Depression: Supporting loved ones through their battle with depression

Depression can rob your loved ones of fully enjoying life or engaging in everyday activities. Instead, they may feel sadness, despair and hopelessness. Not surprisingly, their depression affects you, too, as someone who cares about them, whether it's a family member, friend or even a co-worker facing this serious medical condition.

When a loved one has depression, you can offer support and help in a variety of ways. At the same time, remember to tend to your own physical and emotional needs, too. This way, both of you will be cared for even during the darkest days.
Recognize the symptoms of depression, even if a loved one doesn't


You might think a loved one may have depression even before he or she does. People in the throes of depression sometimes don't recognize the symptoms. Or they may be embarrassed about it or simply think that their situation is hopeless.

Two hallmarks of depression are:
Loss of interest and pleasure in normal daily activities
Feelings of sadness, hopelessness or crying spells

Other signs and symptoms include:
Sleep disturbances
Impaired thinking or concentration
Unintentional weight loss or gain
Agitation or slowing of body movements
Fatigue
Low self-esteem
Less interest in sex
Thoughts of death

If you suspect that a loved one has such symptoms, gently urging him or her to seek medical help may be the best thing you can do. You can also point out that depression is a medical condition that has several effective treatment options. You may also consider discussing how certain other medical conditions, such as thyroid disease, can mimic the symptoms of depression. This may help further persuade your loved one to seek treatment.

If your loved one refuses to seek medical treatment, remember that it may simply be out of shame or a sense that things can't get better. Try to be patient and bring up the topic again — but without being pushy or insensitive. However, if your loved one's depression is so severe that it's debilitating or life-threatening, you may need to consider intervening by contacting a doctor, hospital or emergency medical services.
Don't tell someone with depression to snap out of it


If you've never experienced depression yourself, then it's impossible to know how helpless and hopeless a person can feel in the midst of it.

Understand that depression is a serious illness that requires medical attention. It isn't the result of a character flaw or moral weakness. It may result from a chemical imbalance in the brain. When someone with depression can't get out of bed, go to work or play with their children, it's not laziness. Rather, it may be a debilitating sense of fatigue, overwhelming feelings of worthlessness or the inability to make even simple decisions.

People with depression can no more snap out of it than can people with diabetes or arthritis. If a loved one has depression, don't tell them to smile more or just get over it. People don't enjoy having depression, but they can't simply will themselves into wellness.

Try reading more about the condition and treatment to better understand what it's like to have depression.

And even if your loved one begins depression treatment, don't expect immediate results. Treatments, such as therapy and medication, take time to have an effect on depression symptoms. In the meantime, encourage your loved one to continue treatment and remind him or her that things will improve as time goes on.
Offer support and compassion to a loved one with depression


Even if you can't know what depression feels like, you can offer empathy and compassion. Simply being there for the person can make a difference in the course of his or her illness.

To help someone who has depression, you can:
Gently express concern. Acknowledge their pain but avoid using the words "I know how you feel" if you really don't. Although you may think you know what's causing the depression, avoid offering solutions. Listen if he or she wants to talk, but try not to ask too many intrusive questions. People with depression often don't have the energy or inclination to discuss their symptoms, and they may instead just stop talking altogether.
Ask how you can help. Depression may leave your loved one unable to take care of regular chores and tasks. Make yourself as available as possible to help balance the checkbook, keep the home in order, run errands and take care of children or pets, for instance. Keep in mind that your loved one may not be able to offer suggestions. If that's the case, give specific suggestions about what you're willing to do and ask if it's OK if you go ahead and do them, such as mowing the lawn.
Give positive reinforcement. Depression can make people feel worthless. They may judge themselves harshly and find fault with everything about themselves, from their appearance to their job to their thoughts and feelings. You can remind your loved one about his or her positive qualities and how much he or she means to you and others.
Encourage healthy behaviors. Depression steals away motivation, energy and interest. Ask your loved one to join you on a walk, for a movie, or to work on a hobby or other activities he or she previously enjoyed. But don't try to force him or her into doing something. If your loved one is in treatment for depression, help him or her remember to take prescribed medications and to attend therapy appointments.
Watch for depression symptoms that worsen


People with depression are at an increased risk of taking their own life. Stay alert for suicide warning signs such as:
Agitated behavior and sleeplessness
Statements about no longer living, such as "You won't have to worry about me much longer"
Giving away possessions or saying goodbye to friends
Suddenly cheering up after a period of depression, which could actually signal a renewed sense of energy to follow through on suicide plans

If you think a loved one is considering suicide, encourage him or her to call a doctor, mental health clinic or suicide hot line immediately. If your loved one's life is in imminent danger but he or she refuses to seek help, call for emergency help yourself.
Keep depression from taking a toll on you


Supporting someone with depression isn't easy. You may find yourself stressed and you may even begin to think that things won't improve. It can be even more difficult if you have others to care for as well.

Share your feelings with a caregivers' support group or discuss the situation with a therapist, relative or confidante. See your doctor if you develop any problems that you think require medical attention.

And finally, remind yourself that with appropriate treatment, most people with depression do see an improvement in their symptoms. Better days may be on the horizon — for both of you.

Deep brain stimulation: An experimental depression treatment

Depression is usually a very treatable condition. Often, standard treatment with antidepressant medications, psychotherapy or electroconvulsive therapy can help improve even severe cases of depression.

