Help for partners and families

Depressive Illness: An Information Guide

On this page:

• How to Relate to the Depressed Person
• Care for Partners and Families
• Family Concerns about Acute Episodes

Seeing a loved one struggle with depression can make people feel sad, concerned, frightened, helpless and anxious.You may experience guilt, anger and frustration. All depressive episodes are upsetting, but the patient’s first one will probably be especially confusing. You may not understand what is happening and why the person is not getting better on his or her own. Without information about depression, you might assume your relative is lazy, give well-meaning advice and become frustrated and annoyed when he or she does not act on it. If your relative talks about suicide, you will understandably live with a great deal of worry.

Families and partners need to get as much information as possible about depression. Knowledge and understanding will improve your ability to assist and support your loved one, deal with your own feelings, and explain the situation to extended family, friends and colleagues. Information is available from the treating physician, social worker or other mental health professionals. In addition to this publication, there are several books written for patients and families. These are usually available through public libraries. Many communities also have self-help and support groups, and psychoeducational groups designed to meet the needs of families.

How to Relate to the Depressed Person

Family members often do not know how to talk to a depressed person. They may be afraid to ask too many questions and inadvertently upset their loved one. At the same time, they do not want the ill relative to feel they are not interested or are avoiding him or her.

Try to be as supportive, understanding and patient as possible. Just recognizing that depression is an illness can help your relative to feel less guilty about his or her impaired functioning.

Tips for Communication:

1. Speak in a calm, quiet voice.
2. Stay focused on one subject at a time. It may be difficult for your relative to concentrate.
3. If the person is quiet and withdrawn, break the ice with neutral, non-threatening statements, such as “It seems a bit warm in here.”
4. Be patient and wait. It may take a while for your loved one to respond.
5. Your ability to listen is a valuable resource to your relative or friend. Depression causes people to talk at length about how bad they feel, yet they may not be ready to discuss solutions to their problems. Listening and letting the person know, in a neutral manner, that you have heard what he or she has said, is a valuable and supportive contribution. You do not have to offer immediate solutions.
6. If your relative or friend is irritable, you probably need to slow down, lower your expectations and use a very neutral approach. Neutral comments about the weather, what you are making for dinner or other routine subjects are the safest way to develop a dialogue. Listen for opportunities to acknowledge or add to your relative’s responses. At these times, conversations about important decisions or issues are unlikely to be productive. You may need to plan to discuss important issues at a later date.

Moderately depressed people may be able to hear your helpful suggestions, but be unable to act on your advice. Avoid quizzing them about what made them feel depressed. Do not blame them for the way they feel, or tell them to snap out of it. This will only reinforce their guilt, loneliness and isolation. Often, depressed people cannot identify what made them depressed or what will be helpful.

If your partner or relative is severely or more chronically depressed, it is normal for you to experience his or her company as particularly draining. Brief, frequent contacts are often the best way to relate to the severely depressed person. If your relative is hospitalized, family members might take turns visiting the patient.

When you are visiting, make a special effort to listen to what the depressed person is saying, rather than telling the person what he or she should do. Avoid longer visits as they are tiring for both the patient and the visitor.

Care for Partners and Families

Whenever someone suffers from a serious illness, it is natural for family members to feel worried and stressed. In an effort to spend time comforting or helping their loved ones, family members may give up their own activities. Over time, they may become isolated from their own network of friends, or find that most of their normal routines and activities have been replaced by the demands of caring for their depressed relative. Often, they are well into this situation before they realize how emotionally and physically drained they have become. This stress can lead to sleep disturbances, exhaustion, or chronic irritability.

It is important to recognize these signs of stress in yourself and look after your own physical and mental health. Recognizing your own limitations and making time for yourself are key elements to “self-care.” Ensure that you have a good support system of reliable friends and relatives. Think about who you want to share the details of the situation with. Mental illness is a difficult thing for some people to make sense of, so it is understandable if you want to be selective and choose only people you know to be supportive.

Consider having your own professional support and joining a self-help organization or relative support program, which may be offered at a local hospital or community mental health clinic. Preserve your interests outside of the family and apart from your ill relative. Acknowledge and accept that sometimes you will have negative feelings about the situation. These feelings are normal and should not be a source of guilt.

Family Concerns about Acute Episodes

1. Compliance with Treatment

While many people are eager to seek treatment for depression, others are reluctant to admit their difficulties. Some people with depression worry that admitting to their depressed feelings is a sign of weakness, or that they will be stigmatized for having psychiatric problems. Others try to cope on their own and do not realize until they are acutely depressed that they have a disorder that can be treated.

If you are worried about a loved one who appears depressed, but is not currently receiving treatment, just letting him or her know that help exists may be enough to get the person to seek treatment. For some patients, it is a long and bumpy road to acceptance that they have a disorder that must be managed over their life span. Some people must endure several depressive episodes before they accept consistent help from doctors and therapists. As a family member, it can be very difficult to watch this process without trying to repeatedly convince the patient that he or she “should take your medication” or “go and talk to your doctor.” Repeated attempts to convince and cajole can lead to heated arguments and power struggles. If you are very close to the depressed person and you feel he or she may not be open to your observation that something is wrong, it is sometimes more effective to have another trusted person approach your relative.

