It is very difficult for families and friends to help someone who is depressed. We are concerned about our loved ones, but often frustrated, angry, and fearful as we attempt to deal with the depressed person's condition (see below).
We've put together some suggestions that may help you help someone receive treatment or help someone manage depression, once diagnosed.
Helping Someone Manage Depression
Medical professionals often remark on how helpful family members and friends can be in reporting changes in depressed patients' symptoms and ensuring that patients consistently take their prescribed medication.
Families need to work together in managing treatment, since mood changes and behaviors affect the whole family, and many issues are involved in treatment. Ways in which you can work as a team are to:
- Partner in treatment. Medications take up to 4 to 6 weeks to take effect, the dosage may need to be adjusted, and medications often need to be changed. You can help your depressed family member or friend by scheduling and tracking medications, making medical appointments, and reporting changes to the medical professional.
- Be understanding. Let your depressed family member or friend continually know that you care. Depressed people need to be reminded that many people are concerned about them.
- Learn about depression. The more understanding you have of the symptoms and issues surrounding depression, the more you can cope, help, and keep your expectations realistic. Review books, brochures, Family Profiles (see www.familyaware.org), and videos on a variety of depression topics.
- Share your feelings as a family. Since depression affects the whole family, it is important for everyone to share their feelings, both the depressed person and caregivers. By talking about issues and emotions, you can uncover what works and what is not helpful to one another.
- Meet with the depressed person's doctor. Meeting with the medical professional from time to time can be very helpful, if your family member or friend with depression will agree to it. You can gain a good understanding of the condition and discuss issues together.
- See a family or couples therapist. Marriages in which a spouse has depression have a much higher likelihood of ending in divorce. Couples therapy can help restore relationships by addressing resentful feelings and honing communication skills. In addition, children with depression in the family need support and ways to become resilient to developing depression themselves. Family therapy helps children understand that they didn't cause the depression, discuss their feelings, and learn coping mechanisms.
- Develop a crisis plan. Talk to your depressed family member or friend about what you will do if there is a crisis, under various circumstances, and where you will take the person. Put the plan in writing.
- Create a support system. Try not to take on caring for a depressed individual all by yourself because it is a difficult task and can bring you down. Talk to other family members about sharing responsibilities.
- Seek immediate help. If at any time your depressed family member or friend talks about death or suicide or may be harmful to you or others, seek immediate help. Contact your doctor, go to your local emergency room, or call 1-800-273-TALK.
Questions for the Clinician
A good way to partner in treatment and provide emotional support is to go to appointments periodically with the depressed person. You can keep track of the clinician's recommendations, discuss changes in symptoms, and review the treatment plan.
Before you see the clinician
- What types of patients and conditions do you currently treat in your practice?
- What do you do when you are unsure of a patient's diagnosis or treatment?
- How do you involve families and friends in treatment?
During the visit
- What is the possible diagnosis at this point?
- How definite is this diagnosis? If not definite, what are the other possibilities?
- What your recommended treatment (e.g., medication, psychotherapy)?
- What are the expected results of treatment?
- What signs should we look for that indicate the therapy is working?
- How soon will we see these signs?
- What will you recommend if this course of therapy does not work?
- Why have you chosen this particular medication?
- What are the risks and side effects of the medication?
- Is this a case that you normally treat and that is within your practice capabilities?
- What role can we play in helping with treatment?
- Which days and times are best to reach you?
- Who can answer our questions as they come up and when you are unavailable?
- What have your been your experiences with our insurance company and how can we facilitate the reimbursements?
- Do you recommend that we get a consult with another psychiatric specialist?
If treatment is not working
- Is there something else we need to be doing?
- Are there any issues that may contribute to our family member or friend not responding to treatment (e.g., noncompliance with medication)?
- How can we help in getting treatment to work?
- Should we get a second opinion?
