Depression and its management in the family

Depression is a mental condition with serious social, professional and personal consequences. It affects people of all ages regardless of socio-economic status. Although there is more and more talk lately about depression and mental health, we still face stigma and find it difficult to treat and recognize this disorder.

Depression is a major factor in suicide, so it is crucial that people suffering from this disorder receive some form of treatment.

There are treatments that work, both psychological and drug treatments and alternative treatments (transcranial electrical stimulation), but around 35% of patients do not receive any form of treatment.

It’s not always obvious when someone is going through a depressive episode, sometimes even the person affected doesn’t understand what’s going on. That’s why it’s important to understand what depression looks like. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines a major depressive episode as a state of sadness and loss of interest or pleasure in activities that were previously pleasurable. Symptoms must also last at least two weeks and at least 5 of the following types of symptoms must occur:
  1. Sleep problems almost every day (either sleeping too much – hypersomnia or too little – insomnia)
  2. Changes in appetite or weight (too low or too high appetite and sudden weight changes)
  3. Low energy and fatigue almost every day
  4. Difficulty concentrating, making decisions, psychomotor agitation or sluggishness that is noticeable to others
  5. Recurring thoughts about death and suicide, suicide attempt or a specific plan to commit suicide
Living with someone with depression can be challenging because you don’t always know what to do and how to react in a way that is healthy for the other person. The most important thing you can do for the depressed person is to provide emotional support. Sometimes it can be hard to offer this unconditional support because the negative state of the person affected can end up affecting you in one form or another.

It is important, however, to acknowledge their distress and accept that for a time the person’s condition will be marked by sadness, withdrawal or even irritation that is not related to you in particular, but is simply a depressive symptom. Therefore you have to learn not to take things personally and offer space and empathy according to the person’s needs.

In general, social support alleviates psychological distress. If there is a perception of emotional availability on the part of loved ones, a kind of protective barrier against depressive episodes and a wider range of psychological disorders appears. Providing emotional support means creating a safe space that allows trust to develop, offering care, empathy and love.

When a person suffers from depression, they are not the only one suffering, the family is also impacted. Depression isn’t always obvious from the start, but even if the person shuts down, doesn’t talk about how they’re feeling and tries to mask their symptoms, the dynamics in the family change. It creates a tense atmosphere, marked by agitation and worry. Family members may feel some level of guilt because there may be a sense that they should be able to do more to help the person recover from depression as quickly as possible. Family members may also experience feelings of fear and anxiety, feelings of helplessness, irritation or even anger at the current situation. These feelings then lead to guilt and shame for being angry at the person with depression → these are all normal feelings and it is important to set our minds in such a way that we understand that it is normal to be angry at the situation itself, not at the person or the behaviours they are experiencing due to depression. Recovery is a longer process, and the depressed person needs to take an active role in recovery, not something others can do to instantly cure him/her or make him/her feel better, and the best thing you can do is to build an environment where the person with depression feels safe to navigate that depressive episode until the symptoms improve.

anxiety disorder

How a family responds to a member’s depression has a major impact on the recovery process

For example, a hostile, critical environment, and even pressure to display a positive attitude (stemming from good intentions to make the person feel better) can worsen symptoms of depression and prolong the period when symptoms are active. If family members don’t understand what is causing the symptoms, even if they notice them, they may blame the person suffering from depression for being too sensitive, too weak or lazy. They may also think that the person is consciously choosing to do nothing out of convenience or laziness and is complacent.

It is difficult for a person with depression to cope with many situations that are part of everyday life. Low energy and motivation can make a person feel overwhelmed even with the most mundane activities, such as getting out of bed, cooking or taking care of personal hygiene. When the affected person is no longer able to contribute to household chores, there is more for others to do, and some things may remain undone which can create frustration and tension. Because of this, family members may start to resent it because they feel there is too much pressure on them. Also, symptoms of depression can sometimes be difficult to interpret correctly. Symptoms such as tiredness, fatigue, irritability and social isolation are easy to misinterpret. Difficulty recognising depressive symptoms can lead to conflict in relationships. For example, the partner might misinterpret social isolation as lack of interest or avoidance and symptoms of irritability as anger directed specifically at them.

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What NOT to do when you want to help someone with depression?

  1. ⚠️ Avoid taking things personally – pay attention to your own emotions and try not to interpret the depressed person’s irritability or aloofness as personal attacks
  2. Don’t minimize the depressed person’s emotional experience – guilt in depressed people is magnified and they can easily become self-blaming or feel like a burden to others. Phrases like “let it pass”, “try to smile more and think more positively”, “it’s only in your head”, “you have to be strong and get over it” can be very damaging to a person with depression.
  3. ⛔ Don’t try to do everything for the depressed person out of a desire to make them feel better – relieving her of any kind of effort – cleaning for her, bringing her food to her bed, not letting her do anything because you want to let her rest – this kind of behaviour can maintain the symptoms of depression because it brings the benefit of being cared for much more than before, and this is an unconscious mechanism that maintains the symptoms. It is important to encourage the person to do small activities that are not very energy-consuming and to provide support in carrying out the activities. These small activities not only increase the level of positive emotions but also help the person to slowly regain a sense of autonomy.
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What to do when you want to help someone with depression?

  1. 👐 Patiently listen to the person if they feel the need to talk about how they are feeling, don’t interrupt them and don’t talk over them (if interrupted, people with depression can easily lose their focus due to difficulty concentrating)
  2. 🤗 Show empathy and emotional availability (including physical contact, e.g. hugging) according to the needs of the person affected (under no circumstances should we force them to tell a story or hug us if they don’t feel they want to – we are close to them, but also offer space if they need it)
  3. 👯 Make a schedule of activities together that she might enjoy to raise her positive emotions, without being too demanding (e.g. a walk, going out for coffee, ice cream, watching a movie together or cooking), small activities that you agree on together.
  4. 👨‍⚕️ Direct the person to specialist help and support them in following treatment
  5. ☯️ Create a relaxed atmosphere at home – when we are going through depression it helps a lot to avoid stress as much as possible, and routines are great for this because they give more predictability and give the feeling that we have more control over our lives, which significantly reduces stress
  6. 📖 Get informed about depression And watch for the warning signs of suicide
  7. 🥗 Healthy eating and daily movement helps increase wellbeing – plan healthy meals to cook together with the depressed person and do any kind of exercise together, even if it is light exercise, every day
  8. 🆘 If you feel overwhelmed and tired from interacting with the depressed person, consider seeking specialist help yourself.

When a family member or close friend suffers from depression it is challenging for everyone, but depression is treatable and emotional and social support greatly improves treatment outcomes.

Bibliography:

  1. Mojtabai, R., Olfson, M., & Han, B. (2016). National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics, 138(6).
  2. Nasser, E. H., & Overholser, J. C. (2005). Recovery from major depression: the role of support from family, friends, and spiritual beliefs. Acta Psychiatrica Scandinavica, 111(2), 125-132.
  3. Leahy, R. L., Holland, S. J., & McGinn, L. K. (2017). Treatment plans and interventions for depression and anxiety. ASCR [Asociaţia de Ştiinţe Cognitive din România].
  4. American Psychiatric Association. (2016). DSM-5 Diagnostic and Statistical Manual of Mental Disorders. Bucharest: Callisto Medical Publishing House. _

Author: Psih. Cristina Roncea – Psychotherapist

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