When someone you care about is emotionally shut off, withdrawn or so miserable that they can’t be reached, it is very frustrating and even painful. Because you care, you want to do something to help, and helping is very difficult. Here is some background information on the basics of depression, and some steps to follow if you want to help.           

Different professionals in the medical, research, anthropological, biochemical, and psychological fields have different answers about what causes depression. The “chemical imbalance” theory most depression medication is based on is shaky, because research now shows that brain chemistry can be influenced by changing thinking, behavior and self-awareness. In my experience, I find that the tendency to become depressed is largely a result of a learned behavior and belief system that is focused on hopelessness. In my office, people who are depressed often express hopelessness and a feeling that they can’ t be in charge of their own lives. When that belief system changes, there is no longer depression. Some depression tends to be cyclical in nature recurring at regular intervals, which could be a result of genetics, but no one knows for sure.

Situational depression is experienced when people are deeply hurt, disappointed, or have experienced a great loss or tragic situation. It is often a component of Post-Traumatic Stress Disorder. This type of depression is gradually worked through and can be overcome. Not everything that seems to be depression is truly depression. It’s very common for people to say they are “depressed” when they’re overwhelmed or upset, but that turns out to be grief, disappointment  or hurt, which is a different thing. Any situation in which someone’s  expectations are unrealistic can be considered a “set up” for disappointment, which some people experience as depression. If there’s an underlying belief that "I don’t deserve happiness" then the common difficulties of developing a new relationship after divorce or loss will be seen as disasters, and depression can result.

Men more often react to difficult life experiences by getting depressed, because they are less comfortable expressing their feelings, so their disappointment and hurt gets compacted into a hopeless, depressed feeling. Women are more likely to have a hormonal component to their depression, which can cycle with the menstrual cycle. Men are more prone to depression, and other mood disorders. Women are more likely to express their emotions, have family and friends to talk to, and thus often stave off depression. Men are less likely to have or utilize this support.

Symptoms of depression include having no energy, perhaps not able to get out of bed. Withdrawing, lack of connection or intimacy, lack of communication. Feeling hopeless to fix whatever is lacking or problematic in one’s life. For most of my clients, depression turns out to be squelched and misunderstood emotions and the result of self-criticism.

Americans tend to look for the quick fix. It seems easier in today’ s “take a pill, feel better” atmosphere to take a pill than to solve the problem. Medical doctors who have no training are prescribing antidepressants because they don’t know what else to do, or because their patients request them. The side effects of antidepressants are no joke. Research shows that the most effective treatment for depression is Cognitive Behavioral Therapy, in combination with mild antidepressants. Drugs cannot fix depression—they simply mask it. In severe depression (the kind where the person can’t function) antidepressants can help, but recent research shows they don’t work better than a placebo in mild depression. Suicidal and self-destructive tendencies are treated by examining the causes of anger and self-hatred, through a combination of Gestalt, Cognitive Behavioral, and Depth Psychology. 

Your thoughts affect your mood, and how you relate  to yourself can either lift or dampen your spirits. Neuronal activity in the brain activates hormones which are synonymous with feelings. Constant self-criticism results in a “what’s the use” attitude, which leads to depression. Continuous free-floating thoughts of impending failure or disaster lead to anxiety attacks. Negative self-talk creates stress. What I do to help clients become aware of self-inflicted stress is first, to ask them to become aware of what they’re saying to themselves—if there is a constant stream of negativity, it will create stress—just as being followed around by someone who’s constantly carping on you would be stressful. Also, if they’re fighting within themselves—not able to come to a solid idea of what they want—that will make it difficult to make decisions, and increase the stress.

Most of my clients don’t realize that they are responsible for their own feelings, and no one else is responsible for making them feel better. I think it’s a mistake to classify normal emotions, such as the grief and upset after a relationship problem, as pathological, which is what true depression is. Human beings need to know how to grieve, to be sad, to get over difficult events. A lot of drugs have been sold by labeling normal emotions as “depression”—but it doesn’t help people’s mental health. Heartbreak is a part of real life, the more you love, the more you risk a broken heart, and the older you get, the more losses you encounter. We need to know how to grieve, recover and bounce back—it’s a healthy human psychological skill. 

Counseling and grief groups can always be helpful. We live in a social environment that’s very uncomfortable with grief—your friends and family may not be able to support you well enough, so if that’s the case, counseling and groups can be very helpful. 