2. The Suicidal Relative

People who are depressed to the point of suicide may refuse treatment because they feel so hopeless and worthless. In such a case, you or another trusted person should insist that the depressed person see his or her doctor or go to the emergency department of a local hospital. Most people will agree to go to the hospital; however, if the person refuses, you can then ask a doctor to make a house call and certify that the person must be hospitalized. If this is not possible, a visit to a justice of the peace, who issues an “order to certify,” will allow emergency personnel to take your relative to the hospital.

Although it is a painful and difficult decision, it is sometimes necessary to involve the police in order to get an ill person to the hospital. Family members often feel overwhelmingly guilty about this decision, even when it is necessary to protect the person’s life. It is important to remember that when people threaten suicide, they are usually making a plea for help, which should be taken seriously. Suicidal thinking is usually a temporary emotional state during which a person needs to be in a place of safety.

Once in hospital, if your relative is quite ill and impaired, it is sometimes better for both the patient and the family if visits are frequent, but short. Patients who are acutely ill do not benefit from long conversations where they can become overwhelmed as they ruminate, or repeatedly focus on their feelings of hopelessness and negativity. Frequent, brief contacts allow you to stay in touch with your relative, and reassure him or her that you remain supportive.

For some patients, being in hospital is very difficult to tolerate. For this reason, they may wish to leave the hospital before the professional staff feel their mood and behaviour are stabilized. For family members, this is particularly difficult as they can foresee the problems at home if the person becomes acutely ill again and requires hospitalization. Some patients will respond to the concerns of friends and family and agree to stay longer in hospital. This is more easily accomplished if there are clear goals to be achieved during the admission. For example, it might be helpful to concretely state that a patient must be stabilized on medication and connected with a day program or community therapist before discharge.

Most jurisdictions in North America have mental health legislation that only permits involuntary hospitalization of people if they threaten to harm themselves or other people, or cannot care for themselves.Many ill people who would benefit from hospitalization do not meet these criteria and therefore may leave the hospital against medical advice.

In these situations, try to negotiate with your relative when it might be best to leave the hospital. What must be accomplished during the admission for you to feel it is safe for the person to return home? Could these issues be discussed in a discharge planning meeting with your relative, the doctor and any other professionals who work with him or her?

Sometimes, you can slow your relative down by saying that you need this meeting to take place before consenting to his or her returning home. Families often feel guilty insisting on these conditions because they are worried the patient will feel rejected. However, the result of premature discharge and poor discharge planning is frequently a relapse in the illness and a more complicated situation.

3. How You Can Best Support Recovery

Once stabilized, you will likely observe your relative make slow, but steady improvement. Over time, he or she may want to discontinue medication, because of the side-effects, or psychotherapy, because of the time commitment involved. Your support in encouraging your loved one to remain in treatment can be very important. Premature termination of medication can contribute to relapse. Reducing or stopping medication should be monitored by a physician. Psychotherapy works best if the client and the therapist mutually agree that the person’s emotional work is complete or the agreed-upon number of sessions has been reached.

Family members, partners and friends are important figures in a patient’s support network. “Just being there” and keeping up an interest in the depressed person is an important contribution to the patient’s recovery process. Once recovered from their illness, patients have commented on how much they appreciated the presence and tolerance of their families and friends.

The recovering person will gradually enter a transitional phase where previous responsibilities are resumed. He or she might benefit from some help with making decisions about which first steps to take. Try to do things with the person, rather than for the person. Giving your opinion before you are asked may be experienced as controlling by your relative. Encourage the person to be as active as possible. Recognize that your relative is an independent adult, who may choose activities or behaviours with which you disagree. Try not to say that the person has made an incorrect choice just because he or she is ill. This can be very hurtful and can complicate your relationship.

As your loved one’s health improves, you should increasingly treat him or her as a well person. This means including the person in family activities, discussions and responsibilities around the house. Some families address and resolve problems through loud arguments and debates, and openly express hostility and anger. Research suggests that patients recovering from depression are at greater risk of relapse if they are exposed to this kind of conflict. As family members or close friends, you need to be sensitive to the needs of your recovering relative and understand that he or she might not be able to manage the highly charged emotions associated with conflict and arguments. Other ways of dealing with family disputes, such as family counselling, may be good resources to consider.

4. Being Ready for a Relapse or a Crisis

Patients and their families often avoid talking about acute crises because these events are uncomfortable to acknowledge and awkward to discuss. However, the best way to handle a crisis is to know what to do before it happens. While the focus should be on maintaining wellness, some planning for a possible crisis can create a sense of security for the ill person and his or her support system.

If possible, when your relative is well, discuss what you should do if he or she should become ill or suicidal. Could you both attend an appointment with the doctor to discuss your relative’s condition and the possibility of a crisis? If your relative became ill, would you have permission in advance to contact his or her doctor? Would you have consent to take the person to the hospital, and which hospital is preferred? If your loved one is acutely ill, would you be allowed to make decisions? Could you put the conditions of an agreement in writing to ensure that these instructions are followed?

A good working relationship with the treating physician and a prearranged plan can help to contain an emergency situation.  

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