Supporting someone who is depressed

I remember as if it were yesterday. It was the summer afternoon when I worked out that my sister could not pull out of her depressive state. She was 13, I was 16, and it was the mid-'80s, when one simply did not talk about mental illness outside the home. Our windows were literally sealed shut, despite the soupy temperatures, as my sister howled like a banshee at the prospect of being dragged out of her room and into the car on a family camping trip.

My mother had been pleading with me for months to stop dismissing my sister's problems as a need for “perspective,” for her to get over herself and all the drama. She was early, our mom, in understanding that depression, like all mental illness, is a disease, one in which your brain betrays you.

“It would be much simpler if she had diabetes or something you could see,” my mother would say, sadly predicting my sister's need to show the world how much she was hurting. She was a beautiful girl; now she's a beautiful woman with a family of her own. But she has always had to suffer the extra indignity of people unable to believe how much invisible pain she's in under the bright skin and blond hair.

The caregiver's juggling act
When you live in the shadow of someone else's despair, you need a broad view, and you need information. Most especially, though, you need a game plan and advice from mental-health professionals that will help you achieve the ideal balance between managing your own sanity and being there for a friend in need.

Being in a relationship with a loved one who is depressed is a juggling act. You must try to balance your desire to help and support the individual while maintaining your own well-being.

Over the years, I've watched many friends and family members grapple with the unseen forces of depression. Two people, the depressive and his or her support person, become engaged in a tortured tango, where it is unclear when one person ends and the other begins. Emotions can overflow and overlap.

A real illness
Karen Liberman, executive director of the Mood Disorders Association of Ontario, believes the first -- and best -- advice for caregivers is for them to imagine their loved one has something tangible, for example, a physical condition such as a brain tumour, and then to imagine that the peculiar or irrational behaviour being exhibited is a result of this tumour.

For instance, if a woman with beautiful children, a loving husband, a good job and a nice car can't get out of bed in the morning, it's hard to sympathize. But you need to know depression is not sadness, and it is not caused by a lack of perspective. The sufferer cannot wish it away.

Understanding depression
The first step in dealing with a loved one with depression is understanding it is neither her fault nor yours. In moments of crisis, stepping back from the situation is invaluable. Experts recommend you walk out of the room, even briefly, to catch your breath. Cut off the conversation if it is going in circles; it is not what you say, it is how you say it. Your loved one is only watching your feet. The big question in her mind is whether she can drive you away.

That said, never be afraid to step away for a bit if you are getting too wrapped up. If you need to, get someone else to help while you get a good night's sleep. If you are well, and as the caregiver you need to be, things always look clearer in the morning.

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A caregiver's risks
Depression is frighteningly common -- and deadly. The Canadian Mental Health Association estimates that almost three million people in this country will suffer from the disease at one point in their lives, and that women suffer twice as often. The role of caregiver for someone who is depressed also often falls to a woman. These caregivers, in the heat of battle, are the ones who often end up overlooked. Their own worries, issues and support systems fall to the wayside.

The caregiver is often the only person in the line of fire -- the only one not driven away by the fierce heat a depressive can give out. Or she may be the only person still calling when a depressive has turned inward, shutting out the rest of the world.

A toxic cycle
Depression is a double-whammy disease: first it ruins your health, and then it (sometimes) makes you reject help. We all get blue from time to time, but we're talking here about clinical depression, the kind that you can't shrug off lightly. “Depression is actually a distortion of thinking -- a cognitive illness,” says Liberman. “People who are depressed can no more think positive thoughts than I can ask you to solve the theory of relativity.”

Liberman herself has battled depression. “There is a terrible stigma. It took me almost five years before I would even seek help, because the nature of the illness itself says it's your fault, you are the problem and this horrible thing called a mental illness is something to be ashamed of, a character weakness. Thus begins the vicious cycle and downward spiral: even if people want to help you, you deny help.”

What's behind depression?
A passionate activist, Liberman stresses that depression is a disease. “We know that depression is a change in the neurochemistry of the brain. We need to de-Freud ourselves. There is a measurable change in serotonin and dopamine levels in the brain,” the chemicals that control our moods.

