Session Two - What can I do when my
family member is depressed?
Materials Needed: Handout E: "What Can
I Do When My Family Member Is Depressed?"
Video: When You Love Someone Who Is Depressed: Depression and its Impact
on Marriage and the Family
Brochures on local treatment options for patients with depression
- Symptoms of depression
- Depression can manifest itself in
many different ways. All human beings feel depressed or down at
times; however, the disorder of Major Depression is more than
just feeling the "blues" every once in a while.
- What are some symptoms of depression?
- Which are most difficult for
you to cope with?
- Feeling sad, blue, or down
- Loss of interest in previously
- Change in appetite or weight
- Change in sleep patterns
- Feeling tired and fatigued OR
- Feeling worthless or guilty
- Trouble concentrating, thinking,
or making decisions
- Thoughts of death or suicide
The diagnosis of a major depressive episode is made when a person
experiences 5 or more of these symptoms that occur nearly every
day for at least 2 weeks – with at least one symptom being depressed
mood or loss of pleasure in previously enjoyed activities (
Approximately 6.6% of the nation (13-14 million
people) suffer from some type of depression every year (Kessler,
Berglund, Demler et al., 2003). It is often called the “common
cold” of mental illness. Many famous people have struggled with
clinical depression, including television reporter, Mike Wallace;
British prime minister, Sir Winston Churchill; Pulitzer-Prize
winning newspaper columnist Art Buchwald; and Academy-Award
winning actor, Rod Steiger.
According to a large community study, the prevalence
of major depression in adults is approximately 16%, making it
one of the most common psychological disorders. The average
duration of an episode is 16 months (Kessler et. al., 2003).
Women who have had at least one episode of depression
outnumber men by a ratio of 1.7 to 1. Also, people living in
poverty are approximately 4 times more likely to suffer from
chronic depression than more affluent people (Kessler et al.,
Depression also tends to be recurrent, as about
80% of individuals with depression experience another episode
within one year (Coryell et al., 1994).
Oftentimes an individual with major depression
also has another psychiatric disorder. For example, one large
study found that almost ¾ of people with major depressive
disorder also met criteria for another disorder (commonly anxiety
disorders and substance use disorders) (Kessler et al., 2003).
Due to the very nature of depression (decreased
concentration, decreased motivation, social withdrawal, fatigue,
etc.), individuals are often less productive in the workforce.
In fact, US workers with depression cost employers approximately
$44 billion per year in lost productive time (Stewart et al.,
2003). Depression has been described as the leading cause of
- Show and discuss video:
- When You Love Someone Who
Is Depressed: Depression and its Impact on Marriage and the
Family. (University of Notre Dame Alumni Association,
- What causes depression?
- No one single factor causes depression.
Oftentimes doctors cannot determine the specific cause of a patient's
illness. The constellation of causes is unique to each individual.
- Family members and friends need
to remember that depression is not the person's fault.
- Several causes are common:
- Certain life events may trigger
a depressive episode (e.g., death of loved one, retirement).
- A strong genetic factor is
present in many cases of depression.
- If one identical twin has
major depression, the other twin has an approximately
50% chance of developing depressive symptoms sometime
in his/her life.
- If one identical twin has
manic-depression, the other twin has a 70% chance of developing
the disorder (Carter & Golant, 1999).
- Depression may be caused by
an imbalance in the level of chemicals in the brain. Many
antidepressants work by regulating the levels of these chemicals
- Medical illness may be a causative
factor in depression.
- Use of certain medications may
cause depressive symptoms (e.g., some anticonvulsants or thyroid
- Excessive use of alcohol and
other drugs may contribute to depression, as alcohol acts
as a depressant on the central nervous system. Further, substance
abuse complicates the diagnosis and treatment of the underlying
- The impact of depression on relationships
- How has your loved one's depression
affected your relationship?
- Your family life?
- Your view of yourself?
- Depression affects the person's
behavior and style of communication (less eye contact, slower
and softer speech, negative thinking, reduced problem solving
- Depression is often accompanied
by an increase in marital tension and arguments.
- Depressed people have greater difficulty
interacting with others. Therefore, the social life of the couple
/ family may be altered.
