important to have that perspective. Be sure to take good care of yourself during the time your loved one is depressed. Consider a support group, keep up with your usual routine as much as possible, and make sure your own needs are being met. This will allow you to maintain a positive outlook and provide the love and support that your depressed loved one needs.