Depression and how it affects the ones around us

Depression is a mental condition with serious social, professional and personal consequences. It affects people of all ages regardless of their socio-economical status. Although there is a lot more talk about depression and mental health these days, we still deal with stigma and have difficulty treating and recognizing this disorder. Depression is a major factor in suicide, so it is crucial that people suffering from this disorder receive some form of treatment. There are treatments that work, both psychological and alternative treatments (transcranial electrical stimulation), or drug based, but around 35% of patients do not receive any form of treatment.

It is not always obvious when someone is going through a depressive episode, sometimes even the affected person does not understand what is happening. That's why it's important to understand what depression looks like. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines a major depressive episode as a state of sadness and loss of interest or pleasure in activities that were previously enjoyable. Symptoms must also last for at least two weeks and at least 5 of the following types of symptoms must occur:

1. Sleep problems almost every night (either sleeping too much - hypersomnia or too little - insomnia)
2. Changes of appetite or weight (too little or too much appetite and sudden changes in weight)
3. Low energy and fatigue almost every day
4. Difficulty concentrating, making decisions, psychomotor agitation or slowness that are also observable by others
5. Recurrent thoughts about death and suicide, attempted suicide, or a specific plan to commit suicide

Living with someone with depression can be challenging because you don't always know what to do and how to react in a healthy way for them. The most important thing you can do for a depressed person is to offer emotional support.

Sometimes it can be difficult to offer this unconditional support because the negative state of the affected person can end up affecting you in one way or another. It is important, however, to recognize their suffering and to accept the fact that for a period, the state of the affected person will be marked by sadness, withdrawal or even irritation that are not particularly related to you, but are simply depressive symptoms. Therefore you must learn not to take things personally and offer space and empathy according to the person's needs.

In general, social support alleviates psychological distress. If there is a perception of emotional availability from loved ones, a kind of protective barrier appears against depressive episodes and a wider range of psychological conditions. Providing emotional support means creating a safe space that allows trust to develop, providing care, empathy and love.

When a person has depression, they are not the only ones who suffer, the person's family is also impacted. Depression isn't always obvious from the start, but even if people shut down, don't talk about how they feel, and try to mask their symptoms, family dynamics change. A tense atmosphere is created, marked by agitation and concern. Family members may feel some level of guilt because they may feel that they should be able to do more to help the person recover from depression as quickly as possible. Family members may still experience feelings of fear and anxiety, feelings of helplessness, irritation or even anger at the current situation. These feelings later lead to guilt and shame for being angry at the person with depression → these are all normal feelings and it is important to set our minds in such a way that we understand that it is normal to be angry at the situation itself, not the person or the behaviors they have because of depression. Recovery is a long process and the depressed person must take an active role in recovery, it is not something others can do to instantly cure them or make them feel better, and the best we can do is to build an environment where the person feels safe to navigate that depressive episode until symptoms improve.

How the family responds to a member's depression has a major impact on the recovery process

For example, an environment that is hostile, critical, and even marked by pressure to display a positive attitude (stemming from good intentions to make the person feel better) can worsen symptoms of depression and prolong the time that symptoms are active. If family members do not understand what is causing the symptoms, even if they notice them, they may blame the person for being too sensitive, too weak, or too lazy. They may also believe that the person is consciously choosing not to do anything out of convenience or laziness and that they are indulging in the situation.

For a person with depression, it is difficult to cope with many situations that are part of daily life. Low energy and motivation can make the person feel overwhelmed with even the most mundane activities, such as getting out of bed, cooking, or taking care of personal hygiene. When the affected person is no longer able to contribute to household chores, there is more for others to do and some things may be left undone which can create frustration and tension. Because of this, family members may start to hold resentment because they feel that there is too much pressure on them. Also, the symptoms of depression can be difficult to interpret correctly at times. Symptoms such as tiredness, fatigue, irritability and social isolation are easily misinterpreted. Difficulty recognizing depressive symptoms can lead to conflict in relationships. For example, the partner may misinterpret social withdrawal as disinterest or avoidance and symptoms of irritability as anger directed towards them.

What NOT to do when you want to help someone with depression?

1. Avoid taking things personally - also pay attention to your emotions and try not to interpret the depressed person's irritability or distant attitude as personal attacks
2. Do not minimize the emotional experience of the depressed person - guilt in depressed people is amplified and they can very easily end up blaming themselves or feeling like a burden to those around them. Phrases like "let it go", "try to smile more and think more positively", "it's only in your mind", "you have to be strong and get over it" can be very harmful for a person with depression
3. Don't try to do everything for the depressed person out of a desire to take care of them - to relieve them of any kind of effort - to clean for them, bring food to their bed, not let them do anything because you want to let them rest - this kind of behavior can maintain symptoms of depression because they bring the benefit of being taken care of much more than before, and this is an unconscious mechanism that maintains symptoms. It is important to encourage the person to do small activities that are not very energy consuming and to support them in carrying out the activities. These small activities, in addition to increasing the level of positive emotions, help the person slowly regain a sense of autonomy.

What to do when a loved one is experiencing depression?

1. Listen patiently to the person if they feel the need to talk about how they are feeling, not to interrupt or talk over them (if interrupted, people with depression can easily lose their thoughts due to difficulty concentrating)
2. Show empathy and emotional availability (including physical contact, e.g. hugs) according to the needs of the affected person (under no circumstances should we force him or her to tell or hug us if one does not feel like it - we are close but we also offer space if needed)
3. Do together things that the person might enjoy to raise the level of positive emotions, but not very demanding ones (eg a walk, going out for coffee in town, for ice cream, watching a movie together or cooking ), small activities that you can choose together
4. Guide the person to get proferssional help, and support them through treatment
5. Create a relaxed atmosphere at home - when we are going through depression it helps a lot to avoid stress as much as possible and routines are very good for this because they give more predictability and feel more in control of our lives, which significantly reduces the stress
6. Learn about depression and be aware of the warning signs of suicide
7. Healthy eating and daily exercise help boost well-being - plan healthy meals with the depressed person to cook together and do any kind of exercise together, even if it's a light one, every day
8. If you feel overwhelmed and tired from interacting with the depressed person, consider seeking professional help yourself.

When a family member or a close friend suffers from depression it is challenging for everyone, but depression is treatable and emotional and social support greatly improves treatment outcomes.

Bibliography:

1. Mojtabai, R., Olfson, M., & Han, B. (2016). National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics, 138(6).
2. Nasser, E. H., & Overholser, J. C. (2005). Recovery from major depression: the role of support from family, friends, and spiritual beliefs. Acta Psychiatrica Scandinavica, 111(2), 125-132.
3. Leahy, R. L., Holland, S. J., & McGinn, L. K. (2017). Treatment plans and interventions for depression and anxiety. ASCR [Cognitive Science Association from Romania].
4. American Psychiatric Association. (2016). DSM-5 Diagnostic and Statistical Manual of Mental Disorders. Bucharest: Callisto Medical Publishing House.