Depression

For families and friends

For people newly diagnosed with depression, the varied reactions of family and friends may be surprising, if not upsetting. Depression stirs a broad range of feelings in others, including sadness, concern, fear, helplessness, anxiety, guilt, frustration, embarrassment, and anger. Although hurtful to the person, the following are all legitimate, normal reactions.

• Most friends and family members will feel relief upon learning the problem has finally been diagnosed. They will better identify with the condition because it has now been given a name.
• Some may feel guilty, believing the illness is a direct result of something they have done (or neglected to do).
• Most are apprehensive, unsure what the future holds.
• Many may feel sad or disappointed once they realize many of their hopes and expectations for the affected individual(s) may not be realized.
• Because of the stigma often associated with mental illness, some may feel embarrassment that a member of their family has been diagnosed with depression.
• Some may acknowledge that serious marital and/or family problems have contributed to the depression and that these problems need to be resolved.

With time, family members and friends begin to adapt to the depressed person's illness and may react in a number of different ways.

• Some may deny the problem exists and may believe it isn't all that serious. They may think that it will resolve itself.
• Some may become highly involved in the depressed person's life, making the depression the focus of everything.
• Some may become distant and detach physically and emotionally from the depressed person.
• Some may become depressed themselves as they grieve the loss of a healthy partner, spouse, parent, child, or friend.
• Some may accept the depression, adjust, and learn new coping skills.
• Some may view the affected person's depression as a reaction to circumstantial stressors or as a "stage-of-life" problem.
• Some may view depression as a challenge to overcome or as an opportunity for the depressed person to grow.

Children's reactions to depression

Children may not understand depression and may feel somehow responsible for a parent's depression, wondering whether the condition is in some way their fault. Children with a depressed parent may:

• try very hard to please or impress the depressed parent
• try to protect one parent from the other's criticism and abuse
• try to excel in school, sports, and extra-curricular activities
• develop behavioral problems at school and at home
• become loyal and protective of their family
• become anxious or depressed themselves
• seek love and attention from people outside the family
• do things to try to help their parent get better

As with older family members and friends, given time, children will adapt and develop ways of coping with their parent's condition: they are often more resilient to stressful situations that adults will admit. Remember to provide children with support and factual, age-appropriate answers to their questions. In doing so, you protect them while enhancing the child's relationship with his or her depressed parent.

• Explain that the depression is not their fault.
• Reassure them that depression is not a terminal condition; a depressed parent will not die.
• Explain that a depressed parent will need time to recover.
• Show children, through your words and actions, that you love, support, and encourage them.
• Children may have a fear of abandonment. Let them know the depressed parent will not leave. If a parent requires hospitalization, explain that this is only temporary.
• Supporting a child can be emotionally and physically draining: ask other family members and friends for help and support.

What to expect

As explained, depression stirs a wide range of emotions in others. Because they may not understand what is happening, family members and friends may find the first depressive episode very confusing: it's natural for them to want to determine the cause of the depression. Some may attribute depression to a negative attitude, laziness, self-pity, apathy, or irresponsibility. Others may deem the condition "growing pains", a "stage-of-life" problem, a "mid-life crisis", or the result of working or studying too hard. Others may feel guilty, believing the depression is somehow the result of something they did or failed to do.

Well-meaning family members and friends will try to "solve the problem" by offering advice. Some may even take offense if that advice isn't followed. Remember that depression saps a person's energy. This lack of energy presents an enormous barrier to taking action of any kind. Instead of offering advice, you may want to:

• Limit stimulation by keeping the depressed person's surroundings as calm as possible.
• Be clear about your expectations.
• Offer support and understanding without passing judgment. Depressed people need to feel they can vent and talk openly without fear of criticism.
• Encourage proper self-care with respect to nutrition, hygiene, bathing, exercise, and sleep.
• Enhance self-esteem and self-confidence by focusing on the positive. Emphasize the person's past achievements and successes. Help foster hope.
• Encourage the person not to "get depressed over being depressed".
• Monitor all medications carefully. Ensure doses are not doubled up or skipped. Consult a physician right away if you note any uncomfortable side effects. Watch for evidence of hoarding medications: this could be a sign the person has suicidal thoughts.
• Talk openly about suicide to determine whether the person has any suicidal thoughts or plans. Take appropriate action if necessary.
• Ask whether you are doing anything to contribute to the depression and be prepared to make adjustments and to problem solve.
• Depression is a major illness: don't expect a depressed person to "snap out of it" and to overcome his or her condition overnight. Overcoming depression requires time and support.

How to help

Everyone needs to feel there are people around who accept us and care about us. Whether it comes from family members or from friends, support and encouragement provide the foundation necessary for a depressed person to begin the healing process toward personal growth and development. Depressed people can take steps toward improved health, well-being, and mood when they feel surrounded by others who understand them and who acknowledge their efforts.

• Treat the depressed person as an adult. Very often, people with depression feel they are condescended, patronized, or given unsolicited advice. It's important to remain sensitive, tactful, and respectful. Be prepared to make some sacrifices: often, family members need to set things aside in order to offer the best support possible.
• Focus on the positive and on the person's accomplishments. Be sure to build confidence and self-esteem by offering supportive statements.
• With depression comes a great deal of self-criticism and self-blame. Avoid negative comments and downplay the person's failures and faults.
• Acknowledge efforts—even when results are not apparent. Statements such as "Nice try!" help keep discouragement to a minimum.
• Laugh together: laughter relieves tension, puts things into persepective, and demonstrates mutual warmth, caring, and understanding. Use genuine humor and avoid sarcasm and condescension.
• Be clear about your expectations. Many problems and misunderstandings can be avoided if you are clear about what you expect from the depressed person.
• Deal with problems when they arise: conflicts are easier to resolve if they're addressed when they first appear. If left too long, problems can escalate and become unmanageable.
• Offer advice sparingly. If a problem doesn't involve you, don't be too quick to offer advice. Depressed people are more likely to develop confidence if they believe their feelings are acknowledged and that others are encouraging them to find solutions on their own.
• Remain hopeful. Living with depression can be discouraging, particularly if an individual is prone to relapse. There is hope for recovery. People do overcome depression and live happy and productive lives, glad for the insight and sensitivity they've gained from their experience.
• Acknowledge that stigma exists. Stigma affects not only depressed people, but it also extends to their families. Accepting that stigma exists and that it is the result of fear and ignorance can help your family better cope with depression.