I see many clients with depression in my therapy room. They bravely recognise that they need help and take those first tentative steps in coming along to see me, unsure whether anything can be done to help them. I always take time to explain what depression is and how it is maintained so they can begin to see a way forward, armed with a renewed sense of hope that this mind state can be beaten with the right help. I have also noticed that they get frustrated with well meaning loved ones who don’t understand what depression is, or the best way to help. I have been asked on many occasions if I have some information that they can share at home to help those around them understand and be supportive. I put some information together a few years ago, adapting things I have learned and useful tips I have read that worked for previous clients. As such I can’t remember all the original sources now, so apologies if I haven’t acknowledged any authors. In this blog I just wanted to share this information to help people. Perhaps you can share it to help someone you know.
What is depression?
When your loved one starts therapy for treating Depression you naturally want to support them in the best way you can. In order to do this effectively it can be helpful to gain an understanding of what Depression is, how it affects someone physically and mentally and what you can do to help.
General understanding of depression is confusingly coloured by many myths: it’s caused by a chemical imbalance in the brain; it’s anger turned inward; it takes a long time to come out of; it stems from childhood events that have to be explored before progress can be made, etc.
The rapid increase in the incidence of depression is one of the reasons we know that depression isn’t a genetic disease. Over the last 30 years, a large body of research evidence shows that most depression is learned, brought about by the way we interact with our environment. We know that the majority of people exposed to adverse life events do not develop depression. So, we know it is not caused as a result of the specific events we experience, but by the way we respond to them.
Sleep and Depression
The role of dreaming is key to a full understanding of depression, and why practical therapies help. We all dream for about two hours a night, even though we often don’t recall it when we wake up. Evidence shows that the function of dreaming, which occurs predominantly during REM sleep, is the metaphorical acting out (not the resolving) of unexpressed, emotionally arousing concerns. Dreaming allows the arousal to be discharged and frees up the brain to deal with the concerns of the following day.
In depression, however, this process goes dramatically wrong. Instead of having about 25% REM sleep, and 75% slow wave sleep (which boosts energy levels in the brain), these proportions become inverted. A depressed person has far too much REM sleep and too little slow wave sleep. The prolonged negative self-examination and rumination, which depressed people experience, creates high levels of emotional arousal and a greater need for discharge during dreaming. This increased discharge activity also depresses and exhausts the brain, leaving the dreamer lacking energy and motivation next morning. Depressed people tell me in therapy that they wake up from sleep feeling exhausted.
Depressed people spend too much time worrying and as such, they are misusing their own imagination. I call it negative self-hypnosis. All this emotionally arousing introspection also prevents them seeing their life situations objectively. High emotional arousal inhibits the logical part of the brain, and blocks rational thought. A depressed brain is a stressed brain.
To the emotional brain, everything is either black or white, good or bad, right or wrong, safe or dangerous. This is because high arousal locks you into a negative, confined viewpoint. It is only the rational part of the brain that can inject the shades of grey and see the bigger picture.
People who aren’t habitual black and white thinkers can snap out of this negative emotional state fairly quickly. People who have a tendency towards endlessly analysing the negative aspects of their lives, catastrophising every little setback and conjuring up more, are more likely to stay locked in their depressive mind state. People who tend to blame themselves for everything that goes wrong, applying a negative thinking style to everything, are the most likely to suffer from depression.
How does Depression feel for my loved one?
Winston Churchill used to refer to depression as like a Black Dog. Having a Black Dog in your life isn’t about feeling a bit down, or sad or blue. At it’s worst, it’s about being devoid of feeling altogether.
- It can ruin your appetite
- Anger may flare up at any provocation
- It can be difficult not to take anger, criticism, negativity and apathy personally
- It likes to wake you up with very repetitive, negative thinking
- You may have noticed they’ve lost the sparkle in their eyes
- Displays of love, affection and intimacy may be out of bounds
- They may create endless lists of everything that is wrong with their life
- They may hatch plans that they believe will fix everything
- Laughter doesn’t come as easily as it used to
- It makes them say negative things
- They may have real difficulty firing up and getting going
- They may have become ultra-sensitive and cry more than usual
- Doing anything or going anywhere requires superhuman strength
- It can make them irritable and difficult to be around
- Activities that used to bring them pleasure may suddenly cease
- Although exhausted they may not be able to sit still and relax
- A tendency to find the negative in everything may become the norm
- There may be signs of over-indulgence
How can I help my loved one?
You may well be right when you say. ‘It’s all in your head!’ but don’t say it. Never tell them they’re ‘just looking for attention’; it’s demeaning and hurtful. They’re not looking for attention but they are probably in need of it.
If you’re genuinely worried about someone, organize a group of close friends or family members to make some sort of contact each day. It can be to help out, have a coffee or simply to say hello.
Pointing out the lovely weather is annoying and pointless.
Don’t push them into things they don’t want to do and then make excuses for their behaviour. This only feeds the despair and keeps denial alive.
They can’t just ‘pull themselves together’. If people could just ‘snap out of it’, they would. No-one ever chooses to have depression.
Learn about the condition together; knowledge is power and validation is a great healer.
Help them to develop a strategy to simplify their life both at home and at work. Stress is one of the biggest drivers of depression.
Encourage any form of regular exercise.
Be sensitive about how you approach the subject; a lot of people aren’t used to talking about their mental health.
Being thoughtful and kind will never go amiss but don’t try and jolly them along, it can often make them feel worse.
If they’re old enough, inform any children about what’s going on. They need to know that the depression isn’t here to stay. Children often think it’s their fault so reassure them that it’s not.
Together, try and learn to recognize triggers and early warning signs. Also know when to give each other a bit of space.
Try not talking. Just listen. Really being there for someone without opinion or judgement is one of the best gifts you can ever give.
Agree to a course of action to get rid of the depression. Don’t just ignore it and consult a professional if you haven’t already.
As a care-giver, compassion, empathy and understanding are vital, but recognize that you alone don’t have the power to rescue your loved one. Professional help is often what’s needed.
Depression in any relationship can be confronting, frightening and frustrating but navigated together, your relationship can become deeper, richer and better for it.
I am Susan Tibbett, a Chartered Psychologist and Hypnotherapist based in York. I specialise in helping people with depression and anxiety. You can contact me at http://www.mindmakeoveruk.com