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Helping Someone
Who is Depressed
For families and friends

www.familyaware.org

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CONTENTS
What is depression? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
What are the signs of depression? . . . . . . . . . . . . . . . . . . . 3
Why are family and friends important? . . . . . . . . . . . . . . . . 5

W H AT I S D E P R E S S I O N ?

Depression is a medical condition that affects people of

all genders, races, ages, and income levels. People who are
depressed feel more than sadness or the blues. They feel
hopeless and suffer deep emotional pain for prolonged
periods. Depression can cause dysfunction in every aspect
of ones life.

How can I help someone receive treatment? . . . . . . . . . . . . 6

Helpful tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
What not to do. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
When your help is refused . . . . . . . . . . . . . . . . . . . . . . . . 8
Helping children and teens. . . . . . . . . . . . . . . . . . . . . . . 10

Nearly one in five Americans will experience depression

sometime in their lifetime, and almost 19 million
Americans suffer from a depressive disorder each year.

What resources are available?. . . . . . . . . . . . . . . . . . . . . . 11

There are three basic types of depression:

How can I help manage treatment? . . . . . . . . . . . . . . . . . . 13

What can I ask a clinician?. . . . . . . . . . . . . . . . . . . . . . . . 15

Types of depression and causes

Major depression, also called unipolar depression, which
is the most common type of depression. It tends to be
episodic but can persistently recur. Symptoms must
persist for at least two weeks.

How do I deal with my own emotions? . . . . . . . . . . . . . . . . 16

What is Families for Depression Awareness?. . . . . . . . . . . . 19
How can I contribute? . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Dysthymia, which is a chronic, unremitting depression. A

dysthymia diagnosis requires fewer symptoms than major
depression but must be present for at least two years.
Bipolar disorder, also called manic depression, which
is depression alternating with elated or irritable moods
and increased energy.

Depression is not just a biological

illness. It is also a family illness
because it affects relationships
with children, grandparents,
aunts, and uncles, and even
friends.
DR. WILLIAM BEARDSLEE ,
physician-in-chief and chairman
of the Department of Psychiatry
at Childrens Hospital of Boston

Many factors can cause depression, including biochemistry

(a chemical imbalance of mood regulation in the brain),
genetics, family history, substance abuse, and an illness
or other difficult life events. Some people have mild
depression, while in others depression is more severe.

Major depression is much more prevalent

among women: 1 in 4 women and 1 in 8
men will experience the condition at some
point in their lives.

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Dont feel that youre part of the

problem. Always remember that
this is a biological condition, its
not because youre a bad spouse.
BILL, husband

Getting treatment
Regardless of the cause, a person should be treated for
depression. One half of people with depression do not seek
treatment because they dont understand their symptoms
or have fear of the stigma of mental illness. Yet of those
who do, 80% are treated effectively with medication,
psychotherapy, or both.
Early treatment is important because:
Untreated depression is long lasting. A depressive
episode, left untreated, can last six months or chronically
for years.

W H AT A R E T H E S I G N S O F D E P R E S S I O N ?

Only a clinician (e.g., primary care physician, psychiatrist,

psychologist) can diagnose depression and rule out other
causes. However, since you see your depressed family
member or friend often, you observe the persons symptoms more than their medical professional may. Therefore,
you are invaluable in helping a clinician become aware
of the depressed persons symptoms.

Signs of depression
If someone you care about has been experiencing several
of the symptoms below for more than two weeks, they
may be suffering from depression:
Feeling miserable and sad almost everyday
Losing interest or pleasure in most activities
Feeling anxious or irritable
Having trouble concentrating or remembering
Feeling tired

Depression is likely to recur. If a person experiences a

single episode of depression, there is a 50% chance of
having another. The chance of recurrence is 70% after
two episodes and 90% after three episodes.

Feeling guilty or worthless

Depression can lead to suicide. Depression is the leading

cause of suicide, and a suicide occurs every 17 minutes
in the United States.

Have medically unexplained aches and pains

Sleeping too much or too little

Eating too much or too little

Thinking of death or suicide

Excessive alcohol consumption and drug abuse are prevalent among those with underlying depressive disorders.

Signs of bipolar disorder

WHEN TO SEEK IMMEDIATE HELP
If at any time your depressed family member
or friend talks about death or suicide, take
these statements seriously. Contact the
persons clinician or call 1-800-SUICIDE. If
you think the person may be harmful to you or

In addition to the symptoms of depression, those suffering from bipolar disorder may be exhibiting several of
the following manic symptoms:
Increased energy or decreased need for sleep
Excessive irritability, euphoria, or aggressive behavior
Increased talkativeness or pressured sleep

others, seek immediate help. Take the person

to your local emergency room or call 911.

