Important Things to Know if Your Relative Suffers From Depression

Supporting Someone with Bipolar - For Family and Friends

1. Many people with major depression will deny that they are sad. In this case, you can usually "read" depression in a person's face. People with depression look as if they are about to cry; the features of their face are distinctly "pulled-down." Some people will report depression as "the blahs," or "feeling nothing," or they complain of aches and pains rather than sadness. DSM-IV indicates that signs to look for are "tearfulness, brooding, irritability, obsessive rumination, anxiety, phobias, excessive worry over physical health, complaints of pain." People with depression are experiencing tremendous distress. This mental and physical anguish is very real for them.

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2. Most major depressions last at least a year. The duration of a depressive episode normally lasts 4 to 6 months, but there is a "tail" to major depression, sufferers remain exceedingly vulnerable to relapse back into the episode if they go off medication too soon. This is why doctors recommend staying on antidepressants for at least 9 months, and then tapering off slowly.

3. Don't be misled by the "functional" depressed person. Many people with an agitated depression, or atypical depression, will try to stay busy to escape their despondency and distract themselves from the pain they are feeling. They will deny their distress and this will lull you into thinking they are not seriously ill. People with milder forms of depression may appear completely functional, but underneath they are making a huge effort just to get through the day. Individuals with depression always find it very had to do the simplest tasks, even if they don't say anything about it.

4. Atypical depression will fool the patient and the family. Because this form of depression can be alleviated by a pleasant ride, a visit with friends, good feedback at work, etc., patients and family members are likely to think the problem is "personal" rather than biological. They will say, "Well, if doing so-and-so cheers her up, why doesn't she feel better more often?" or "If doing thus-and-so improves my mood, then I must work harder to be well."

   This misunderstanding of the illness process will mislead those involved into believing that when the mood goes down, it is a "failure of effort," that the depressed person "just isn't trying hard enough." Remember: mood reactivity is the predominant feature of atypical depression. Just be grateful that your family member has a depression where she or he can sometimes feel better, and don't hold the sufferer responsible for his or her return to despondency.

5. A lot happens in depression that those "outside" don't see. Behind the elaborate cover-up that goes on, the internal process of depression is relentless and tumultuous. Depressed people dwell constantly on self-recriminations about how bad (stupid, ugly, worthless) they are; there is a continual, critical internal voice tearing the person down, questioning every move, second-guessing every decision. Demoralization and hopelessness are universal in this illness, as are indecision, changing one's mind, forgetfulness, inability to concentrate. People with severe depression appear totally self-absorbed and self-involved. This incessant, negative internal dialogue fills the sufferer with intense shame. For this reason, many people with psychotic depression will not readily admit their delusions.

6. It is not possible to predict whether your family member with serious depression will attempt suicide or when. Thoughts of death occur for most people with serious depression. For many, these thoughts are not a wish to die, but simply to be released from the terrible mental anguish they are suffering; or they feel like such a burden, they think that others would be "better off without them." Most people with depression will talk about their thoughts of suicide if you ask them about it, and it is always important to discuss this lethal feature of their illness. However, other people with serious depression will disclose absolutely nothing about suicidal plans. Statistical high-risk factors associated with suicide are: having melancholic depression or bipolar depression (particularly with psychotic features), having a co-morbid panic disorder; history of previous suicide attempts, a family history of completed suicide, concurrent substance abuse.

7. Family members must consult with the doctor making the diagnosis. People with depression feel so guilty and ashamed about themselves, they are not likely to admit these feelings to others. When asked, their tendency to under-report the severity of their condition is a real problem. This is one reason why depression is missed by so many general practitioners - the depressed person either denies it or minimizes it.

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   The DSM-IV criteria for depression, asks for "outside" verifying information to arrive at the correct diagnosis. DSM-IV has included your input as an important diagnostic component, as follows: "A careful interview is essential to elicit symptoms of a major depressive episode. Reporting may be compromised by difficulties in concentrating, impaired memory, or a tendency to deny, discount, or explain away symptoms. Information from additional informants can be especially helpful in clarifying the course of current or prior major depressive episodes and in accessing whether there have been any manic or hypomanic episodes." So, insist on your right to contribute information to the diagnostic process.

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