Helping Someone With Depression Brochure

Helping Someone Who is DepressedFor families and friends

www.familyaware.org

Depression Bro_vfinal 7/31/04 6:34 PM Page A

CONTENTS

Major depression is much more prevalent

among women: 1 in 4 women and 1 in 8

men will experience the condition at some

point in their lives.

What is depression? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

What are the signs of depression? . . . . . . . . . . . . . . . . . . . 3

Why are family and friends important? . . . . . . . . . . . . . . . . 5

How can I help someone receive treatment? . . . . . . . . . . . . 6Helpful tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6What not to do. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7When your help is refused. . . . . . . . . . . . . . . . . . . . . . . . 8Helping children and teens. . . . . . . . . . . . . . . . . . . . . . . 10

What resources are available?. . . . . . . . . . . . . . . . . . . . . . 11

How can I help manage treatment? . . . . . . . . . . . . . . . . . . 13

What can I ask a clinician?. . . . . . . . . . . . . . . . . . . . . . . . 15

How do I deal with my own emotions? . . . . . . . . . . . . . . . . 16

What is Families for Depression Awareness?. . . . . . . . . . . . 19

How can I contribute? . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

WHAT IS DEPRESSION?

Depression is a medical condition that affects people of all genders, races, ages, and income levels. People who aredepressed feel more than sadness or the blues. They feelhopeless and suffer deep emotional pain for prolongedperiods. Depression can cause dysfunction in every aspectof ones life.

Nearly one in five Americans will experience depressionsometime in their lifetime, and almost 19 millionAmericans suffer from a depressive disorder each year.

Types of depression and causes

There are three basic types of depression:

Major depression, also called unipolar depression, whichis the most common type of depression. It tends to beepisodic but can persistently recur. Symptoms must persist for at least two weeks.

Dysthymia, which is a chronic, unremitting depression. Adysthymia diagnosis requires fewer symptoms than majordepression but must be present for at least two years.

Bipolar disorder, also called manic depression, which is depression alternating with elated or irritable moodsand increased energy.

Many factors can cause depression, including biochemistry(a chemical imbalance of mood regulation in the brain),genetics, family history, substance abuse, and an illness or other difficult life events. Some people have mild depression, while in others depression is more severe.

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Depression is not just a biologicalillness. It is also a family illnessbecause it affects relationshipswith children, grandparents,aunts, and uncles, and evenfriends.

DR. WILLIAM BEARDSLEE,physician-in-chief and chairman

of the Department of Psychiatry at Childrens Hospital of Boston

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Getting treatment

Regardless of the cause, a person should be treated fordepression. One half of people with depression do not seektreatment because they dont understand their symptomsor have fear of the stigma of mental illness. Yet of thosewho do, 80% are treated effectively with medication, psychotherapy, or both.

Early treatment is important because:

Untreated depression is long lasting. A depressiveepisode, left untreated, can last six months or chronicallyfor years.

Depression is likely to recur. If a person experiences asingle episode of depression, there is a 50% chance ofhaving another. The chance of recurrence is 70% aftertwo episodes and 90% after three episodes.

Depression can lead to suicide. Depression is the leadingcause of suicide, and a suicide occurs every 17 minutesin the United States.

WHAT ARE THE S IGNS OF DEPRESSION?

Only a clinician (e.g., primary care physician, psychiatrist,psychologist) can diagnose depression and rule out othercauses. However, since you see your depressed familymember or friend often, you observe the persons symp-toms more than their medical professional may. Therefore,you are invaluable in helping a clinician become aware of the depressed persons symptoms.

Signs of depression

If someone you care about has been experiencing severalof the symptoms below for more than two weeks, theymay be suffering from depression:

Feeling miserable and sad almost everyday

Losing interest or pleasure in most activities

Feeling anxious or irritable

Having trouble concentrating or remembering

Feeling tired

Feeling guilty or worthless

Sleeping too much or too little

Eating too much or too little

Have medically unexplained aches and pains

Thinking of death or suicide

Excessive alcohol consumption and drug abuse are preva-lent among those with underlying depressive disorders.

