Monday, January 26, 2015

How to Help a Depressed Person


How to Help a Depressed Person
Multiple Responses:
When a family member or friend suffers from depression, your support and encouragement can play an important role in his or her recovery. However, depression can also wear you down if you neglect your own needs. These guidelines can help you support a depressed person while maintaining your own emotional equilibrium.

Helping a depressed friend or family member
Depression is a serious but treatable disorder that affects millions of people, from young to old and from all walks of life. It gets in the way of everyday life, causing tremendous pain, hurting not just those suffering from it, but also impacting everyone around them.

If someone you love is depressed, you may be experiencing any number of difficult emotions, including helplessness, frustration, anger, fear, guilt, and sadness. These feelings are all normal. It’s not easy dealing with a friend or family member’s depression. And if you don’t take care of yourself, it can become overwhelming.

That said, there are steps you can take to help your loved one. Start by learning about depression and how to talk about it with your friend or family member. But as you reach out, don’t forget to look after your own emotional health. Thinking about your own needs is not an act of selfishness—it’s a necessity. Your emotional strength will allow you to provide the ongoing support your depressed friend or family member needs.

Understanding depression in a friend or family member:
  • Depression is a serious condition. Don’t underestimate the seriousness of depression. Depression drains a person’s energy, optimism, and motivation. Your depressed loved one can’t just “snap out of it” by sheer force of will.
  • The symptoms of depression aren’t personal. Depression makes it difficult for a person to connect on a deep emotional level with anyone, even the people he or she loves most. In addition, depressed people often say hurtful things and lash out in anger. Remember that this is the depression talking, not your loved one, so try not to take it personally.
  • Hiding the problem won’t make it go away. Don’t be an enabler. It doesn’t help anyone involved if you are making excuses, covering up the problem, or lying for a friend or family member who is depressed. In fact, this may keep the depressed person from seeking treatment.
  • You can’t “fix” someone else’s depression. Don’t try to rescue your loved one from depression. It’s not up to you to fix the problem, nor can you. You’re not to blame for your loved one’s depression or responsible for his or her happiness (or lack thereof). Ultimately, recovery is in the hands of the depressed person.

Is my friend or family member depressed?
Family and friends are often the first line of defense in the fight against depression. That’s why it’s important to understand the signs and symptoms of depression. You may notice the problem in a depressed loved one before he or she does, and your influence and concern can motivate that person to seek help.

Be concerned if your loved one...
  • Doesn’t seem to care about anything anymore.
  • Is uncharacteristically sad, irritable, short-tempered, critical, or moody.
  • Has lost interest in work, sex, hobbies, and other pleasurable activities.
  • Talks about feeling “helpless” or “hopeless.”
  • Expresses a bleak or negative outlook on life.
  • Frequently complains of aches and pains such as headaches, stomach problems, and back pain.
  • Complains of feeling tired and drained all the time.
  • Has withdrawn from friends, family, and other social activities.
  • Sleeps less than usual or oversleeps.
  • Eats more or less than usual, and has recently gained or lost weight.
  • Has become indecisive, forgetful, disorganized, and “out of it.”
  • Drinks more or abuses drugs, including prescription sleeping pills and painkillers.

How to talk to a loved one about depression
Sometimes it is hard to know what to say when speaking to a loved one about depression. You might fear that if you bring up your worries he or she will get angry, feel insulted, or ignore your concerns. You may be unsure what questions to ask or how to be supportive.

If you don’t know where to start, the following suggestions may help. But remember that being a compassionate listener is much more important than giving advice. You don’t have to try to “fix” the person; you just have to be a good listener. Often, the simple act of talking to someone face to face can be an enormous help to someone suffering from depression. Encourage the depressed person to talk about his or her feelings, and be willing to listen without judgment.

Don’t expect a single conversation to be the end of it. Depressed people tend to withdraw from others and isolate themselves. You may need to express your concern and willingness to listen over and over again. Be gentle, yet persistent.