Helping Someone Receive Treatment
Families and friends often are unsure how to convince their loved ones to see a medical professional. In a compassionate way, explain to the person that you are concerned that he or she is showing symptoms of depression, a treatable medical condition. Often, people with depression feel very relieved to learn that they are suffering from a medical condition. Ask the person to see a medical professional, offer to make an appointment, and go with the person or call the doctor in advance to state the person's symptoms.
What not to do
When your help is refused
Helping children and teens
- Show you care. Depressed people feel isolated in their pain and hopelessness. Tell your depressed family member or friend how much you and others care about the person, want the person to feel well, and are willing to help. Listen and sympathize with the person's pain.
- Acknowlege the relationship impact. In a caring way, let the person know that depression affects you and others in the family. Your relationship, including intimacy, household responsibilities, and finances, are all adversely affected when someone is depressed.
- Be informed. Read a brochure, Family Profiles (see www.familyaware.org), or a book, or watch a video on depression and share the information with the depressed person. Stress that depression is a treatable, medical condition, like diabetes or heart disease, not a sign of weakness. Assure the person that people with depression do feel better with treatment.
- Use a symptom list. Go through the depression symptom list with the person who is depressed or have the person take a confidential evaluation that will guide him or her toward medical help. Take the symptom list to the appointment for discussion with the medical professional.
- Reach out. Find other people to help you get your loved one into treatment, especially medical and mental health professionals such as your primary care physician or a psychiatrist, psychologist, or social worker. Think of others to whom the depressed person will listen, such as family members, relatives, teachers, friends, or a member of the clergy, then enlist their help.
- Seek immediate help If at any time your depressed family member or friend talks about death or suicide or may be harmful to you or others, seek immediate help. Contact your doctor, go to your local emergency room, or call 1-800-suicide or 911.
What not to do
People with depression are suffering from a medical condition, not a weakness of character. It is important to recognize their limitations.
- Do not dismiss their feelings by saying things like "snap out of it" or "pull yourself together."
- Do not force someone who is depressed to socialize or take on too many activities that can result in failure and increased feelings of worthlessness.
- Do not agree with negative views. Negative thoughts are a symptom of depression. You need to continue to present a realistic picture by expressing hope that the situation will get better.
When your help is refused
Often when you try to help someone who is depressed, your help is declined or nothing you do seems to help. You end up feeling rejected and discouraged that there is nothing more you can do.
Depressed people may reject your help because they feel they should be able to help themselves, and feel worthless when they can't. Instead, they may withdraw or start an argument in an effort to resolve their difficulties. In addition, people with depression have negative thoughts and feel so hopeless that they do not see recovery as a reality.
Fifty percent of people with bipolar disorder have a lack of insight, so they do not realize they are ill. For example, people with bipolar disorder may believe they are a "high-energy person." This makes family involvement in seeking and managing treatment even more critical.
With these difficulties in mind, what can you do if your help is turned away?
- Provide consistent support. Over time, if you consistently show support, the depressed person will see that you are resolute and may accept your help. Continue trying some of the tips discussed in this section.
- Discuss your feelings. When your help is refused, restate how much you care for the person. Let the depressed person know how you feel, gently, by stating an example of the support you have offered and how it makes you feel when it is rejected.
- Focus on behaviors. If the depressed person is reluctant to seek help, then don't try to convince the person that depression is causing the problems. Instead, talk about the depressed person's behaviors and the ways in which treatment can help. For example, after you have listened and sympathized with the depressed person's feelings, try to agree on wellness goals (e.g., consistent sleep and feeling less irritable). Then, try to assign some action steps that you can agree on to reach these goals (e.g., after two weeks, if the person does not improve, you will set up a medical evaluation).
- Agree on professional help. It is important to make sure your loved one gets the professional help he or she needs. Sometimes a primary care physician can seem less threatening, or a psychotherapist, or a couple's therapist.
Helping someone who is depressed and reluctant to seek treatment can be very trying and frustrating. As much as possible, try to enlist the aid of family members, friends, and medical professionals in this process.