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Racing thoughts
Impulsive behavior and poor judgment, such as spending sprees, erratic driving, or sexual indiscretions
Inflated self-esteem
Increased goal-directed activities
Distractibility

Signs of suicide
If the person you care about has been preoccupied with
thoughts of death or suicide, call his or her clinician
today.
It is also very important to remove guns, or at the very
least lock guns in your home.
Warning signs include:
Talking about hopelessness and worthlessness
Suddenly being happier and calmer during a depressive
episode
Making unusual visits or calling people one cares about
Making arrangements or getting ones affairs in order
Giving things away

CAN I ASK IF SOMEONE IS SUICIDAL?

Most people are afraid to ask if someone is
contemplating suicide for fear that it might

W H Y A R E FA M I LY A N D F R I E N D S
I M P O RTA N T ?

Family and friends are essential in helping those who

are depressed. Sufferers of depression are often unable to
function and need family and friends to help recognize
and manage their condition. Health care coverage may
not provide enough psychiatric visits or hospital stays.
Family and friends are left to fill the void.
Unfortunately, family and friends operate with little
knowledge and guidance on how to recognize and
cope with depression. Clinicians normally focus on the
depressed patient, not family and friends. In the past
and even now, families are often blamed for causing
the depression. Social stigma associated with depression
causes many families to live in secrecy, afraid and
unprepared to talk about the condition openly.
Family and friends are very much affected by depression.
In helping a depressed person, they take on additional
responsibilities at home and work. Depression symptoms,
including withdrawal, irritability, and hopelessness, strain
relationships. Those living with someone who is depressed
are much more likely to become depressed themselves.
The good news is that when families and friends are
armed with knowledge of depression and find support,
they are able to improve treatment results and cope
effectively. According to research, families that discuss
depression and increase their understanding of the
condition achieve long-term positive change in family
functioning and increased resiliency in children. By
learning about depression and about ways to help the
depressed person and handle your own emotions, you
can effectively manage depression over time.

upset the person or cause the person to

commit suicide. Suicidal thoughts are a clear
indication that someone is depressed and an
extremely unsafe condition for the depressed
person. It is important to ask if the person
is feeling suicidal and, if so, to contact your
clinician immediately.

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H OW C A N I H E L P S O M E O N E
R E C E I V E T R E AT M E N T ?

Families and friends often are unsure how to convince

someone who is depressed to see a medical professional.
In a compassionate way, explain to the person that you
are concerned that he or she is showing symptoms of
depression, a treatable medical condition. Often, people
with depression feel very relieved to learn that they are
suffering from a medical condition. Ask the person to see
a medical professional and offer to make an appointment.
Make sure to go with the person or call the clinician in
advance to state the persons symptoms (so the symptoms
are not overlooked or denied).

Know that you are being helpful

to a depressed family member
even when it seems like youre
not.
NELL CASEY, author and sister

Be informed. Read a brochure, Family Profiles (see

www.familyaware.org), or a book, or watch a video
on depression and share the information with the
depressed person. Stress that depression is a treatable
medical condition, like diabetes or heart disease, not
a sign of weakness. Assure the person that people with
depression do feel better with treatment.
Use a symptom list. Go through the depression symptom list with the person who is depressed or have the
person take a confidential evaluation that will guide
him or her toward medical help. Take the symptom
list to the appointment for discussion with the medical
professional.
Reach out. Find other people to help you get your
depressed family member or friend into treatment,
especially medical and mental health professionals
such as your primary care physician or a psychiatrist,
psychologist, or social worker. Think of others to
whom the depressed person will listen, such as family
members, relatives, teachers, friends, or a member
of the clergy, then enlist their help.

What not to do
Helpful tips
Show you care. Depressed people feel isolated in their
pain and hopelessness. Tell your depressed family member or friend how much you and others care about the
person, want the person to feel well, and are willing to
help. Listen and empathize with the persons pain.
Acknowledge the relationship impact. In a caring way,
let the person know that depression affects you and
others in the family. Your relationship, including
intimacy, household responsibilities, and finances,
are all adversely affected when someone is depressed.

People with depression are suffering from a medical

condition, not a weakness of character. It is important
to recognize their limitations.
Do not dismiss their feelings by saying things like snap
out of it or pull yourself together.
Do not force someone who is depressed to socialize or
take on too many activities that can result in failure and
increased feelings of worthlessness.
Do not agree with negative views. Negative thoughts
are a symptom of depression. You need to continue to
present a realistic picture by expressing hope that the
situation will get better.