But if standard depression treatment doesn't work, you might wonder if experimental treatment can help. One potential option is deep brain stimulation. This procedure hasn't been approved by the Food and Drug Administration (FDA) to treat depression, but it may be available to you through a clinical trial.
How deep brain stimulation works


Deep brain stimulation is a highly experimental treatment for depression in which the brain is stimulated with electrical impulses in an attempt to change mood. The procedure hasn't been FDA approved for depression and is in only the early stages of research. However, deep brain stimulation has become a standard treatment for people with Parkinson's disease.

Deep brain stimulation requires two surgical procedures — surgery on your brain to implant electrodes and surgery on your chest to implant a neurostimulator device. Because the procedure is new and experimental for depression, it may not be performed exactly the same way everywhere.

In general, here's how surgery for deep brain stimulation works. For the brain surgery portion, you're given local anesthetics to numb the area being operated on. You remain awake and alert, however, so that the surgeon can talk to you to make sure the proper areas of your brain are being stimulated. Your head is placed in a special frame to keep it still during surgery. Two holes are drilled in your skull. Guided by imaging techniques, the surgeon implants electrodes on both sides of your brain.

During the second portion of surgery, the surgeon implants the neurostimulator in your chest. Wires from the brain electrodes are placed under your skin and guided down to the battery-operated neurostimulator. The neurostimulator sends electrical signals along the wires to the electrodes, stimulating the brain.

The neurostimulator can be easily programmed from outside your body. Dosage of the electrical impulses is customized to the individual. Stimulation is generally continuous, 24 hours a day.
How deep brain stimulation affects depression


Exactly how deep brain stimulation can affect depression isn't clear. Researchers theorize that certain regions deep within the brain influence mood and depression. They believe that the areas associated with depression may be overactive in certain people. Sending electrical impulses to these areas may "reset" them to normal functioning, researchers speculate.

Little research has been done using deep brain stimulation in people with depression. One clinical trial included just six people, for instance. Follow-up of these people has been short, which means it's not known if any improvements in depression symptoms will last long term. Additional research is needed to learn more about how deep brain stimulation works and how safe and effective it is for depression.
Who may benefit from deep brain stimulation


Because deep brain stimulation is experimental, it's available only through participation in clinical trials. In addition, because of the risks involved, its use is limited to people who have severe, debilitating depression that has not improved with other treatments. Talk to your doctor to see if it may be an option for you.
Side effects of deep brain stimulation


Any surgical procedure carries risks. Because deep brain stimulation involves brain surgery, the procedure may be especially risky. In addition, the neurostimulation itself may cause side effects.

Common side effects and adverse health problems associated with deep brain stimulation include:
Bleeding in the brain
Infection
Delirium
Unwanted mood changes
Movement disorders
Lightheadedness
Insomnia

In addition, people who have undergone deep brain stimulation to treat Parkinson's disease have reported such side effects and adverse events as panic attack, speech difficulty, movement problems and even suicide.

The long-term risks of deep brain stimulation for depression aren't known.

There also are possible inconveniences associated with deep brain stimulation. For instance, the hardware may malfunction, and batteries must be replaced every one to three years.
Weighing the pros and cons of deep brain stimulation


Deep brain stimulation is a serious and potentially risky procedure. Even if you are a candidate for a clinical trial to test deep brain stimulation, you and your doctors must carefully weigh the pros and cons of the procedure. If your depression is incapacitating or life-threatening, you may be more willing to face the risks involved with deep brain stimulation.

Combined reuptake inhibitors and receptor blockers

Certain brain chemicals called neurotransmitters are associated with depression, including the neurotransmitters serotonin (ser-oh-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin). Research suggests that abnormalities in neurotransmitter activity can affect mood and behavior.

Combined reuptake inhibitors and receptor blockers are dual-action antidepressants that act on brain cells both by inhibiting the reabsorption (reuptake) of neurotransmitters into nerve cells and by blocking nerve cell receptors. This leaves more of these neurotransmitters available in the brain, thereby boosting mood.

Here are the combined inhibitors and blockers that have been approved by the Food and Drug Administration specifically to treat depression, with their generic names followed by available brand names in parentheses:
Trazodone (Desyrel)
Nefazodone (Serzone)
Maprotiline
Side effects and safety concerns


Side effects of combined inhibitors and blockers include:
Dry mouth
Dizziness
Drowsiness
Lightheadedness
Nervousness
Nausea
Constipation
Weakness
Vision problems
Confusion
Headache

Trazodone has been associated with priapism — persistent, usually painful erections not associated with sexual arousal. If this occurs, seek medical treatment immediately. Many of those cases have required surgical correction, resulting in permanent impairment of erectile function or impotence.

In rare cases, nefazodone (nef-AY-zoe-done) can cause life-threatening liver failure. Don't take it if you already have liver problems. Know the signs and symptoms of possible liver dysfunction, such as yellowing of your skin or the whites of your eyes, unusually dark urine, loss of appetite, nausea or abdominal pain. Contact your doctor immediately if you experience any of these problems.

Maprotiline has been associated with seizures, so people with a history of seizures usually shouldn't take this medication.

In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior, particularly early in treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring at the beginning of treatment or upon a change in treatment, or you may need to stop the medication if your symptoms worsen.
From MayoClinic.com