Signs of bipolar disorder

In addition to the symptoms of depression, those suffer-ing from bipolar disorder may be exhibiting several of the following manic symptoms:

Increased energy or decreased need for sleep

Excessive irritability, euphoria, or aggressive behavior

Increased talkativeness or pressured sleep

WHEN TO SEEK IMMEDIATE HELP

If at any time your depressed family member

or friend talks about death or suicide, take

these statements seriously. Contact the

persons clinician or call 1-800-SUICIDE. If

you think the person may be harmful to you or

others, seek immediate help. Take the person

to your local emergency room or call 911.

Dont feel that youre part of theproblem. Always remember thatthis is a biological condition, itsnot because youre a bad spouse.

BILL, husband

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Racing thoughts

Impulsive behavior and poor judgment, such as spend-ing sprees, erratic driving, or sexual indiscretions

Inflated self-esteem

Increased goal-directed activities

Distractibility

Signs of suicide

If the person you care about has been preoccupied withthoughts of death or suicide, call his or her cliniciantoday.

It is also very important to remove guns, or at the veryleast lock guns in your home.

Warning signs include:

Talking about hopelessness and worthlessness

Suddenly being happier and calmer during a depressiveepisode

Making unusual visits or calling people one cares about

Making arrangements or getting ones affairs in order

Giving things away

WHY ARE FAMILY AND FRIENDS IMPORTANT?

Family and friends are essential in helping those who are depressed. Sufferers of depression are often unable tofunction and need family and friends to help recognizeand manage their condition. Health care coverage maynot provide enough psychiatric visits or hospital stays.Family and friends are left to fill the void.

Unfortunately, family and friends operate with littleknowledge and guidance on how to recognize and cope with depression. Clinicians normally focus on thedepressed patient, not family and friends. In the pastand even now, families are often blamed for causing

the depression. Social stigma associated with depressioncauses many families to live in secrecy, afraid and unprepared to talk about the condition openly.

Family and friends are very much affected by depression.In helping a depressed person, they take on additionalresponsibilities at home and work. Depression symptoms,including withdrawal, irritability, and hopelessness, strainrelationships. Those living with someone who is depressedare much more likely to become depressed themselves.

The good news is that when families and friends arearmed with knowledge of depression and find support,they are able to improve treatment results and copeeffectively. According to research, families that discussdepression and increase their understanding of the condition achieve long-term positive change in familyfunctioning and increased resiliency in children. Bylearning about depression and about ways to help thedepressed person and handle your own emotions, youcan effectively manage depression over time.

CAN I ASK IF SOMEONE IS SUICIDAL?

Most people are afraid to ask if someone is

contemplating suicide for fear that it might

upset the person or cause the person to

commit suicide. Suicidal thoughts are a clear

indication that someone is depressed and an

extremely unsafe condition for the depressed

person. It is important to ask if the person

is feeling suicidal and, if so, to contact your

clinician immediately.

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HOW CAN I HELP SOMEONE RECEIVE TREATMENT?

Families and friends often are unsure how to convincesomeone who is depressed to see a medical professional.In a compassionate way, explain to the person that youare concerned that he or she is showing symptoms ofdepression, a treatable medical condition. Often, peoplewith depression feel very relieved to learn that they aresuffering from a medical condition. Ask the person to seea medical professional and offer to make an appointment.Make sure to go with the person or call the clinician inadvance to state the persons symptoms (so the symptomsare not overlooked or denied).

Helpful tips

Show you care. Depressed people feel isolated in theirpain and hopelessness. Tell your depressed family mem-ber or friend how much you and others care about theperson, want the person to feel well, and are willing tohelp. Listen and empathize with the persons pain.

