by Annette Dekker

hances are, if you do not struggle with depression yourself, you care about someone who does. If so, you know that depression exerts its influence on a large circle of people, not just the person who has the diagnosis. Many people’s stories have happy endings of recovery because depression is treatable; others, unfortunately, have tragic endings. And still others are living out their stories as you read this article.

Depression is so prevalent that it has been called the “common cold” of mental illness. One in 33 children, one in eight adolescents, and one in six of the elderly are at some time affected by this mood disorder. In any given year, almost 10 percent of adults deal with its symptoms. Depression can even seem as contagious as the common cold: if someone you love has it, the ripple effects can leave you wondering whether you might be next.

Depression’s Effect on Family
Depression casts a shadow on so many facets of a person’s life—physical, mental, emotional, spiritual, behavioral, and relational—that a person with depression often remarks, “I’m not the same person I used to be.”

Persistent negative and self-critical thoughts; feelings of sadness, hopelessness, and low worth; low energy and lethargy; changed eating and sleeping patterns; difficulties in concentrating, remembering, or making even small decisions; irritability, anxiety, tears, a tendency to withdraw, and minimal response to any encouragement are more than just symptoms. They are dramatic lifestyle changes that can become a vicious cycle for the person suffering from depression and can stress even the most upbeat, nurturing family and friends. If threats of or attempts at suicide begin, the depression presses harder on everyone in the household. Living with someone who fights depression can be, well, depressing.

Everyone wants the intruder of depression to disappear, but depression has a way of hanging around—especially if left untreated. “It’s as though my son has crawled into a deep, dark hole, and nothing I do can get him out. Sometimes I’m afraid I’ll be pulled down with him if I keep trying to be helpful,” said one parent. Family members may experience a variety of ambivalent but normal responses. Here are just a few:
• Censoring and second-guessing the things I say and do.
• Increased empathy and understanding for those who suffer.
• A walking-on-eggs feeling in my own home.
• Helpless because I can’t “make it all better”—but wanting so much to be helpful.
• Heightened vigilance and determination to protect my loved one.
• Powerless when I want to take control but realize I can’t.
• Fear and sleepless nights of worry.
• Gratitude for little graces.
• Blaming self, others, and God.
• Anger and frustration that spills over in ways I don’t like.
• Hopeless some days, somewhat hopeful on others.
Many of these feelings are similar to those experienced by people who suffer from depression—perhaps they give you a glimpse into their stories.

In a marriage, relationship dynamics undergo radical shifts during periods of depression—from a loving partnership to that of a caregiver and one needing, but perhaps not wanting, care. How much irritability and alienation can the marriage tolerate? Verbal and emotional abuses, as well as incidents of domestic violence, are more likely to occur, with either person initiating the abuse. The likelihood of substance abuse also increases. Will the couple come to see each other as strangers, even adversaries, or as comrades who have different and changing roles in a battle they are waging together?

Children whose parents struggle with depression are amazingly resourceful. Some do their best to be “the adult” and try to comfort or at least avoid upset, while others play the clown or find other ways of creating distraction from depression. Even if not informed about the depression, they intuit the needs of the parent and may minimize their own needs. Informing children about the nature of depression may circumvent the self-blame or guilt that they often feel.

Postpartum depression (a mother’s depression after the birth of a baby) is particularly difficult, but important, to recognize. Body and hormonal changes, adjustments to the baby, sleep deprivation, and changes in eating patterns are all normal in the months following birth, so symptoms of depression are often dismissed. Besides, the birth of a baby is supposed to be a happy time; anxiety, exhaustion, shifting moods, and tears are sometimes hidden by the mother, who feels ashamed and blames herself for not being “good enough.”

Postpartum depression responds well to medication and psychotherapy. The sooner it is recognized and treated, the better, for the benefit of the mother, newborn, and the rest of the family. (For more information, see www.aamft.org/families/Consumer_Updates/Postpartum_Depression.htm.)

Depression changes relationships: a once-intimate partner feels like a stranger, a happy-go-lucky child seems like someone else’s troubled kid, and a friend seems so unfamiliar that it’s uncomfortable to be together. But relationships are a vital part of recovery from depression.

Relationships Part of the Cure
Although love alone does not provide a magical cure, supportive relationships do facilitate the healing process. Often the caring people around a person suffering with depression are the ones who need to ensure that the condition is diagnosed and treated. They may recognize the symptoms of depression sooner than the one who is depressed and have the energy and clarity of mind to seek out professional help.

Encouraging the depressed person to request help and to be involved in a plan for recovery is a first step of vital importance: the sooner treatment begins, the more effective it is likely to be. While a plan for recovery starts with loving support, it needs to be multifaceted. The following are some ideas to consider:
• Hold family discussions with and without the person fighting depression. Involve family, friends, and professionals in developing and implementing a recovery plan, including a plan to address potential suicide threats.
• Encourage taking prescribed medication and adopting healthy eating and sleeping patterns. Do some form of exercise together with the depressed person. (Research shows that regular exercise can be an effective treatment for mild depression.)
• Gently invite the person to participate in activities that used to provide pleasure.
• Become informed about depression. Some people still believe that depression is an indicator of weakness or a lack of faith. It is not. It is an illness that has multiple effects and responds to treatment. It should not be a shameful secret.
• Do not minimize symptoms or imply blame for the depression—for example, telling a person to “snap out of it” or to “pray more.” (See the following website for the best and worst things to say: www.truebluefriends.au.com/bestworst. html.
• Decide what you are (and are not) able and willing to do and to tolerate. For instance, “We will accept your being more grumpy than usual, but that does not give you permission to be cruel to your sister.” “Spending half the day in bed is fine, but we expect and want you to join us for dinner.” “Whether you feel like it or not, personal hygiene is a necessity.”
• Adapt household rules to accommodate the changes everyone faces. Be appropriately firm regarding agreed-upon rules and boundaries.
• Recognize that depression is not a constant—there are better days and worse days. Develop a code of colors or a scale that gives a visual message about what kind of day it is. (This is easier than asking or answering, “How are you?” 20 times a day.) Do not ask 20 questions; just be there (without hovering). Use a calendar to mark the better days—to remind everyone that there are some—or to monitor symptoms. Have discussions on better days about how best to resist the influence of depression on the bad days.
• Recognize that the illness makes it difficult for the depressed person to respond to all your helpfulness—even though a part of him or her really wants to.
• Recognize that you are not superhuman and that self-care is as vital as caregiving. Explore and express your own feelings with someone you trust—a friend, a pastor, a therapist, or the family doctor. Consult with friends and professionals about the decisions you face; arrange for some time of respite to give you a break and a fresh perspective.
• Ask for help—prayers, pastoral care, a casserole, or childcare—from your faith community. Respond to the shadow depression casts on peoples’ lives with as much compassion and care as you would any other serious illness.
The Paradox of Depression
Depression’s strong influence needs to be both accepted and resisted. An “either/or” approach denies the influence of depression or relinquishes personal power—and in either case gives depression more power over people’s lives. A “both/and” stance grants balance and grace as people journey through depression. When this challenge is jointly taken on by family, friends, and faith community—living reminders of the God who says, “I am with you”—it is more likely that depression becomes only a chapter, not the whole story, of people’s lives.