by Suma Chand, MPhil, PhD

Family members often feel frustrated and helpless as they do not know what to say or how to behave with their loved one who they may view as not being proactive in trying to get better or being irritable and negative with them.

On the other hand, patients often report feeling judged and blamed for an illness that does not have the obvious and clear cut manifestations that physical illnesses have. I have often had my patients with depression tell me that they wished they had a major physical illness like cancer because people would then treat them with more understanding. What they are trying to convey is the fact that depression is often not viewed as the serious illness that it is and they don’t get the understanding or support that they long for. 

One of the first things I would advise family members would be to educate themselves about depression from valid and reliable sources so they develop a good understanding of the disorder. Being armed with knowledge about the disorder will help them to understand the different ways in which depression can impact their loved one and this will help to guide their own behavior with them.  

Expressing acceptance  

Receiving acceptance and love acts like a balm to someone with depression who is in emotional pain. Here are some of the ways in which acceptance can be expressed verbally:

“I know that you are dealing with an illness that is very troubling. I am here for you no matter what. We will fight this together.”

“Remember I love you no matter what.” 

“Don’t hesitate to ask me for help. It makes me happy to be able to help you. I know you would do the same for me if the tables were turned.” 

Expressing and demonstrating support 

While verbal expressions of acceptance and support are imperative, individuals with depression often need actual behaviors of support to help them make progress with their recovery just as an individual with a debilitating physical illness would need physical support. 

Here are some ways in which support can be expressed verbally and followed through with the associated behaviors:

 “I can go with you for your therapy and psychiatry appointments, if it will make it easier for you.”

“I understand that the depression is causing you to feel very fatigued and it is hard for you to do much. How can I help? If you want to try and do some of the things your therapist/psychiatrist has suggested I can do it with you or be with you as you do it.”

“Shall we watch some TV together?”

“Shall we go for a walk? We can go just as far as you want to go.”

“Would you like to try and spend a few minutes playing the piano (or any other activity that used to give pleasure before) and see how you feel about it? That is something you have always enjoyed.” 

“It is okay for us to skip the family gathering/party we have been invited for. I know that it is hard for you to socialize with large groups of people at this stage. I will decline the invitation, on our behalf don’t worry about it.”

“Would you like to meet with your good friend/favorite sibling? They are keen to meet with you. We can have him/her over for a short visit or meet in a restaurant.” 

 “Don’t worry if you cannot get something done in the morning. I know mornings are harder for you. It’s okay to do it later in the day when you feel better and have more energy.”

Helping your loved one with Depression develop balancing thinking

Aaron Beck, the father of cognitive behavior therapy, termed depression a thinking disorder. He noted that the thinking of individuals with depression tends to be dominated by characteristically negative and distorted thinking patterns.  They are particularly hard on themselves and tend to view the future as being bleak which triggers feelings of hopelessness. Hopelessness is a dangerous feeling since increased levels of this state can move the person towards suicidal thinking and behaviors.  Here are some things family members can say and do to help their loved one to develop a more balanced outlook: 

“I don’t know if you noticed but you have been more active of late - walking more, doing more chores around the house, you’re not crying much, you have been smiling more too -------.”

“How about we spend some time talking about some of the nice things that happened today or some of the things we felt grateful for? Will you go first, or should I?”

Talking about suicide

This is an important topic to bring up since depression is a major risk factor for suicide. Talking about it with individuals with depression does not make them think about doing it as many people fear. It will in fact help to prevent suicidal behaviors, since it will help ensure that they get the level of help they need and precautions can be taken to keep them safe. Here is an example of how it can be brought up: 

 “I was reading that people who suffer from depression can have thoughts of taking their own lives. This made me concerned about you dearest. Do you have such thoughts?” 

Silence can be golden sometimes

When their loved is being negative or irritable it can be difficult for family members to not take it personally. The best way for a family member to respond would be to let it go and not retaliate with anger. Being negative and irritable is a part of the depressed mood state and often linked to distorted thinking and erroneous perceptions, which is characteristic of depression. If necessary, the issue can be clarified later. However, it needs to be done with kindness and after some time has passed when both the patient and the family member are less upset and calmer.  

Depression is an illness that causes people to feel alone and isolated, so a family member showing up and being there with them makes a big difference. Sometimes, nothing needs to be said and all that is needed is a compassionate ear where you listen with empathy. Just being around your loved one in silence is okay too. It conveys caring and alleviates their sense of isolation. 

About the Author: 

Suma-Chand_website.jpg Suma Chand, MPhil, PhD., is a Professor and Director of the Cognitive Behavior Therapy Program in the Department of Psychiatry and Behavioral Neuroscience at the St Louis University School of Medicine. She is a board member of the National Social Anxiety Center (NSAC) and a member of the ADAA Public Education Committee.

Thank you for this helpful article. Those suffering from depression wish they had a physical illness instead of the emotional pain that is often dismissed by friends and family (just move on, it's all in your head, you are just seeking attention) and so they become isolated which makes depression even worse, and sometimes to the point of suicide.

What an awesome article, I thought you were talking to me personally. Love reading the Mental Health Articles !!!

the article was very helpful i copy some of the text about how to talk to a relative that is suffering from depression . and not to take personally the mood swings.
and rather be more proactive . what my biggest fear is that those that know that
a person is felling depress can be taken advantage of .the situation .
Thank you very much for the article.

Thank you for such a brilliant and honest piece. Having depression myself, I can attest to how impactful a sincere "how are you?" can be. It's all about redirecting thoughts and correcting misperceptions. During my most difficult times, colleagues were actually the ones supporting me when loved ones eventually became frustrated.

I used to suffer terribly with depression and can tell you now, it's a day-to-day battle; it takes time and persistence to overcome, for sure, but there ARE ways to train and rewire your brain to beat it. Comment “loose my chains” if you would like me to send you a direct contact.

I am very happy I came with such a wonderful article. with words of encouragement and reassurance to a family member. that is suffering of depression. and very important not to take personally the mood swings . and rather being understanding
Thank you v very much for the article.

I have found my friends were more supportive of me than my family. Friends were there for me during my lowest times, including hospitalizations. During one of my bouts, my brothers each made ignorant comments; they are both MD's. One said "you're acting like a baby" and the other told me to "buck up and move on". That comment was from the brother that sexually abused me when I was 7. No compassion whatsoever! That brother did end up with a sincere apology for what he did following my last hospitalization(2 years ago) and a call from my therapist telling him how much hurt and pain I was in and what a high suicide risk I was at the time. I am presently 64.
I read a comment on another site a while ago from a woman who was told to 'pick yourself up by your bootstraps'. Her reply to that person was, 'My bootstraps are broken'.

Thank you for expressing exactly how I have been feeling the past 6mos. A silent living hell of hurt, sadness, anxiety in which I've lost family who never got it.

Margaret Gladd…

January 29, 2020

Your incite is so on target, may I send your article to the spouse of a client who is being greatly impacted by his family's reaction to his diagnosis of major depression.

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Im having a hard time relating and dealing with this. Thanks for your insight. Its hard to understand when nothing is really that bad.

very well written and you've captured the essence of the disease. I hope to share some of this info online, many friends are falling prey to depression, anxiety, and agoraphobia.