Acknowledge the relationship impact. In a caring way,let the person know that depression affects you andothers in the family. Your relationship, including intimacy, household responsibilities, and finances, are all adversely affected when someone is depressed.

Be informed. Read a brochure, Family Profiles (seewww.familyaware.org), or a book, or watch a video on depression and share the information with thedepressed person. Stress that depression is a treatablemedical condition, like diabetes or heart disease, not a sign of weakness. Assure the person that people withdepression do feel better with treatment.

Use a symptom list. Go through the depression symp-tom list with the person who is depressed or have theperson take a confidential evaluation that will guidehim or her toward medical help. Take the symptomlist to the appointment for discussion with the medicalprofessional.

Reach out. Find other people to help you get yourdepressed family member or friend into treatment,especially medical and mental health professionalssuch as your primary care physician or a psychiatrist,psychologist, or social worker. Think of others towhom the depressed person will listen, such as familymembers, relatives, teachers, friends, or a member of the clergy, then enlist their help.

What not to do

People with depression are suffering from a medical condition, not a weakness of character. It is important to recognize their limitations.

Do not dismiss their feelings by saying things like snapout of it or pull yourself together.

Do not force someone who is depressed to socialize ortake on too many activities that can result in failure andincreased feelings of worthlessness.

Do not agree with negative views. Negative thoughtsare a symptom of depression. You need to continue topresent a realistic picture by expressing hope that thesituation will get better.

Know that you are being helpfulto a depressed family membereven when it seems like yourenot.NELL CASEY, author and sister


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When your help is refused

Often when you try to help someone who is depressed,your help is declined or nothing you do seems to work.You end up feeling rejected and discouraged that there isnothing more you can do.

Depressed people may reject your help because they feelthey should be able to help themselves, and they feelworthless when they cant. Instead, they may withdraw orstart an argument in an effort to resolve their difficulties.In addition, people with depression have negativethoughts and feel so hopeless that they do not see recoveryas a reality.

Fifty percent of people with bipolar disorder have a lackof insight, so they do not realize they are ill. For example,people with bipolar disorder may believe they are a high-energy person. This makes family involvement in seek-ing and managing treatment even more critical.

With these difficulties in mind, what can you do if yourhelp is turned away?

Provide consistent support. Over time, if you consistent-ly show support, the depressed person will see that youare resolute and may accept your help. Continue tryingsome of the tips discussed in this section.

Discuss your feelings. When your help is refused, restatehow much you care for the person. Let the depressedperson know how you feel, gently, by stating an exam-ple of the support you have offered and how it makesyou feel when it is rejected.

Focus on behaviors. If the depressed person is reluctantto seek help, then dont try to convince the person thatdepression is causing the problems. Instead, talk aboutthe depressed persons behaviors and the ways in which

treatment can help. Continue trying to get the person toa clinician, even if it is on the pretense of other healthconcerns. For example, after you have listened andempathized with the depressed persons feelings, try toagree on wellness goals (e.g., consistent sleep and feelingless irritable). Then, try to agree on some action steps to reach these goals (e.g., after two weeks, if the persondoes not improve, you will set up a medical evaluation).

Agree on professional help. It is important to make sureyour loved one gets the professional help he or sheneeds. Sometimes a primary care physician can seem lessthreatening, or a psychotherapist, or a couples therapist.

Helping someone who is depressed and reluctant to seektreatment can be very frustrating. As much as possible,try to enlist the aid of family members, friends, andmedical professionals in this process.

Bipolar disorder is vastly under-diagnosed. On average, it takes 20 years, or until a person isalmost 40 years of age, beforebipolar disorder is diagnosed. DR. NASSIR GHAEMI, directorof the Bipolar Disorder Research

Program at Cambridge Hospital

Read the entire interview at www.familyaware.org.

LACK OF INSIGHT

50% of bipolar patients have a lack of insight,

meaning that they do not realize they are ill.

