When You or Someone You Love Is Depressed

By Neli A. Rogers, MS, LMFT

    There are many misconceptions about mental illness. In this article I’ll address two questions we might have when we or a loved one is struggling with depression

  1.      How can we go beyond the myths and stigma and get the facts? 

  2.      What impact do these conditions have on the family, and how can we best respond when they affect us, our spouses, or our children?

    People still tend to view mental illness differently than they view physical illness.  This tends to create undo stress and fears when we, or our loved ones, suffer from any type of mental illness.  There still remain many myths and misconceptions about mental illness.  Since depression is a very common  mental illness, these myths and misconceptions are faced by many who are depressed and must suffer silently at times for fear of being “judged” by others.

    Some believe that people with depression are just “faking” their symptoms, that they are lazy, and they can just “snap out of it” any time they choose to do so.  There might also be a belief that people with depression are dangerous, their disease may not be treatable, or that we need to stay away from them.

    Those who believe in these myths and misconceptions, add much unnecessary pain and hardship to themselves and others.  Therefore, the first thing we need to do when faced with depression is to get the facts.  This may take effort, but if we commit to finding the truth, “half the battle” is won. 

    Here are the facts:

    According to the National Institute of Mental Health (NIMH), “In any given 1‑year period, 9.5 percent of the population, or about 18.8 million American adults, suffer from a depressive illness.” [1] 

The NIMH describes depression on their website on depression as follows:

A depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression. [2]

The Mayo Clinic website on depression describes depression as follows:

Depression is a disorder that affects your thoughts, moods, feelings, behavior and even your physical health. People used to think it was "all in your head" and that if you really tried, you could "snap out of it" or just "get over it." But doctors now know that depression is not a weakness, and it's not something you can treat on your own. Depression is a medical disorder with a biological and chemical basis. [3]    

    Sometimes a stressful life event triggers depression. Other times depression seems to occur spontaneously with no identifiable specific cause. Depression is much more than grieving or a bout of the blues. Depression may occur only once in a person's life. Often, however, it occurs as repeated episodes over a lifetime, with periods free of depression in between. Or it may be a chronic condition, requiring ongoing treatment over a lifetime.

    People of all ages and races suffer from depression. Medications are available that are generally safe and effective, even for the most severe depression. “With proper treatment, most people with serious depression improve, often within weeks, and can return to normal daily activities.” [4]

    Hopefully, as we refer to these two very reliable sources of information about depression (the National Institute of Mental Health and the Mayo clinic), we can put aside the misconceptions that depression is not a disease, that people are faking it, or that they can just “snap out of it.” 

    In continuing our efforts to “get the facts,” I’ll now present an overall view of depression—its most common symptoms, its causes, and who gets it. 

    According to the Diagnostic and Statistical Manual of Mental Disorders, mental health professionals diagnose depression when four or more of the following symptoms have been present for at least two weeks, generally nearly every day:

• Feeling sad or irritable during the course of the day

• Loss of interest or pleasure in activities once enjoyed, including sex

• Changes in weight or appetite

• Changes in normal sleep patterns, difficulty falling asleep, interrupted sleep, early morning awakening

• Fatigue or loss of energy

• Feeling worthless, hopeless, or feeling unreasonable guilt

• Inability to concentrate, remember things, or make decisions

• Restlessness or decreased activity

• Complaints of physical aches and pains for which no medical cause can be found

• Thoughts of suicide or death [5]

    There is no single known cause of depression.  Experts believe that there are many factors that can trigger a depressive episode.  Some of these factors include:  heredity, stress, certain medications, certain illnesses, personality type, low self-esteem, pessimism, hormones, giving birth, drugs, and alcohol.

    The exact mechanism in the brain which leads to depression is not completely known, but experts believe that a combination of genetic vulnerability combined with one of the above-mentioned factors may trigger an imbalance in the brain chemicals called neurotransmitters, which in turn causes depression.  The neurotransmitters mostly linked with depression are serotonin, norepinephrine, and dopamine. [6] Most medications for depression are related to the regulation of these three brain chemicals.

    Women experience depression about two times more often than men, perhaps due to their hormones, menstrual cycle changes, pregnancy, miscarriages, pre-menopause, menopause, and postpartum—which is one of the most vulnerable times for women to develop a depressive episode.  Even though women are more susceptible to depression and they attempt suicide more often than men, men are more vulnerable to suicide completion (four times the rate of women).  Because of this fact, we need to be watchful for suicidal risk when men are depressed.  For the last two decades, depression in children has been taken more seriously.  Because children’s symptoms may be somewhat different from adults’ symptoms, their depression is sometimes misdiagnosed.  If children have a change of behavior and are irritable, sulking, clinging to parents, anxious, or they “just don’t seem to be themselves,” parents should have them checked by a doctor or mental health professional. 