Ways to start the conversation:
  • I have been feeling concerned about you lately.
  • Recently, I have noticed some differences in you and wondered how you are doing.
  • I wanted to check in with you because you have seemed pretty down lately.
  • Questions you can ask:
  • When did you begin feeling like this?
  • Did something happen that made you start feeling this way?
  • How can I best support you right now?
  • Have you thought about getting help?
  • Remember, being supportive involves offering encouragement and hope. Very often, this is a matter of talking to the person in language that he or she will understand and respond to while in a depressed mind frame.
  • What you can say that helps:
  • You are not alone in this. I’m here for you.
  • You may not believe it now, but the way you’re feeling will change.
  • I may not be able to understand exactly how you feel, but I care about you and want to help.
  • When you want to give up, tell yourself you will hold on for just one more day, hour, minute—whatever you can manage.
  • You are important to me. Your life is important to me.
  • Tell me what I can do now to help you.

Avoid saying:
  • It’s all in your head.
  • We all go through times like this.
  • Look on the bright side.
  • You have so much to live for why do you want to die?
  • I can’t do anything about your situation.
  • Just snap out of it.
  • What’s wrong with you?
  • Shouldn’t you be better by now?

Taking care of yourself while helping a depressed person
There’s a natural impulse to want to fix the problems of people we love, but you can’t control a loved one’s depression. You can, however, control how well you take care of yourself. It’s just as important for you to stay healthy as it is for the depressed person to get treatment, so make your own well-being a priority.

Remember the advice of airline flight attendants: put on your own oxygen mask before you assist anyone else. In other words, make sure your own health and happiness are solid before you try to help someone who is depressed. You won’t do your friend or family member any good if you collapse under the pressure of trying to help. When your own needs are taken care of, you’ll have the energy you need to lend a helping hand.

Tips for taking care of yourself
Think of this challenging time like a marathon; you need extra sustenance to keep yourself going. The following ideas will help you keep your strength up as you support your loved one through depression treatment and recovery.
  • Speak up for yourself. You may be hesitant to speak out when the depressed person in your life upsets you or lets you down. However, honest communication will actually help the relationship in the long run. If you’re suffering in silence and letting resentment build, your loved one will pick up on these negative emotions and feel even worse. Gently talk about how you’re feeling before pent-up emotions make it too hard to communicate with sensitivity.
  • Set boundaries. Of course you want to help, but you can only do so much. Your own health will suffer if you let your life be controlled by your loved one’s depression. You can’t be a caretaker round the clock without paying a psychological price. To avoid burnout and resentment, set clear limits on what you are willing and able to do. You are not your loved one’s therapist, so don’t take on that responsibility.
  • Stay on track with your own life. While some changes in your daily routine may be unavoidable while caring for your friend or relative, do your best to keep appointments and plans with friends. If your depressed loved one is unable to go on an outing or trip you had planned, ask a friend to join you instead.
  • Seek support. You are NOT betraying your depressed relative or friend by turning to others for support. Joining a support group, talking to a counselor or clergyman, or confiding in a trusted friend will help you get through this tough time. You don’t need to go into detail about your loved one’s depression or betray confidences; instead focus on your emotions and what you are feeling. Make sure you can be totally honest with the person you turn to—no judging your emotions!

Encouraging a depressed person to get help
Beating depression, one day at a time

You can’t beat depression through sheer willpower, but you do have some control—even if your depression is severe and stubbornly persistent. The key to depression recovery is to start with a few small goals and slowly build from there. Feeling better takes time, but you can get there if you make positive choices for yourself each day and draw on the support of others. Read Dealing with Depression.

While you can't control someone else’s recovery from depression, you can start by encouraging the depressed person to seek help. Getting a depressed person into treatment can be difficult. Depression saps energy and motivation, so even the act of making an appointment or finding a doctor can seem daunting. Depression also involves negative ways of thinking. The depressed person may believe that the situation is hopeless and treatment pointless.

Because of these obstacles, getting your loved one to admit to the problem—and helping him or her see that it can be solved—is an essential step in depression recovery.