- Some depressed people are unable
to work. Therefore, other family members may have to get a job
for the first time or work two jobs to compensate for the reduced
- Family members often become frustrated
with the depressed person's behavior, thinking the patient should
just "get over it" or "cheer up."
- Depressed people often have decreased
interest in physical intimacy and sexual activity. Partners often
worry that the patient is no longer physically attracted to them,
which can increase the tension in the relationship.
- Important issues surrounding suicide
(parts adapted from Woolis, 1992)
FACILITATOR NOTE: As these issues may be difficult to discuss, the
facilitator may wish to normalize any anxiety when talking about these
issues. Coping skills will be addressed in the next section.
- Many family members worry a great
deal that their loved ones may try to kill themselves.
- Individuals with mental illness
do commit suicide at a rate that is 12 times higher than the
- Over 90% of suicides are associated
with a mental disorder (Clark & Fawcett, 1992).
- More specifically, one-third
of all clinically depressed patients attempt suicide, and
approximately 15,000 people with mood disorders kill themselves
each year (Adamec, 1996).
- One in every 10 young men with
schizophrenia commit suicide (McGuire, 2000).
- Men are 4 to 5 times more likely
to complete suicide than women. Women are 3 times more likely
to attempt (but not complete) suicide than men (Moscicki,
- Many reasons exist for why people
consider and attempt suicide:
- Some make a decision to end
their lives - they are very unhappy with their lives and feel
hopeless that the situation will improve.
- Some engage in reckless behavior
because they don't think they will die (e.g., jump off a tall
building believing they are super-human). Their judgment is
impaired, and they may not understand the consequences of
- Some hear voices telling them
to harm themselves.
- Some do not know how to ask
for help more directly, but kill themselves unintentionally
(e.g., take too much pain medicine; cut wrists, etc.)
- Red flags that warrant further exploration:
- Changes in the level of depression
(more depressed or happier than usual), especially if he/she:
- Has a specific plan for
how they would kill themselves
- Has access to lethal means
(such as weapons, pills, etc.)
- Feels worthless
- Talks about having done
an unforgivable behavior
- Feels hopeless about the
- Hears voices telling them
to harm themselves
- Begins to get their affairs
in order (e.g., writes a will, gives things away, systematically
contacts old friends or relatives)
- Has experienced a recent
significant loss (or perceived loss)
- Lives with chronic medical
illness and/or chronic pain
- Has previously attempted suicide
OR has a history of being impulsive
- Talks about killing him/herself
(e.g., "everyone would be better off without me")
- Makes suicidal gestures (takes
too many pills, cuts wrists, etc.)
- Talks about being indestructible
or having supernatural powers during a manic or delusional
- Increases use of alcohol or
other drugs. These substances may increase the level of depression
AND may lower inhibitions, both of which are dangerous with
- What do I do if my family member
- What have you found to be helpful
for yourself and for your loved one when he/she shares thoughts
- How do you feel in these situations?
- TALK ABOUT IT! Asking about
suicide will NOT put ideas in the patient's head and will
not make the situation worse. Your family member may even
feel relieved to be able to talk about it.
- Discussing suicidal ideation
can be very important, as 50-70% of people who complete
suicide communicate their intent in advance, usually to
a family member (Adamec, 1996).
- Offer emotional support by:
- LISTENING in a nonjudgmental,
- Empathizing with their feelings
(e.g., "it must be awful to feel that way")
- Reminding them of recent
- Normalizing depression and
thoughts of suicide
- Expressing your concern,
care, and willingness to help
- Ask if they have a plan about
how they are thinking about killing themselves. If they describe
a specific plan, then:
- Seek professional help immediately
- Try to get them to make
an agreement with you that they will not act on these
plans without first talking to you, a hotline, or a mental
- Put away any objects that
they may use to harm themselves (guns, knives, pills,
- If the person is delusional
(expressing false beliefs), seek professional help.
- If you don't know what to do,
call a professional (e.g., suicide hotline, mental health
- National SUICIDE Hotline: 1-800-SUICIDE
- Suicide hotline in Oklahoma City: (405) 848-CARE
- Sometimes suicide happens without
warning and nothing can prevent it from occurring.