Helping children and teens
Each year, 3 to 6 million Americans under the age of 18 suffer from depression. Although the symptoms of depression are the same as those for adults, children and teens may not be able to express their feelings as well or may exhibit different emotions. Look for signs of declining school performance (e.g., poor grades), frequent temper tantrums, outbursts of crying, or unexplained irritability.
Your child must receive treatment for depression. Children need to learn how to continue to develop and find ways to cope. In addition, teens suffering from depression are at risk for committing suicide, the third leading cause of death among 15 to 24 year olds.
Treatment of depression for children and teens includes psychotherapy and medication. Psychotherapy helps children and teens learn how to express their feelings and gain critical communication skills. The use of medication is an emerging field in child psychiatry, and medications have been approved for children in certain age groups.
Dealing with your own emotions
The stress of caring for a depressed person is significant. Family and friends often develop depression themselves and suffer from anxiety or a host of other problems. Be sure to expand your social network through support groups and other caring communities. Try to find other people to help you care for your loved one, so you don't shoulder the responsibility by yourself.
- It's not your fault. You did not cause your family member to be depressed. It is not due to anything you said or did. Depression is a medical condition that needs to be treated, just like heart disease or diabetes.
- You are not alone. Depression is an extremely common condition, and many families are caring for someone with depression. You can meet them through depression support groups.
- Your reactions are normal. Most caregivers experience a range of feelings, from compassion and understanding to frustration, anger, and hatred. These feelings are to be expected because it is extremely difficult not to take a depressed person's behavior personally. Symptoms such as withdrawal and irritability adversely affect you and create conflict in your relationship.
- Your emotions will change. Family caregivers commonly go through various emotional stages as they find out their loved one has depression and then move to managing the condition over the long term. Initial reactions are relief, shock, or even denial. Often families say they thought a magic cure would exist for the condition, and it would go away. As time goes on, you may feel angry or resentful that your life is different from other families' lives. You may grieve for the person you once knew and feel you have lost them. As you find effective treatment for your depressed friend or family member, you will feel relieved and lucky that your loved one is doing better. You may also be ready to reach out and volunteer or advocate for depression awareness.
- Take time to care for yourself. Set healthy boundaries and limitations on how much you will do. Take a vacation from caregiving from time to time. Be sure to schedule time for yourself to do activities that you enjoy. Do not be afraid to seek counseling for yourself, to process and deal with your own emotions.
- Find social support. Dealing with depression can be very lonely and isolating. You've watched the healthy person you once knew deteriorate and suffer. Your friends don't understand, and it is difficult for you to go out. Make sure you find sources of social support through support groups and your community.
- Have hope. Remember that in most cases, depression is highly treatable (80% of patients improve with treatment). Depression is cyclical, so it will be worse at times, then become easier. Sometimes caregiving will be overwhelming, but it is manageable. Finding the right treatment takes time but does happen eventually.
Why family and friends are important
Family and friends are essential in helping those who are depressed. Sufferers of depression are often unable to function and need family and friends to help recognize and manage their condition. Health care coverage may not provide enough psychiatric visits or hospital stays. Family and friends are left to fill the void.
Unfortunately, family and friends operate with little knowledge and guidance on how to recognize and cope with depression. Clinicians normally focus on the depressed patient, not family and friends. In the past and even now, families are often blamed for causing the depression. Social stigma associated with depression causes many families to live in secrecy, afraid and unprepared to talk about the condition openly.
Family and friends are very much affected by depression. In helping a depressed person, they take on additional responsibilities at home and work. Depression symptoms, including withdrawal, irritability, and hopelessness, strain relationships. Those living with someone who is depressed are much more likely to become depressed themselves.
The good news is that when families and friends are armed with knowledge of depression and find support, they are able to improve treatment results and cope effectively. According to research, families that discuss depression and increase their understanding of the condition achieve long-term positive change in family functioning and increased resiliency in children. By learning about depression and about ways to help your depressed loved one and handle your own emotions, you can effectively manage depression over time.