If your friend or family member resists getting help for depression:
  • Suggest a general check-up with a physician. Your loved one may be less anxious about seeing a family doctor than a mental health professional. A regular doctor’s visit is actually a great option, since the doctor can rule out medical causes of depression. If the doctor diagnoses depression, he or she can refer your loved one to a psychiatrist or psychologist. Sometimes, this “professional” opinion makes all the difference.
  • Offer to help your depressed loved one find a doctor or therapist and go with them on the first visit. Finding the right treatment provider can be difficult, and is often a trial-and-error process. For a depressed person already low on energy, it is a huge help to have assistance making calls and looking into the options.
  • Encourage the person to make a thorough list of symptoms and ailments to discuss with the doctor. You can even bring up things that you have noticed as an outside observer, such as, “You seem to feel much worse in the mornings,” or “You always get stomach pains before work.”
  • Supporting your loved one's depression treatment
  • One of the most important things you can do to help a friend or relative with depression is to give your unconditional love and support throughout the treatment process. This involves being compassionate and patient, which is not always easy when dealing with the negativity, hostility, and moodiness that go hand in hand with depression.
  • Provide whatever assistance the person needs (and is willing to accept). Help your loved one make and keep appointments, research treatment options, and stay on schedule with any treatment prescribed.
  • Have realistic expectations. It can be frustrating to watch a depressed friend or family member struggle, especially if progress is slow or stalled. Having patience is important. Even with optimal treatment, recovery from depression doesn’t happen overnight.
  • Lead by example. Encourage your friend or family member to lead a healthier, mood-boosting lifestyle by doing it yourself: maintain a positive outlook, eat better, avoid alcohol and drugs, exercise, and lean on others for support.
  • Encourage activity. Invite your loved one to join you in uplifting activities, like going to a funny movie or having dinner at a favorite restaurant. Exercise is especially helpful, so try to get your depressed loved one moving. Going on walks together is one of the easiest options. Be gently and lovingly persistent—don’t get discouraged or stop asking.
  • Pitch in when possible. Seemingly small tasks can be hard for a depressed person to manage. Offer to help out with household responsibilities or chores, but only do what you can without getting burned out yourself!

The risk of suicide is real
What to do in a crisis situation
If you believe your loved one is at an immediate risk for suicide, do NOT leave the person alone.
In the U.S., dial 911 or call the National Suicide Prevention Lifeline at 1-800-273-TALK.

In other countries, call your country’s emergency services number or visit IASP to find a suicide prevention helpline.

It may be hard to believe that the person you know and love would ever consider something as drastic as suicide, but a depressed person may not see any other way out. Depression clouds judgment and distorts thinking, causing a normally rational person to believe that death is the only way to end the pain he or she is feeling.

When someone is depressed, suicide is a very real danger. It’s important to know the warning signs:
  • Talking about suicide, dying, or harming oneself
  • Preoccupation with death
  • Expressing feelings of hopelessness or self-hate
  • Acting in dangerous or self-destructive ways
  • Getting affairs in order and saying goodbye
  • Seeking out pills, weapons, or other lethal objects
  • Sudden sense of calm after a depression

If you think a friend or family member might be considering suicide, talk to him or her about your concerns as soon as possible. Many people feel uncomfortable bringing up the topic but it is one of the best things you can do for someone who is thinking about suicide. Talking openly about suicidal thoughts and feelings can save a person’s life, so speak up if you're concerned and seek professional help immediately!

It’s often frustrating and can make a person feel helpless to try and help someone who’s depressed or who suffers from depression. Whether it’s clinical depression or the winter blues, a person who’s depressed is often looking for ways to get help, but may not know where or how to start.

That’s where you come in.

By recognizing the signs of depression, you can be a great help to a friend or loved one who may be just starting to grapple with it, but not recognize it themselves.

Here are 10 ways you can help someone today with depression.
  1. Recognize the symptoms.
  2. Convince the depressed person to get treatment or, in the case of a depressed child or adolescent, help the youngster get treatment.
  3. Tell the depressed person that he or she is loved, deserves to feel better, and will feel better with appropriate treatment.
  4. Recommend helping resources.
  5. If the depressed person is not functioning, accompany him or her to treatment until normal function returns.
  6. If the depressed person is too young or ill to provide needed information to the therapist, act as a go-between as long as needed.
  7. If the depressed person is suicidal or having hallucinations or delusions, arrange for hospitalization.
  8. If the depressed person is functional and refuses treatment, seek the assistance of others — friends, doctor, clergy, relatives — who might convince him or her that treatment is needed and will help.
  9. Don’t give up too soon — the depressed person may have to hear more than once and from several people that he or she deserves to feel better and can, with proper treatment.