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When your help is refused

Often when you try to help someone who is depressed,
your help is declined or nothing you do seems to work.
You end up feeling rejected and discouraged that there is
nothing more you can do.
Depressed people may reject your help because they feel
they should be able to help themselves, and they feel
worthless when they cant. Instead, they may withdraw or
start an argument in an effort to resolve their difficulties.
In addition, people with depression have negative
thoughts and feel so hopeless that they do not see recovery
as a reality.
Fifty percent of people with bipolar disorder have a lack
of insight, so they do not realize they are ill. For example,
people with bipolar disorder may believe they are a highenergy person. This makes family involvement in seeking and managing treatment even more critical.
With these difficulties in mind, what can you do if your
help is turned away?
Provide consistent support. Over time, if you consistently show support, the depressed person will see that you
are resolute and may accept your help. Continue trying
some of the tips discussed in this section.
Discuss your feelings. When your help is refused, restate
how much you care for the person. Let the depressed
person know how you feel, gently, by stating an example of the support you have offered and how it makes
you feel when it is rejected.

treatment can help. Continue trying to get the person to

a clinician, even if it is on the pretense of other health
concerns. For example, after you have listened and
empathized with the depressed persons feelings, try to
agree on wellness goals (e.g., consistent sleep and feeling
less irritable). Then, try to agree on some action steps
to reach these goals (e.g., after two weeks, if the person
does not improve, you will set up a medical evaluation).
Agree on professional help. It is important to make sure
your loved one gets the professional help he or she
needs. Sometimes a primary care physician can seem less
threatening, or a psychotherapist, or a couples therapist.
Helping someone who is depressed and reluctant to seek
treatment can be very frustrating. As much as possible,
try to enlist the aid of family members, friends, and
medical professionals in this process.
Bipolar disorder is vastly underdiagnosed. On average, it takes
20 years, or until a person is
almost 40 years of age, before
bipolar disorder is diagnosed.
DR. NASSIR GHAEMI, director
of the Bipolar Disorder Research
Program at Cambridge Hospital

Read the entire interview at www.familyaware.org.

Focus on behaviors. If the depressed person is reluctant

to seek help, then dont try to convince the person that
depression is causing the problems. Instead, talk about
the depressed persons behaviors and the ways in which

LACK OF INSIGHT
50% of bipolar patients have a lack of insight,
meaning that they do not realize they are ill.

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Become as educated as you can

about the disorder. Involve your
whole family in the care of your
child.
BILL AND NANCY, parents.

Helping children and teens

Each year, 3 to 6 million Americans under the age of 18
suffer from depression. Although the symptoms of depression are the same as those for adults, children and teens
may not be able to express their feelings as well or may
exhibit different emotions. Look for signs of declining
school performance (e.g., poor grades), frequent temper
tantrums, outbursts of crying, or unexplained irritability.
Your child must receive treatment for depression. Children
need to learn how to continue to develop and find ways
to cope.
In addition, teens suffering from depression are at risk
for committing suicide, the third leading cause of death
among 15 to 24 year olds.
Treatment of depression for children and teens includes psychotherapy and if needed, medication. Psychotherapy helps
children and teens learn how to express their feelings and
gain critical communication skills. The use of medication is
an emerging field in child psychiatry. Medication is prescribed and monitored on a case-by-case basis, depending
on the individual's symptoms, needs, and family history.

W H AT R E S O U RC E S A R E AVA I L A B L E ?

Medical professionals
To receive coverage under many health insurance plans,
your depressed family member or friend may need to see
his or her primary care physician first, who may refer to
a mental health specialist: psychiatrist, psychologist, social
worker, psychiatric nurse practitioner, or psychopharmacologist. Check the health plans coverage guidelines.
Sources of medical referrals include the following:
Your state department of mental health or human
services.
American Association for Marriage and Family Therapy,
www.aamft.org, 703-838-9808
American Medical Association,
www.ama-assn.org, Doctor Finder
American Psychological Association,
www.apa.org, 1-800-964-2000
National Association of Social Workers,
www.socialworkers.org, 202-408-8600
U.S. Department of Health and Human Services
Knowledge Exchange Network (KEN),
www.mentalhealth.org, 1-800-789-2647.
More medical help is listed under Resources, Medical
Help at www.familyaware.org.

Help In Crisis
National Hopeline Network
800-422-4673 or 800-SUICIDE (784-2433)

TEEN RISK OF DEPRESSION AND SUICIDE

Among 2001 high school students:
28.3% experienced some symptoms of
depression
19% considered attempting suicide
14.8% made a suicide plan
8.8% attempted suicide
Source: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention,
2001 national survey.