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Helping children and teens

Each year, 3 to 6 million Americans under the age of 18suffer from depression. Although the symptoms of depres-sion are the same as those for adults, children and teensmay not be able to express their feelings as well or mayexhibit different emotions. Look for signs of decliningschool performance (e.g., poor grades), frequent tempertantrums, outbursts of crying, or unexplained irritability.

Your child must receive treatment for depression. Childrenneed to learn how to continue to develop and find waysto cope.

In addition, teens suffering from depression are at risk for committing suicide, the third leading cause of deathamong 15 to 24 year olds.

Treatment of depression for children and teens includes psy-chotherapy and if needed, medication. Psychotherapy helpschildren and teens learn how to express their feelings andgain critical communication skills. The use of medication isan emerging field in child psychiatry. Medication is pre-scribed and monitored on a case-by-case basis, dependingon the individual's symptoms, needs, and family history.

WHAT RESOURCES ARE AVAIL ABLE?

Medical professionals

To receive coverage under many health insurance plans,your depressed family member or friend may need to seehis or her primary care physician first, who may refer to a mental health specialist: psychiatrist, psychologist, socialworker, psychiatric nurse practitioner, or psychopharma-cologist. Check the health plans coverage guidelines.

Sources of medical referrals include the following:

Your state department of mental health or human services.

American Association for Marriage and Family Therapy,www.aamft.org, 703-838-9808

American Medical Association, www.ama-assn.org, Doctor Finder

American Psychological Association, www.apa.org, 1-800-964-2000

National Association of Social Workers, www.socialworkers.org, 202-408-8600

U.S. Department of Health and Human ServicesKnowledge Exchange Network (KEN), www.mentalhealth.org, 1-800-789-2647.

More medical help is listed under Resources, MedicalHelp at www.familyaware.org.

TEEN RISK OF DEPRESSION AND SUICIDE

Among 2001 high school students:

28.3% experienced some symptoms of

depression

19% considered attempting suicide

14.8% made a suicide plan

8.8% attempted suicide

Source: U.S. Department of Health and HumanServices, Centers for Disease Control and Prevention,2001 national survey.

Become as educated as you canabout the disorder. Involve yourwhole family in the care of yourchild. BILL AND NANCY, parents.

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Help In Crisis

National Hopeline Network800-422-4673 or 800-SUICIDE (784-2433)


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Medical emergencies

If your family member or friend is suicidal, contact your clinician immediately, go to your local emergency room,or call 800-SUICIDE or 911.

Support groups

Depression and Bipolar Support Alliance, www.dbsalliance.org, 800-826-3632

National Alliance for the Mentally Ill, www.nami.org, 800-950-NAMI

Child and Adolescent Bipolar Foundation www.bpkids.org 847-256-8525

Other resources

American Academy of Child and Adolescent Psychiatry,www.aacap.org, 202-966-7300

American Foundation for Suicide Prevention,www.afsp.org, 888-333-AFSP

American Psychiatric Association, www.psych.org, 888-357-7924

American Psychiatric Nurses Association,www.apna.org, 703-243-2443

National Institute of Mental Health,www.nimh.nih.gov, 800-421-4211

National Mental Health Association, www.nmha.org, 800-969-6642

Screening for Mental Health, www.mentalhealthscreening.org, 781-239-0071

HOW CAN I HELP MANAGE TREATMENT?

Medical professionals often remark on how helpful familymembers and friends can be in reporting changes indepressed patients symptoms and ensuring that patientsconsistently take their prescribed medication.

Families need to work together in managing treatment,because mood changes and behaviors affect the wholefamily, and many issues are involved in treatment. Waysin which you can work as a team are to:

Partner in treatment. Medications take up to 4 to 6weeks to take effect, the dosage may need to be adjusted,and medications often need to be changed. You can helpyour depressed family member or friend by schedulingand tracking medications, making medical appointments,and reporting changes to the clinician.