If all efforts to encourage the depressed person to seek treatment have failed, and the depressed person is having a demoralizing impact on those around, further action is needed:
  • A supervisor might threaten personnel action unless the depressed employed gets treatment.
  • A spouse, with the assistance of a mental health specialist, can explore separation from the depressed husband or wife who refuses treatment.
  • Parents of a depressed adult can clarify, with the help of a mental health specialist, how much assistance to give their depressed offspring.
  • Children, other relatives, friends, or doctors of adepressed older person can assist him or her to get help from a mental health specialist who has geriatric experience and who may be willing to reach out to the older person by telephone and home visits.

It isn’t always easy to help the depressed person get treatment, but it can be done, and helping can make you both feel better.

If your loved one is struggling with depression, you may feel confused, frustrated and distraught yourself. Maybe you feel like you’re walking on eggshells because you’re afraid of upsetting them even more. Maybe you’re at such a loss that you’ve adopted the silent approach. Or maybe you keep giving your loved one advice, which they just aren’t taking.

Depression is an insidious, isolating disorder, which can sabotage relationships. And this can make not knowing how to help all the more confusing.

But your support is significant. And you can learn the various ways to best support your loved one. Below, Deborah Serani, PsyD, a psychologist who’s struggled with depression herself, shares nine valuable strategies.

1. Be there.
According to Serani, the best thing you can do for someone with depression is to be there. “When I was struggling with my own depression, the most healing moments came when someone I loved simply sat with me while I cried, or wordlessly held my hand, or spoke warmly to me with statements like ‘You’re so important to me.’ ‘Tell me what I can do to help you.’ ‘We’re going to find a way to help you to feel better.’”

2. Try a small gesture.
If you’re uncomfortable with emotional expression, you can show support in other ways, said Serani, who’s also author of the excellent book Living with Depression.

She suggested everything from sending a card or a text to cooking a meal to leaving a voicemail. “These gestures provide a loving connection [and] they’re also a beacon of light that helps guide your loved one when the darkness lifts.”

3. Don’t judge or criticize.
What you say can have a powerful impact on your loved one. According to Serani, avoid saying statements such as: “You just need to see things as half full, not half empty” or “I think this is really all just in your head. If you got up out of bed and moved around, you’d see things better.”

These words imply “that your loved one has a choice in how they feel – and has chosen, by free will, to be depressed,” Serani said. They’re not only insensitive but can isolate your loved one even more, she added.

4. Avoid the tough-love approach.
Many individuals think that being tough on their loved one will undo their depression or inspire positive behavioral changes, Serani said. For instance, some people might intentionally be impatient with their loved one, push their boundaries, use silence, be callous or even give an ultimatum (e.g., “You better snap out of it or I’m going to leave”), Serani said. But consider that this is as useless, hurtful and harmful as ignoring, pushing away or not helping someone who has cancer.

5. Don’t minimize their pain.
Statements such as“You’re just too thin-skinned” or “Why do you let every little thing bother you?” shame a person with depression, Serani said. It invalidates what they’re experiencing and completely glosses over the fact that they’re struggling with a difficult disorder – not some weakness or personality flaw.

6. Avoid offering advice.
It probably seems natural to share advice with your loved one. Whenever someone we care about is having a tough time, we yearn to fix their heartache.

But Serani cautioned that “While it may be true that the depressed person needs guidance, saying that will make them feel insulted or even more inadequate and detach further.”

What helps instead, Serani said, is to ask, “What can we do to help you feel better?” This gives your love one the opportunity to ask for help. “When a person asks for help they are more inclined to be guided and take direction without feeling insulted,” she said.

7. Avoid making comparisons.
Unless you’ve experienced a depressive episode yourself, saying that you know how a person with depression feels is not helpful, Serani said. While your intention is probably to help your loved one feel less alone in their despair, this can cut short your conversation and minimize their experience.

8. Learn as much as you can about depression.
You can avoid the above missteps and misunderstandings simply by educating yourself about depression. Once you can understand depression’s symptoms, course and consequences, you can better support your loved one, Serani said.

For instance, some people assume that if a person with depression has a good day, they’re cured. According to Serani, “Depression is not a static illness. There is an ebb and flow to symptoms that many non-depressed people misunderstand.” As she explained, an adult who’s feeling hopeless may still laugh at a joke, and a child who’s in despair may still attend class, get good grades and even seem cheerful.