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Medical emergencies
If your family member or friend is suicidal, contact your
clinician immediately, go to your local emergency room,
or call 800-SUICIDE or 911.

Support groups
Depression and Bipolar Support Alliance,
www.dbsalliance.org, 800-826-3632
National Alliance for the Mentally Ill,
www.nami.org, 800-950-NAMI
Child and Adolescent Bipolar Foundation
www.bpkids.org 847-256-8525

Other resources
American Academy of Child and Adolescent Psychiatry,
www.aacap.org, 202-966-7300
American Foundation for Suicide Prevention,
www.afsp.org, 888-333-AFSP
American Psychiatric Association,
www.psych.org, 888-357-7924
American Psychiatric Nurses Association,
www.apna.org, 703-243-2443
National Institute of Mental Health,
www.nimh.nih.gov, 800-421-4211
National Mental Health Association,
www.nmha.org, 800-969-6642
Screening for Mental Health,
www.mentalhealthscreening.org, 781-239-0071

H OW C A N I H E L P
M A N A G E T R E AT M E N T ?

Medical professionals often remark on how helpful family

members and friends can be in reporting changes in
depressed patients symptoms and ensuring that patients
consistently take their prescribed medication.
Families need to work together in managing treatment,
because mood changes and behaviors affect the whole
family, and many issues are involved in treatment. Ways
in which you can work as a team are to:
Partner in treatment. Medications take up to 4 to 6
weeks to take effect, the dosage may need to be adjusted,
and medications often need to be changed. You can help
your depressed family member or friend by scheduling
and tracking medications, making medical appointments,
and reporting changes to the clinician.
Be understanding. Let your depressed family member or
friend continually know that you care. Depressed people
need to be reminded that many people are concerned
about them.
Learn about depression. The more understanding
you have of the symptoms and issues surrounding
depression, the more you can cope, help, and keep
your expectations realistic. Review books, brochures,
Family Profiles (see www.familyaware.org), and videos
on a variety of depression topics.
Share your feelings as a family. Since depression affects
the whole family, it is important for everyone to share
their feelings, both the depressed person and caregivers.
By talking about issues and emotions, you can uncover
what works and what is not helpful to one another.
Meet with the depressed persons clinician. Meeting with
the medical professional from time to time can be very
helpful if your family member or friend with depression
will agree to it. You can gain a good understanding of
the condition and discuss issues together.

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You have to make sure the

depressed person really knows
that youre on his side.
ROSE STYRON, poet and wife

What do you do when you are unsure of a patients

diagnosis or treatment?
How do you involve families and friends in treatment?

During the visit

What is the possible diagnosis at this point?

See a family or couples therapist. Marriages in which a

spouse has depression have a much higher likelihood
of ending in divorce. Couples therapy can help restore
relationships by addressing resentful feelings and
honing communication skills.
In addition, children with depression in the family need
support and ways to become resilient to developing
depression themselves. Family therapy helps children
discuss their feelings, learn coping mechanisms, and
understand that they didnt cause the depression.
Develop a crisis plan. Talk to your depressed family
member or friend about what you will do if there is a
crisis, under various circumstances, and where you will
take the person. Put the plan in writing.
Create a support system. Try not to take on caring for a
depressed individual all by yourself because it is a difficult task and can bring you down. Talk to other family
members about sharing responsibilities.
W H AT C A N I A S K A C L I N I C I A N ?

A good way to partner in treatment and provide emotional support is to go to appointments periodically with
the depressed person. You can keep track of the clinicians
recommendations, discuss changes in symptoms, and
review the treatment plan.

Before you see the clinician

What types of patients and conditions do you currently
treat in your practice?

How definite is this diagnosis? If not definite, what

are the other possibilities?
What is your recommended treatment (e.g., medication,
psychotherapy)?
What are the expected results of treatment?
What signs should we look for that indicate the
treatment is working?
How soon will we see these signs?
What will you recommend if this course of treatment
does not work?
Why have you chosen this particular medication?
What are the risks and side effects of the medication?
Is this a case that you normally treat and that is within
your practice capabilities?
What role can we play in helping with treatment?
Which days and times are best to reach you?
Who can answer our questions as they come up (when
you are unavailable)?
What have been your experiences with our insurance
company, and how can we facilitate reimbursements?
Do you recommend that we get a consult with another
psychiatric specialist?