- Even with warning signs, there
still may be nothing you can do.
- Family members can benefit from
discussing this issue with their loved ones when they are
not actively suicidal. Together, the caregiver and patient
can create a plan for how to cope with this inherently stressful
situation if it arises again in the future (Spaniol &
- Consider seeking professional
help for yourself. Caregivers often experience intense anxiety,
worry and feelings of powerlessness when patients make suicidal
threats (Jones, Roth & Jones, 1995).
- Provide local treatment options for
individuals struggling with depression
Example: Oklahoma City VA Medical Center
- Depression Management Class
- Day Treatment Center
- The Day Treatment Center provides
a structured intensive program for veterans experiencing chronic
mental illness (including depression).
- Anti-depressant Medications
patient's primary care provider can prescribe many anti-depressant
medications. In addition, psychiatrists in the mental health
units have special training in prescribing and monitoring
Antidepressant medications are not habit
forming, so patients do not have to worry about becoming
addicted to the drug.
Antidepressants are quite effective. Most
studies demonstrate at least a 50% decrease in symptoms
for approximately 70% of patients (Tamminga et al., 2002).
- Electroconvulsive Therapy (ECT)
- Electroconvulsive Therapy (ECT),
also known as shock treatment, is a safe and painless (yet
rather controversial) treatment option for patients with severe
depression who do not improve with medications. The success
rate of ECT (80-90%) is higher than that with antidepressants
(approximately 70%). ECT is administered by deliberately inducing
a seizure, and the potential adverse effects of this procedure
(e.g., confusion and memory loss) must be considered (Tomb,
- The patient should discuss this
option with his/her psychiatrist if interested in this treatment.
- Coping strategies for the family
- Acknowledge that clinical depression
is a legitimate illness. Learn about depression and its impact
on the family.
Some Good Books on Depression:
What to do when someone you love is depressed. (1996).
M. & S. Golant.
Overcoming depression. (1987). D. & J. Papolos.
When someone you love is depressed. (1996). L. Rosen
& X. Amador.
Sherman, M.D., & Sherman, D.M. (2006). I’m not alone: A teen’s guide to living with a parent who has a mental illness. Edina, MN: Beaver’s Pond Press. Available at www.seedsofhopebooks.com
Interesting Movies on Depression:
Relevant Web Sites:
www.depression.com comprehensive resources about depression
www.depressionfallout.com help for those dealing with depressed loved one
www.depressionoptions.com depression and sexual functioning
www.intimacyanddepression.com examines effects of depression on relationships
www.nimh.nih.gov/publicat/depression.cfm National Institute of Mental Health
www.dmda.org Depression and Bipolar Disorder Alliance
www.familyaware.org Families for Depression Awareness
- Have realistic expectations
(e.g., depression cannot go away overnight)…but also maintain
- New antidepressants and
treatment strategies are being studied and released on
the market. Many patients with depression are able to
lead constructive lives.
- For example, the movie Patch
Adams starring Robin Williams depicts a young man admitted
to a psychiatric unit due to major depression and suicidal
ideation who later becomes a successful physician.
- Be an active team member in
the care of your loved one. Ask questions of doctors, nurses,
psychologists, and other health care providers.
- Offer emotional support, patience,
and compassion. Encourage your loved one to exercise and do
activities that he/she used to enjoy. Allow your loved ones
to care for themselves as much as possible.
- Stay in contact with your social
- Obtain professional help for
yourself when needed.
- Maintain good sleep habits,
both for you and your loved one (e.g., go to bed and get up
at the same time every day; reduce caffeine intake).
- Make healthy lifestyle choices
(healthy diet; regular exercise; avoid use of alcohol).
- Try not to take the depression
personally - it's not your fault! You cannot cure depression
with love any more than you can cure cancer with love.
- Don't exclude the depressed
person from family discussions or decisions.
- Don't try to do everything for
the depressed person.
- Don't criticize the person for
their depressed behavior or expect him/her to be able to simply
"snap out of it."
- Don't feel that you need to
apologize for your loved one.
Special thanks to Lisa Swisher, Ph.D. who contributed to this session outline.