“The truth is that depressive symptoms are lingering elsewhere, hidden or not easy to see, so it’s important to know that depression has a far and often imperceptible range,” Serani said.

9. Be patient.
Serani believes that patience is a pivotal part of supporting your loved one. “When you’re patient with your loved one, you’re letting them know that it doesn’t matter how long this is going to take, or how involved the treatments are going to be, or the difficulties that accompany the passage from symptom onset to recovery, because you will be there,” she said.

And this patience has a powerful result. “With such patience, comes hope,” she said. And when you have depression, hope can be hard to come by.

Sometimes supporting someone with depression may feel like you’re walking a tightrope. What do I say? What do I not say? What do I do? What do I not do?

  1. Encourage the person to seek medical aid, especially that of a psychiatrist. This specialist has the type of expert knowledge that is needed to treat depression. Most importantly psychiatrists know the types of medication that may be needed and the doses that may prove adequate. For antidepressants to work, the dose must be at a therapeutic level. General practitioners, however well-intentioned, often give doses that are too low. Even low doses of antidepressants have negative side-effects. To endure these side-effects without receiving any real benefit can be a particularly painful experience. It makes the person lose confidence in the medication that may be the only source of hope of being healed. If it is possible, attend the appointments with the psychiatrist. Knowing details of the disease and of the course of treatment can be very helpful. The depressed person can greatly benefit from having a friend who knows how the disease is likely to progress.

  1. Know details of the medication that the depressed person is receiving. This allows encouragement to be given. Antidepressants take from four to six weeks to have a strongly beneficial effect. The first three weeks of taking these drugs can be filled with ghastly side effects. The depressed person needs constant encouragement to persevere. At first the depression remains severe. To this is added a whole range of side effects: headache, dry mouth, muscular weakness, stomach pain, drowsiness. If one is anxious or affected by panic and fear, these early weeks of treatment can be very distressing. Constantly this person needs to hear: “trust! It will be all right. Don't give up!”

  1. Be ready for a whole range of moods. Depression can make each day a nightmare of variation. It may be that in the morning all is bleak and dark. A person may be so panic-stricken that even being alone for a few minutes seems to be impossible. This mood may last for hours. In such times be quietly and faithfully present. The depressed person does not want to manifest this behavior. No one wants to be afraid, anxious, panic-stricken. But it happens to the person. What gives strength is simple presence.

  1. During the dark and fear-filled times that a person is enduring, do not give advice on how to cope. Yes, the person should “smarten up, appreciate all life's blessings, pull up bootstraps and get on with life.” No one wants to do that more than the depressed person. But it is not possible at the moment.

  1. When the depressed person expresses fears about the future, give assurance that change will come. It seems to be impossible for the ill person. Keep emphasizing that it will be so.

  1. The depressed person may express suicidal thoughts. These should be taken very seriously. There are degrees of this type of thinking. If the depressed person finds life unbearable and “wants to die”, encouragement should be given with emphasis that life may change and become better. If the depressed person appears to be searching for actual means of committing suicide, the doctor should be informed. Here a test of loyalty may occur. The depressed person may feel betrayed by the friend who reveals the suicidal intentions to the doctor and lash out in anger. At this point there may be a great temptation to give up on the depressed person and leave. There would certainly be ample justification if one were to do that. But if the friend departs, the depressed person becomes more desperate than ever. Bear the anger, seeing its source as the disease, not the person.

  1. Even when medication is given, a depressed person may express wishes to die for weeks. Listening to such talk can be very wearying. Have a few answers that you always give. For example, “your life is precious.” “You have work still to do here on earth.” “God has a plan for you.” “If you are here, you have some purpose to fulfill.”

  1. A depressed person often rushes to person after person for help. This depressed individual tends to focus only on the terrible suffering that is being experienced. People soon grow weary of this type of conversation. Soon rejection after rejection occurs. The depressed person desperately needs someone to care, someone to hold onto. Most people cannot fulfill this role. If you are a casual friend to whom a depressed person is clinging, be merciful. Listen gently. Give a little of your time. Perhaps not much will be asked of you. You may not be phoned. You may not need to visit. But be gentle and understanding for the short time that is asked of you. Nothing hurts a depressed person so deeply as the sight of people avoiding encounters and fleeing away.