Be understanding. Let your depressed family member orfriend continually know that you care. Depressed peopleneed to be reminded that many people are concernedabout them.

Learn about depression. The more understanding you have of the symptoms and issues surroundingdepression, the more you can cope, help, and keepyour expectations realistic. Review books, brochures,Family Profiles (see www.familyaware.org), and videoson a variety of depression topics.

Share your feelings as a family. Since depression affectsthe whole family, it is important for everyone to sharetheir feelings, both the depressed person and caregivers.By talking about issues and emotions, you can uncoverwhat works and what is not helpful to one another.

Meet with the depressed persons clinician. Meeting withthe medical professional from time to time can be veryhelpful if your family member or friend with depressionwill agree to it. You can gain a good understanding ofthe condition and discuss issues together.


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See a family or couples therapist. Marriages in which aspouse has depression have a much higher likelihoodof ending in divorce. Couples therapy can help restorerelationships by addressing resentful feelings and honing communication skills.

In addition, children with depression in the family needsupport and ways to become resilient to developingdepression themselves. Family therapy helps childrendiscuss their feelings, learn coping mechanisms, andunderstand that they didnt cause the depression.

Develop a crisis plan. Talk to your depressed familymember or friend about what you will do if there is acrisis, under various circumstances, and where you willtake the person. Put the plan in writing.

Create a support system. Try not to take on caring for adepressed individual all by yourself because it is a diffi-cult task and can bring you down. Talk to other familymembers about sharing responsibilities.

WHAT CAN I ASK A CLINICIAN?

A good way to partner in treatment and provide emo-tional support is to go to appointments periodically withthe depressed person. You can keep track of the cliniciansrecommendations, discuss changes in symptoms, andreview the treatment plan.

Before you see the clinician

What types of patients and conditions do you currentlytreat in your practice?

What do you do when you are unsure of a patientsdiagnosis or treatment?

How do you involve families and friends in treatment?

During the visit

What is the possible diagnosis at this point?

How definite is this diagnosis? If not definite, what are the other possibilities?

What is your recommended treatment (e.g., medication,psychotherapy)?

What are the expected results of treatment?

What signs should we look for that indicate the treatment is working?

How soon will we see these signs?

What will you recommend if this course of treatmentdoes not work?

Why have you chosen this particular medication?

What are the risks and side effects of the medication?

Is this a case that you normally treat and that is withinyour practice capabilities?

What role can we play in helping with treatment?

Which days and times are best to reach you?

Who can answer our questions as they come up (whenyou are unavailable)?

What have been your experiences with our insurancecompany, and how can we facilitate reimbursements?

Do you recommend that we get a consult with anotherpsychiatric specialist?

Forty percent of clinicians report that their

patients have difficulty staying on their

medication.

Source: National Mental Health Association

Survey, 2001

You have to make sure thedepressed person really knowsthat youre on his side.ROSE STYRON, poet and wife

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If treatment is not working

Is there something else we need to be doing?

Are there any issues that may contribute to our familymember or friend not responding to treatment (e.g.,noncompliance with medication)?

How can we help in getting treatment to work?

Should we get a second opinion?

HOW DO I DEAL WITH MY OWN EMOTIONS?

Helping someone who is depressed is very difficult forfamilies and friends. Although we are concerned aboutthem, we are often frustrated, angry, and fearful as weattempt to deal with their condition.

The stress of caring for a depressed person is significant.Family caregivers often develop depression themselvesand suffer from anxiety or a host of other problems. Be sure to expand your social network through supportgroups and other caring communities. Try to find otherpeople to help you care for the depressed person so youdont shoulder the responsibility by yourself.

Remember:

Its not your fault. You did not cause your family mem-ber to be depressed. It is not due to anything you saidor did. Depression is a medical condition that needs tobe treated, just like heart disease or diabetes.

You are not alone. Depression is an extremely commoncondition, and many families are caring for someonewith depression. You can meet them through depressionsupport groups.