With clients, the first thing I would do is ask what happened to make them unhappy. If it’s a result of an event, like a breakup, then I’d guide them through grief—writing, talking, and creating a ritual all  help people express and move through their grief. I do a lot of listening, because grief needs a witness. Then I help the client re-frame the relationship. In a breakup or loss, I help my clients sort out their feelings, figure out what they’re angry about, what they’re sad about, and to help them see the relationship more realistically, recognize its flaws, and why it ended. After getting through the initial stages of the grief,  we’d talk about what went wrong, and what the client can learn from the experience to improve future relationships.

To Help a Friend Who Is Depressed:

1. Don’t try to cheer your friend up. It just sounds like you don’t understand.

2. Listen, listen, listen: Your friend needs someone who can hear whatever the problem is. It doesn’ t matter if it seems like a small or big problem to you, it’s overwhelming to your friend, and he or she needs to talk about it. A lot.

3. Be sympathetic: “I’m sorry that happened to you.” “You don’ t deserve that.” “That sucks.” are all good responses that will tell your friend you understand. Listening may take a long time, or go on for several sessions. Your friend has probably not felt safe to talk about it before this, so it’s bottled up.

4. Be helpful: After your friend talks it out enough, he or she will naturally begin to analyze his or her feelings, what is going on, etc. rather than just complaining. If you’re listening, you’ll notice when this change happens. Then, you can make some suggestions: that your friend talk to a particular adult who understands, you can offer to help with homework, etc. If your friend is upset or angry with his or her own parents, don’t suggest talking to them—let a responsible, caring adult assess the situation first.  

5. If your friend won’t talk, or talks about suicide or hurting someone else, then it’s time for action. Tell someone who has the power to help that your friend is in danger. Don’t worry if your friend said not to tell—that’ s just the time when telling may save a life. 

If the person you’re worried about is your spouse, don’t try to make a diagnosis. You can point out whatever behavior you’re noticing and say “You know I care about you. I see that you’re crying a lot (or sleeping too much, or unwilling to talk) and I think that indicates a problem. Will you come to counseling with me?”  If your partner will go to counseling with you, the therapist will be able to diagnose the depression and make recommendations. Your partner won’ t feel criticized, as he or she would if you said it was depression.  Counseling will also help you handle situations more effectively, and help you not create more drama and dysfunction in the relationship.

If your spouse is diagnosed with depression, here’s what to do:

1.Understand the diagnosis and what it means
Both partners should be present in medical appointments, so both understand what’s going on. If you don’t completely understand what the doctor says, or the doctor hasn’t taken enough time with you, or just for extra support, search online for special interest groups focused on the disease. You will learn a lot from those who are already experienced.

2. Help your partner do what the Dr. says, but don’ t take charge
Managing depression is a big adjustment, so help your partner remember to take medicine, keep dr. appointments, and do whatever exercise, medical at-home procedures, or other self-care processes. However, make sure these things are still your partner’s responsibility to do. Both of you will feel better if you are supportive, not parental. 

3. Take very good care of yourself.
Taking care of a depressed spouse is exhausting, so you must take extra care of yourself, too. Utilize whatever help is available from medical insurance, family and friends. Arrange for other people to be available to give you a break, and don’t feel bad about going off on your own from time to time—you need it. 

4. Keep your romance alive
Find as many ways as you can to let each other know you love one another. However you may have to adjust your sexual life, do it. Do whatever you can to keep your physical connection alive within the limits of the illness. Have as much fun as you can, every chance you get. Make it a challenge to discover new ways to enjoy each other, and to relax and laugh together.

©  2014 Tina B. Tessina adapted from: It Ends With You: Grow Up and Out of Dysfunction (Kindle and Paperback)

Author Bio: Tina B. Tessina, Ph.D. is a licensed psychotherapist in S. California since 1978 with over 35 years’ experience in counseling individuals and couples and author of 13 books in 17 languages, including It Ends With You: Grow Up and Out of Dysfunction; The Unofficial Guide to Dating Again; Money, Sex and Kids: Stop Fighting About the Three Things That Can Ruin Your Marriage, The Commuter Marriage, and her newest, The Ten Smartest Decisions a Woman Can Make After Forty and  Love Styles: How to Celebrate Your Differences. She writes the “Dr. Romance” blog, and the “Happiness Tips from Tina” email newsletter.

Online, she’s known as “Dr. Romance” Dr. Tessina appears frequently on radio, and such TV shows as “Oprah”, “Larry King Live” and ABC News.

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