Caring for Someone with Major Depression

The first step in helping a loved one who is struggling with depression is to recognize what the issue is. People with depression cannot always tell when they are going through a depressive episode. It helps to have friends or family who are aware of the signs and who are willing to reach out and encourage that loved one to talk about it, to seek a professional diagnosis, and to get treatment.

There are nine possible diagnostic symptoms of major depression. Some people with depression will experience some or all of these:

1. Depressed mood. Sadness and a generally depressed mood that lasts nearly all day, every day for a period of time that may be several days to several weeks. This person just can’t shake the bad mood.
2. Lack of interest in activities. Someone with depression will lose interest in things he or she once enjoyed, but also may slack on chores or personal hygiene, at school, or at work and with other responsibilities.
3. Weight loss or weight gain. Depression can trigger unusual overeating or loss of appetite.
4. Changing sleep habits. Depression also triggers changes in sleeping habits, making it more difficult to sleep or causing someone to sleep much more than normal.
5. Unusual agitation or slow movements. Watch for behavioral changes. A person in a depressed state may either become strangely agitated or irritable or the opposite: slowed down in movements and speech.
6. Lack of energy. Depression can make someone feel unusually fatigued, even if there is no obvious reason to not have enough energy.
7. Guilt and shame. People with depression often experience a deep sense of guilt, worthlessness, and shame. They may talk about being useless, unworthy of others, or about hating themselves.
8. Difficulty concentrating. Depression can cause cognitive difficulties, even in someone normally bright. Your loved one may struggle to focus on one thing or make decisions.
9. Suicidal thoughts. Watch for signs of suicidal thoughts, talking about death, or attempts at suicide.

If you recognize any of these signs in someone you care about, and if they persist or do not seem to go away after several days or a week, your loved one may have major depression. It is important that he or she get a professional medical opinion, preferably an evaluation and diagnosis by a psychiatrist. This can be a difficult subject to broach, but it is important to reach out and offer help so they can get treatment or enter rehab.

One of the most important things to remember when talking to someone about depression is to be compassionate, to listen, and to offer to be there. What someone with depression does not need is advice on how to feel better, or “get over it.” Be gentle and ask questions to get your loved one to open up instead. Express concern, but don’t be judgmental.

There are many misconceptions about major depression. It is particularly difficult to understand if you have never experienced it. This doesn’t mean you can’t be empathetic and help a loved one, though. You simply need to understand a few basic facts about what this person is going through:

• A loved one’s depressive episode is not an attack against you. Depression affects relationships, and it can feel personal, especially when it is a partner struggling with this illness and exhibiting signs of being deeply unhappy.
• Depression is not something you can just “snap out of.” This is a serious mental health condition that requires professional treatment. It will not get better without treatment; an episode of depression goes well beyond a typical depressed mood anyone might experience from time to time.
• You can’t fix someone who has major depression. It isn’t up to any one person to rescue someone struggling with depression. That person needs to get professional treatment and rely on support from as many people as possible to get better.
• Enabling doesn’t help. We often enable people out of love and caring, but it hurts more than it helps. Making excuses for someone, for instance, or hiding the consequences of depression will not help that person. He or she needs to face it and get help.

Once your loved one has gotten a diagnosis from a mental health professional, he or she will still need your help and support with ongoing care. Just as when you first talked to your loved one about your concerns, the most important thing you can do is be compassionate and non-judgmental, while making sure your family member, friend, or partner knows that you are there to provide support. Be a good listener and only offer advice or suggestions that are consistent with the treatment plan. Supporting the treatment plan can be a big help. Here are some things you can do:

• Monitor medications. Sticking with and finding the right antidepressant can be frustrating. It can take weeks to get any relief, and then side effects may mean switching to another medication and starting over. Encourage your loved one to stick with it and to tell you about how the medication is making them feel.
• Help with household tasks. When someone is in the depths of a depressive episode, just doing the dishes seems like a monumental chore. Help out by doing some of these kinds of tasks without asking.
• Be patient and realistic. Treatment for depression takes time. Be patient with someone going through this and have realistic expectations.
• Provide good examples. If your friend or family member has been given some tools by a therapist to try at home, such as relaxation techniques or journaling, join in. These kinds of strategies are good for everyone, so encourage your loved one by doing them together.
• Get out together. Encourage your loved one to get out with you. Even if it is just a walk around the block, the exercise and social time are beneficial.

Caring for someone with depression can be emotionally and physically draining, especially if you live with this person. Studies have found that caregivers of people with major depression have a decreased quality of life, but it doesn’t have to be that way. Avoid burnout and compassion fatigue by remembering to take care of you too. Take time away from caring for your loved one to do things that make you feel better and that you enjoy. Set boundaries with your loved one, and don’t forget to prioritize your own needs and goals.

It is also important to enlist help from other people. Other family members or friends can get involved, too, and follow your lead in how to support someone with depression. Helping someone with this mental illness is more than one person can handle, so reach out when you feel like you are doing too much and it is affecting your well-being.

A very real risk of depression is suicide. Not all people with depression will attempt suicide, but it is a greater risk than in someone without this mental health condition. Warning signs of suicidal thoughts or that someone may attempt suicide include:

• Talking about death a lot, or a preoccupation with death
• Self-harm, such as cutting
• Saying good-bye, getting affairs in order, giving things away
• Expressing extreme self-hate
• Acquiring a lot of pills, a gun, or some other means of suicide
• Suddenly seeming calm after being depressed

If you notice any of these signs, or any other unusual behaviors that concern you, it is important to take action:

• Talk to your loved one and express your concern.
• Try to keep him or her in a safe environment, where there are no objects that can cause harm.
• Call your loved one’s doctor or therapist.
• Call a suicide hotline.
• If necessary, call 911.

When talking to someone you think may be suicidal it is crucial to be compassionate, to listen, and to not be judgmental or dismiss their feelings. Offer support, tell the person they matter to you, and ask what you can do for them in the moment.

Caring for someone with depression isn’t always easy, but this is an illness that is best tackled with the support of loved ones. Taking the time and making the effort to support and care for someone with depression can help make treatment more effective and lead to better outcomes for the person who is struggling.