  1. If you are a close friend, let the depressed person cling for a time. It will not last. Above all be there when others reject the depressed person, as they will. Such rejections may bring many tears. They certainly add to the depression. Be one who accepts. Depressed people need to have their worth confirmed.

  1. A depressed person is often overwhelmed by irrational fears. Doing activities alone seems impossible. Staying alone, even more so. The person is fully aware that such fears are totally irrational. Adults feels shame and horror at their inability to do things that children easily do. Embarrassment at being afraid joined with true inability to be free from fear brings intense suffering. Be gently understanding of someone in this state. Do not comment upon it. The person knows how irrational the behavior is. Just understand that the fear is real and be merciful.

  1. A depressed may find it very hard to live alone. If possible, stay with the person. If this is not possible, perhaps contact several friends and see if each could take one evening.

  1. As treatment proceeds, the depressed person will improve. It is important to know that recovery is very slow. Casual friends will expect a complete recovery. They will breathe a sigh of relief and have no further tolerance of any signs of depression. But depression likes to cling. A person can feel almost normal in the evening only to find the next morning that all is bleak once more. The depressed person needs to receive understanding of these mood swings with constant assurance of hope.

  1. One feature of depression is an inability to make even the simplest decisions. When a depressed person does make some choice, the one not chosen immediately seems to be the correct one. For the normal person for whom decision-making is easy, such indecision causes contempt and scorn. Depressed persons need help in making decisions, which still must be their responsibility. The agony and suffering that accompanies such decisions is very real. Patience and tolerance prove most helpful.

  1. The depressed person often feels quite worthless. All life seems to be a failure. Give constant assurance of the person's past activities and future productivity.

  1. If you have friends who have also suffered depression, be willing to let them speak to the depressed person. Often someone can get through the darkest days because there is a network of those who have walked the same path.

  1. Share in activities with the depressed person. Often this individual finds it terrifying to be at home alone. Be ready to do what seems to soothe anxiety and bring some peace. Invite the depressed person also to share in your own activities in order that your patterns of activity are preserved.

  1. Above all, patience, patience, patience. Depression is a disease. It is marked by a chemical imbalance in the brain. No one ever wants to be depressed. No one can simply throw off a moderate or severe depression. It would be nice if someone could. “Being there” is the most important thing, being there patiently with gentle understanding. Depression brings an agony within in which death seems to be a blessed relief from anxiety, fear, and loneliness. It takes a great friend to stay with someone in this state, to stay without lecturing, without condemnation, without exasperation, without fleeing.

  1. Why would one choose to help a depressed person? The answer is hard to give but love is certainly a factor, loving concern for a fellow human being who has been struck by a terrible disease. We human beings are frail; we seem best when we help each other.

Caring for someone with depression or anxiety can be challenging. Although every personal experience is unique, there are aspects of the role that are common to many carers.

The beyondblue Guide for Carers – Caring for others, caring for yourself includes helpful information for carers and relatives of people who have either just been diagnosed, are recovering, or are in the early stages of depression/anxiety.

The guide covers topics such as:
  • recognising that something is not right
  • taking the first step
  • getting to the first appointment
  • accessing information
  • keeping up the momentum
  • working towards recovery
  • overcoming setbacks
  • emergency and crisis situations

The guide also looks at the importance of taking care of you – the carer.

Things you can do to help someone with depression or anxiety:

  • Let the person know if you've noticed a change in their behaviour.
  • Spend time talking with the person about their experiences and let them know that you're there to listen without being judgmental.
  • Suggest the person see a doctor or health professional and/or help them to make an appointment.
  • Offer to go with the person to the doctor or health professional.
  • Help the person to find information about depression and anxiety from a website or library.
  • Encourage the person to try to get enough sleep, exercise and eat healthy food.
  • Discourage the person from using alcohol or other drugs to feel better.
  • Encourage friends and family members to invite the person out and keep in touch, but don't pressure the person to participate in activities.
  • Encourage the person to face their fears with support from their doctor/psychologist.
  • It would be unhelpful to:
  • put pressure on the person by telling them to 'snap out of it' or 'get their act together'
  • stay away or avoid them
  • tell them they just need to stay busy or get out more
  • pressure them to party more or wipe out how they're feeling with drugs and alcohol.

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