Your reactions are normal. Most caregivers experience arange of feelings, from compassion and understandingto frustration, anger, and hatred. These feelings are tobe expected because it is extremely difficult not to takea depressed persons behavior personally. Symptomssuch as withdrawal and irritability adversely affect youand create conflict in your relationship.

Your emotions will change. Family caregivers commonlygo through various emotional stages as they find outsomeone in their family has depression and then moveto managing the condition over the long term. Initialreactions are relief, shock, or even denial. Often familiessay they thought a magic cure would exist for the con-dition, and it would go away. As time goes on, you mayfeel angry or resentful that your life is different fromother families lives. You may grieve for the person youonce knew and feel you have lost. As you find effectivetreatment for your depressed friend or family member,you will feel relieved that the person is doing better.You may also be ready to reach out and volunteer oradvocate for depression awareness.

WHY ME?

Common family caregiver emotions

I feel

Overwhelmed Trapped

Cheated Angry

Guilty Frustrated

Tired Sad

Afraid Anxious

Embarrassed Lonely

Fearful Responsible

Helpless Like Im walking on

eggshells

Its manageable. No one shouldhave to suffer and live withouttreatment. PATRICE, wife (left)

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Take time to care for yourself. Set healthy boundariesand limitations on how much you will do. Take a vacation from caregiving from time to time. Be sure to schedule time for yourself to do activities that youenjoy. Do not be afraid to seek counseling for yourselfto process and deal with your own emotions.

Find social support. Dealing with depression can bevery lonely and isolating. Youve watched the healthyperson you once knew deteriorate and suffer. Yourfriends dont understand, and it is difficult for you to go out. Make sure you find sources of social supportthrough support groups and your community.

Have hope. Remember that in most cases, depression is highly treatable (80% of patients improve with treat-ment). Depression is cyclical, so it will be worse attimes, then become easier. Sometimes caregiving willbe overwhelming, but it is manageable. Finding theright treatment takes time but does happen eventually.

WHAT IS FAMILIES FOR DEPRESSION AWARENESS?

Our mission is to help families recognize and cope with

depressive disorders.

Families for Depression Awareness is a 501(c)(3) non-profit organization helping families and friends recognizeand cope with depressive disorders. The organizationprovides education, outreach, and advocacy to supportfamilies. Families for Depression Awareness is made upof families who have lost a family member to suicide orhave watched a loved one suffer with depression, withlittle knowledge about how to help.

Our programs include:

Our educational Web site, www.familyaware.org

Family Profiles and Expert Profiles

Free brochures

Media campaigns

Outreach education to associations, schools, police stations, health facilities, religious organizations, employers, and nursing homes

Conferences and events

Advocacy to support families with depression

The more you know, the better you can cope.

FREE EMAIL ALERT

Join our email list to learn about new family profiles, news, events, and ways you can help. Go to www.familyaware.org

Founder Julie Totten (right) with her mother Peggy TottenSexton (left) sharing photos of Mark Totten (middle photo),lost to suicide, and family members Linda Sexton (rightphoto) and Norman Totten (left photo) with depression.

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HOW CAN I CONTRIBUTE?

Help us continue helping families by making a gift.Families for Depression Awareness is a nonprofit,501(c)(3) organization that needs public support to continue its programs. Your gift is tax deductible!

All gifts are acknowledged in writing for your securityand tax purposes. Gifts are deductible on federal taxreturns and some state returns.

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Make a donation as a gift for friends and family. We sendthem a note card, informing them that a gift has beenmade in their name.

Please mail your contribution form to:Families for Depression Awareness

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Questions? Call 781-890-0220

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OT H E R :


395 Totten Pond Road

Waltham, MA 02451

781-890-0220 / [email protected]

www.familyaware.org

Production of this booklet is supported by an educationalgrant from Eli Lilly and Company.

2004 Families for Depression Awareness 1/08

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Documents

Helping Someone With Depression Brochure