Once you've got that indisputable fact down, the next step is gathering knowledge. Says Liberman: “If your loved one had heart disease or cancer, you'd learn about it -- the signs and symptoms -- and seek out the best medical care. Do the same for a person who is depressed.”

After that, a caregiver needs to learn to separate her feelings from those of the person who is depressed. With all the intense emotion flying around, there is a danger some can be transferred to the caregiver. The caregiver can get so wrapped up in her charge that her work will slip and her home life will crumble.

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Contagious emotions
Cheryl Rolin-Gilman is an advanced practice nurse with women's and addictions programs at the Centre for Addiction and Mental Health in Toronto. “Much of what the support person is feeling is being picked up from the depressed person,” she says, listing anger, sadness, frustration, helplessness and hopelessness as examples. She urges caregivers to “consider that some of what you are feeling is not totally your own, that it gets transplanted onto you.”

Lend an ear
Rolin-Gilman says she tells family members in support groups that being there is what's most important, and that “you don't need to feel like you have the ‘right' answers or feel like you should ‘fix' things. That is not your role. Just listen.

“Whatever you say is probably going to be fine, so long as you are not pooh-poohing or diminishing the experience of the sick person. A depressed person is not hearing you clearly, anyway,” she says.

But there are a few provisos. Experts agree that relating anecdotes or your personal experiences to someone who is depressed is not always the best idea. “The medication that worked a miracle for one patient,” says Rolin-Gilman, “will not necessarily work for everyone.” And other people's “success” stories may just serve to highlight a depressed person's overwhelming feelings of worthlessness, that they can't get well as quickly or as dramatically.

Responsibility #1: Take care of yourself
Rolin-Gilman also says caregivers have a responsibility to keep themselves healthy. “After all, who is going to help if you get sick yourself?” Sometimes you need to set boundaries to protect yourself or because a depressed loved one is not ready to seek treatment. “If you've given her the information about how to get help, sometimes you have to sit back and wait for someone to seek it,” says Liberman.

But, she cautions, and this is a big but, “if you feel the depressed person is in a suicidal state, get her to an emergency department immediately.” Signs can include complete withdrawal, a sudden change of behaviour and more obvious things that sound like clichés but aren't: if someone is giving away her things and writing meaningful notes to the future, step right up and intervene.

Seek support
With all this drama, it is important to remember what your relationship was like before depression came into your lives. “It is useful to hope the relationship will come back,” says Rolin-Gilman. “In the meantime, you need to take care of yourself. It's helpful to have some contacts outside of that relationship, too, so your whole world isn't revolving around that issue.”

Support groups can be a huge help, pulling the caregiver, the person so often ignored in the equation, out of her own isolation. Sitting in a room even once a week, with someone who gets it, Liberman says, can be a lifeline. And sometimes it's best to just wait for a storm to pass and learn which battles to pick.

A caregiver's survival guide
1. Don't blame yourself.
Remind yourself that mood disorder is a physical illness like any other.
2. Get support for yourself.
Contact your local Canadian Mental Health Association branch (www.cmha.ca) for support groups or chapters in your area.
3. Don't take things personally.
This one is easier said than done because mood disorders manifest themselves in many ways. If necessary, leave the room and catch your breath.
4. Teach yourself.
Knowledge is one of your best tools as a caregiver. Make sure you're aware of the best possible care and treatment options.
5. Be good to yourself.
If you're healthy and happy, you're in much better form to be supportive to a depressed loved one. Define your personal boundaries and set aside time for yourself.
6. Provide positive reinforcement.
Progress is often difficult to measure. Encourage your loved one during the low times and applaud her during the good times.
7. Forgive yourself.
You are not a hero. You do not have a cure. Like everyone, you have shortcomings, too. Be realistic in what you expect of yourself.
8. Draft a crisis plan.
With the help of your loved one, devise a plan that will work in a variety of situations. Put it in writing.
9. Develop a positive outlook and hang on to it.
Be optimistic. Remember your relationship with the depressed person when she was healthy. Keep that image in your mind.

Nobody suffering from depression should feel alone. It's time to destigmatize mental illness.

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