Forty percent of clinicians report that their

patients have difficulty staying on their
medication.
Source: National Mental Health Association
Survey, 2001

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Its manageable. No one should

have to suffer and live without
treatment.
PATRICE, wife (left)

If treatment is not working

Is there something else we need to be doing?
Are there any issues that may contribute to our family
member or friend not responding to treatment (e.g.,
noncompliance with medication)?
How can we help in getting treatment to work?
Should we get a second opinion?
H OW D O I D E A L W I T H M Y
OW N E M OT I O N S ?

Helping someone who is depressed is very difficult for

families and friends. Although we are concerned about
them, we are often frustrated, angry, and fearful as we
attempt to deal with their condition.
The stress of caring for a depressed person is significant.
Family caregivers often develop depression themselves
and suffer from anxiety or a host of other problems.
Be sure to expand your social network through support
groups and other caring communities. Try to find other
people to help you care for the depressed person so you
dont shoulder the responsibility by yourself.
Remember:
Its not your fault. You did not cause your family member to be depressed. It is not due to anything you said
or did. Depression is a medical condition that needs to
be treated, just like heart disease or diabetes.

16

You are not alone. Depression is an extremely common

condition, and many families are caring for someone
with depression. You can meet them through depression
support groups.
Your reactions are normal. Most caregivers experience a
range of feelings, from compassion and understanding
to frustration, anger, and hatred. These feelings are to
be expected because it is extremely difficult not to take
a depressed persons behavior personally. Symptoms
such as withdrawal and irritability adversely affect you
and create conflict in your relationship.
Your emotions will change. Family caregivers commonly
go through various emotional stages as they find out
someone in their family has depression and then move
to managing the condition over the long term. Initial
reactions are relief, shock, or even denial. Often families
say they thought a magic cure would exist for the condition, and it would go away. As time goes on, you may
feel angry or resentful that your life is different from
other families lives. You may grieve for the person you
once knew and feel you have lost. As you find effective
treatment for your depressed friend or family member,
you will feel relieved that the person is doing better.
You may also be ready to reach out and volunteer or
advocate for depression awareness.

WHY ME?
Common family caregiver emotions
I feel
Overwhelmed
Cheated
Guilty
Tired
Afraid
Embarrassed
Fearful
Helpless

Trapped
Angry
Frustrated
Sad
Anxious
Lonely
Responsible
Like Im walking on
eggshells

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Take time to care for yourself. Set healthy boundaries

and limitations on how much you will do. Take a
vacation from caregiving from time to time. Be sure
to schedule time for yourself to do activities that you
enjoy. Do not be afraid to seek counseling for yourself
to process and deal with your own emotions.
Find social support. Dealing with depression can be
very lonely and isolating. Youve watched the healthy
person you once knew deteriorate and suffer. Your
friends dont understand, and it is difficult for you to
go out. Make sure you find sources of social support
through support groups and your community.
Have hope. Remember that in most cases, depression
is highly treatable (80% of patients improve with treatment). Depression is cyclical, so it will be worse at
times, then become easier. Sometimes caregiving will
be overwhelming, but it is manageable. Finding the
right treatment takes time but does happen eventually.
W H AT I S FA M I L I E S F O R
D E P R E S S I O N AWA R E N E S S ?

Our mission is to help families recognize and cope with

depressive disorders.
Families for Depression Awareness is a 501(c)(3) nonprofit organization helping families and friends recognize
and cope with depressive disorders. The organization
provides education, outreach, and advocacy to support
families. Families for Depression Awareness is made up
of families who have lost a family member to suicide or
have watched a loved one suffer with depression, with
little knowledge about how to help.

Our programs include:

Our educational Web site, www.familyaware.org
Family Profiles and Expert Profiles
Free brochures
Media campaigns
Outreach education to associations, schools, police
stations, health facilities, religious organizations,
employers, and nursing homes
Conferences and events
Advocacy to support families with depression
The more you know, the better you can cope.
F R E E E M A I L A L E RT

Join our email list to learn about new family

profiles, news, events, and ways you can help.
Go to www.familyaware.org

Founder Julie Totten (right) with her mother Peggy Totten

Sexton (left) sharing photos of Mark Totten (middle photo),
lost to suicide, and family members Linda Sexton (right
photo) and Norman Totten (left photo) with depression.
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CONTRIBUTION FORM
H OW C A N I C O N T R I B U T E ?

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395 Totten Pond Road

Waltham, MA 02451
781-890-0220 / info@familyaware.org
www.familyaware.org

Production of this booklet is supported by an educational

grant from Eli Lilly and Company.
2004 Families for Depression Awareness

1/08