Supporting a loved one experiencing depression

When a loved one is affected by depression, it can be difficult to understand or know how to help

Depression is an incredibly complex and individualized experience. There isn't one truth or simple solution that works for every person.

Downward-spiraling staircase of depression

Gaining perspective on what your loved one is experiencing is a crucial part of the process. Visualizing depression as a downward spiral is one way to simplify and understand clinical depression.

One way to develop perspective is by visualizing depression as a steep, downward-spiraling staircase. Your loved one may be having difficulty finding an open door along that staircase or may not be able to turn around without your support and guidance.

The downward-spiraling staircase may start with the person feeling worse than usual from a physical, social or psychological stressor. A worsened mood may lead to taking part in fewer meaningful or enjoyable day-to-day activities. Self-criticism and stress increase due to mounting responsibilities or missed opportunities. Depressive thinking may encompass guilty thoughts, pessimism, putting themselves down and irritable behavior.

As the spiral develops, a complex dynamic emerges. Your loved one may become increasingly stressed while simultaneously less able to cope with stress. The response of the brain is to slow, stop and depress. A person can get stuck in the spiral for weeks, months or years.

The silver lining is that if people can spiral down, they can spiral back up. However, depression affects the motivation, energy and curiosity needed to spiral up.

It can be disheartening and stressful that you can't fix a loved one's depression. But you can help them start and continue moving on an upward path.

Symptoms of depression

Depression symptoms vary from person to person, including:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
• Insomnia or sleeping too much
• Tiredness and lack of energy, so even small tasks take extra effort
• Changes in appetite — reduced appetite and weight loss, or increased cravings for food and weight gain
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or taking unnecessary blame for things
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent mention of death, suicidal thoughts, suicide attempts or death from suicide

For many with depression, symptoms can be severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Others may generally feel miserable or unhappy without knowing why.

Children and teens may show depression by being irritable or cranky rather than sad. Clinical depression doesn't require profound sadness. Rather it can be lack of positive emotion instead of intensely negative feelings.

Encourage treatment for symptoms

People with depression may not recognize or acknowledge their symptoms. They also may have difficulty asking for help or recognizing how treatment can help.

Here's what you can do to help:

• Talk to the person about what you've noticed and why you're concerned.
• Explain that depression is a complex condition, not a personal flaw or weakness
• Remind them there are people who want to help them.
• Suggest seeking help from a health care or a mental health professional
• Consulting with a primary care professional can be the best place to start since a trusting relationship already has been established.
• Express your willingness to help by setting up appointments, accompanying your loved one and attending family therapy sessions.
• Offer to help prepare a list of questions and notable changes to discuss at an initial consultation.

Provide support

Your support and understanding can kick-start or reinforce the healing process.

Here are some ideas for helping your loved one:

• Encourage sticking with treatment.
  Help your friend or loved one remember to take prescribed medications and keep appointments.
• Be willing to listen without judgment — when desired.
  When your loved one wants to talk, listen carefully and intently. Avoid giving too much practical advice or opinions, or making judgments. Just listening and being understanding can be a powerful healing tool.
• Give positive reinforcement.
  Remind your loved one about his or her positive qualities and how much the person means to you and others.
• Offer assistance.
  Certain tasks for your loved one may be hard to do. Suggest specific tasks you're able to help with or take on.
• Help establish a routine.
  Depression may make it hard for your loved one to make spontaneous healthy choices. Developing routines and scheduling everyday activities becomes crucial. Offer to make a schedule for meals, medication, physical activity and sleep, outside time or time in nature, and help organize household chores.
• Make plans together.
  Ask your loved one to join you on a walk, see a movie or work together on a hobby or other activity. Don't try to force the person into doing something.
• Be patient.
  For some people, symptoms can quickly improve after starting treatment. For others, it will take much longer.

Be aware of suicide risk

People experiencing depression are at an increased risk of death from suicide.

If you believe a loved one's illness is severe or life-threatening emergency, please reach out to these resources for help:

• Call the 988 Suicide and Crisis Lifeline at 988. To reach the Veterans Crisis Line, use the same number and press "1."
• Call 911.
• Contact a health care professional or hospital.

Remember to take care of yourself

Witnessing a loved one's struggle with depression and knowing you can't fix it is challenging. Understand that emotions you experience, such as frustration, helplessness, fear, guilt or anger, are all natural responses. It's important to take care of yourself, too. Validate your feelings and prioritize your own mental health by devoting time to hobbies, meaningful experiences, physical activity and other valued, meaningful relationships.

Jessie Wolf is a clinical social worker in Family Medicine in New Prague, Minnesota.