    People may have just one episode of depression, which is diagnosed as Major Depressive Disorder Single Episode, or they may have recurrent episodes, which are diagnosed as Major Depressive Disorder Recurrent.  Each episode can be classified as mild, moderate, severe without psychotic features, or severe with psychotic features.  If a person has periods of depression and periods of mania, he or she is diagnosed with Bipolar Disorder.  If a person has a prolonged, low-grade depression that lasts for over two years, he or she is diagnosed with Dysthymic Disorder. [7]

    Now we will discuss the second question:  What impact do these conditions (depression) have on the family, and how can we best respond when they affect us, our spouses, or our children?

    Depression affects not only the person suffering from it but also their loved ones.  Serious depression can be very detrimental to marital relationships, and a mother who is severely depressed can have a huge impact on her children’s wellbeing.  Because depression leads people to feel exhausted, worthless, helpless, and hopeless, they are not able to function at their normal capacity.  This places a great burden on themselves, their spouses, and their children. In NIH Publication No. 00-3561, the National Institute of Mental Health gives the following advice for people with depression:

• Set realistic goals in light of the depression and assume a reasonable amount of responsibility.

• Break large tasks into small ones, set some priorities, and do what you can as you can.

• Try to be with other people and to confide in someone; it is usually better than being alone and secretive.

• Participate in activities that may make you feel better.

• Mild exercise, going to a movie, a ballgame, or participating in religious, social, or other activities may help.

• Expect your mood to improve gradually, not immediately. Feeling better takes time.

• It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition—change jobs, get married or divorced—discuss it with others who know you well and have a more objective view of your situation.

• People rarely "snap out of" a depression. But they can feel a little better day-by-day.

• Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.

• Let your family and friends help you. [8]

Here are some important things you can do if one of your loved ones has depression:

• Make sure you have the facts and do not fall victim to any of the myths and misconceptions discussed earlier.  Depressed people already have enough feelings of guilt, hopelessness, and worthlessness.  They need your support, acceptance, and rational thinking to help them counteract their irrational thoughts.  They need your emotional support.  For example, do not accuse the person of faking the illness or being lazy.  This only makes matters worse.

• Encourage them to get the appropriate diagnosis and treatment.  This usually requires medication and psychotherapy.  Make sure they take their medications.  Participate in their therapy, if indicated.

• Be sure to be patient, affectionate, and encouraging.  Sometimes you may need to have supportive therapy for yourself so you can understand what they are going through.  You may need to develop your own coping skills to deal with the disruptions in your life brought about by the illness.

• Do not ignore remarks of suicide.  If your loved one mentions suicide, or a wish to die, or has marked hopelessness, report these symptoms to the person’s therapist.

• Make sure you remain hopeful and positive so you can continuously reassure the depressed person.

    The most effective treatment for depression is a combination of medications and psychotherapy.  Medications are prescribed by medical doctors, preferably psychiatrists.  Psychotherapy is provided by mental health professionals (marriage and family therapists, psychologists, social workers, etc.)  Research shows that interpersonal and cognitive/behavioral therapies are very effective in helping people with depression. If you or your loved one has depression, seek help as soon as possible since early treatment is more effective and prevents unnecessary pain and suffering for you and your loved one.

    If we seek out the help we need when depression strikes our families, we will be able to handle its effects much more effectively and avoid undo stress and pain. Depression is not a sin or a lack willpower or faith. Depression is a treatable disease. There are many good self-help books on depression. One book I would like to recommend is Feeling Good: The New Mood Therapy by David Burns.

    If we seek out the help we need when depression strikes our families, we will be able to handle its effects much more effectively and avoid undo stress and pain. In Closing, I would like to re-emphasize that depression is not a sin, depression is not a lack willpower, depression is not a lack or faith. Depression is a medical disorder with a biological and chemical basis. Depression is a treatable disease. I hope that each of us, when we know of someone with depression, we’ll treat them with love and tenderness so we can help them heal.

References:

[5], [7] American Psychiatric Association:  Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition. Washington, DC, American Psychiatric Association, 1994.

[3], [4], [8] http://www.mayoclinic.com/health/depression/DS00175

[1], [2], [6] https://www.nimh.nih.gov/health/topics/depression

Other Helpful resources:

Burns, David D., M.D. Feeling Good—The New Mood Therapy.  New York:  Avon Books, 1992.

Mental Health America: (800) 969-6642;

or, in a crisis: 988 - Suicide and Crisis Lifeline

National Alliance on Mental Illness (NAMI):  (800) 950-6264.

National Institute of Mental Health  https://www.nimh.nih.gov/

Depression and Bipolar Support Alliance: (800) 826-3632.