Depression Affects The Whole Family

[snowy]

Depression Is A Family Matter
Families do better than patients at recognizing depression and mania.
By PsychologyToday.com

Depression is not just a medical matter. It's a family one, too.

The behaviors and mood of a depressed person affect the whole family. There's the irritability, which sets off conflicts and derails family dynamics. The negative thought patterns, which become a prism of pessimism for everyone. The withdrawal that literally disrupts relationships and breeds wholesale feelings of rejection. There are major responsibilities that get displaced. There is a general burden of stress.

And yet, families can be major forces of care, comfort, even cure. They are crucial to proper recognition and treatment of the disorder, not just at the beginning but throughout. They are the de facto caregivers, willingly or not. They contribute powerfully to the emotional atmosphere the depressed person inhabits, and so can be agents of recovery. Or not.

Yes, depression has a huge impact on families. And families have a huge impact on depression.

Nassir Ghaemi, M.D., assistant professor of psychiatry at Harvard, contends it's not even desirable to make the correct diagnosis of depression without the family. For one thing, many people -- particularly those at either end of the age spectrum and those with medical conditions -- don't realize they are depressed or may attribute symptoms to other things. The perspective of family members is useful.

But it's downright essential for prescribing. "In order to treat any depression accurately, you have to know whether it is unipolar or bipolar -- in other words, whether the person has been manic in the past," says Dr. Ghaemi. "Our research shows that 50% of patients are not even aware they are manic when experiencing mania. Family members recognize manic symptoms twice as often."

Then there's the need for continuing diagnosis, because one episode of depression doesn't eliminate the possibility that mania will develop, especially in persons under 30. Bipolar disorder typically begins with a depressive episode, and the average age of onset is 19. But a first manic episode does not occur until age 25, on average.

The younger the patient, the greater the risk they will end up having bipolar disorder. Standard antidepressants could precipitate mania. In those cases, Dr. Ghaemi considers it essential to warn patients and family about manic symptoms. Even in established cases of bipolar disorder managed with mood stabilizers, the Harvard psychiatrist considers family members indispensable for the early recognition of manic symptoms.

When prospective patients first call for an evaluation, Dr. Ghaemi asks that they bring in a family member. "Then I ask the family to feel free to call me any time the patient is developing mood symptoms of any variety."

Confidentiality is not a problem. "There's no confidentiality constraints against my ear being open," says Dr. Ghaemi. "I can't say anything, but I can listen to what they say."

What's more, the attitude of family towards medications prescribed can spell the difference between compliance and continuing illness. If family members are not on the side of treatment, Dr. Ghaemi teaches patients to cope with that. Ideally, a family supports the treatment plan, reminding the patient to take medication.

Julie Totten knows how much of a family matter depression is. She learned the hard way, having grown up -- perhaps too quickly -- in a household ravaged by depression.

To spare others the pain she endured as a sister and daughter of undiagnosed depression, she has established an organization dedicated to helping families recognize the disorder and motivating them to seek and manage treatment.

Families for Depression Awareness (www.familyaware.org) urges family members to show they care, because depressed people feel isolated in their pain and hopelessness. "Depression often divides families," says Totten. Some people don't understand it and want to run far from it.

"Others do everything in their power to get a person well, including hunting out magic cures." Ultimately, she says, "they realize there's no such thing. And they feel cheated. Depression has to be managed."

No one disputes the need for treatment of the depression. Psychologist David Miklowitz, Ph.D., goes one step further. He has developed a treatment targeting the family, on the grounds that family dynamics affect the outcome of mood conditions.

Research shows that the course of the illness is worsened by "expressed emotion," a measure of attitudes expressed by a caregiver relative to a psychiatrically ill patient. It consists of criticism, hostility and emotional over-involvement. An atmosphere of high expressed emotion multiplies the chance of relapse two to three times, reports Dr. Miklowitz, professor of psychology at the University of Colorado.

Expressed emotion usually sets up a conflictual relationship between patient and relative. And that has biological effects. "Patients become hyperaroused," explains Dr. Miklowitz. "Imaging studies show that fear centers are activated in the brain when depression-susceptible people hear a family member criticizing them."

Expressed emotion "seems to impair the maximal benefit of medications," adds Harvard's Dr. Ghaemi. "Part of the problem is medications work best for symptoms. They don't necessarily work best for recovery of function. Complete functional recovery occurs in about 50% of unipolar patients and in about a third of bipolar patients. Patients seem to do better with interventions geared toward family issues."

Enter family-focused therapy, a treatment Dr. Miklowitz initially devised for families of bipolar patients but which is now also applied to those of unipolar patients. It aims to reduce expressed emotion by educating families about depression, training them in communication skills, and boosting their problem-solving skills. Over the past decade, three studies demonstrate that it dramatically reduces the relapse rate. A major national trial of the treatment program in bipolar disorder is now underway.

"The idea of psychoeducation is just starting to hit the market," observes Dr. Miklowitz. "Family education should be part of the treatment, especially for recurrent disorders like depression."

How many of you had one or more parents who suffered from depression? A sibling? A spouse?

When I was growing up, my mother suffered a serious nervous breakdown when I was in the 6th grade. We were the only ones who saw the signs, because all of the sudden Mom didn't make much sense any more. She was subsequently diagnosed with both post-traumatic stress disorder and bipolar disorder. Needless to say, this event had a profound effect on me as a teenager, and made me super-aware of my own emotions, thoughts, and feelings. It's also made me more aware of mental illness in society.

Both my brother and I have been diagnosed with clinical depression. I think one of the results of this is a deeper understanding of what it means to have a mental illness, and a deeper understanding of those who also suffer from mental problems. For those of you who come from families with depression, or suffer from depression yourself, would you say that the experience has made you more empathetic?

Would you say that your family unit has been profoundly affected by someone in it with depression? How did your family react? Despite the mental illness present, would you say your family unit was healthy or unhealthy? As the article suggests, did your family unit recognize the symptoms of depression before a medical professional did? How did your family unit contribute to the treatment of the person suffering?

[ngdawg]

My grandmother suffered from depression and was hospitalized for it. My mother (her daughter) was not clinically depressed, but moody and later suffered from anxiety-based angina. My youngest sister committed something akin to suicide, but not killing herself, she 'wrecked' her car hoping to be put into a coma...she just got bumped up.
My history of depression I've gone over and I (along with my youngest sister) suffered through post-partem depression and mine, at least, bordered on psychosis( warped imaginings, fear of or thoughts of harming the baby).
Interestingly enough, our only brother is the only one we could consider 'sane'.
Whether it's just a female thing or not, I can't say. The only one who has not sought prefessional help is my mother, although she keeps harping on how great it is and everyone else should seek it.

[Gilda]

I've been diagnosed with unipolar depression, and have probably been depressed most of my 20's possibly as far back as my early teens. I know that my depression affects my family, that when I'm in a depressive episode it can negatively affect Grace and to a lesser extent, Sissy. The support I get from them is as important as anything I get from my therapist. I've gone with Sissy and with Grace to therapy on occasion, and they've urged me to talk to my therapist about things I discuss with them that I might otherwise have been reluctant to talk about with my therapist. They're also monitoring me to help determine the antidepressant I'm taking is helping any--it's often easier for a family member to notic improvements than it is for the patient.

Sissy's wanting to be here to support me just caused an argument with her boyfriend. That has more to do with my anxiety more than depression, but they are related conditions.

ngdawg: Depression is far more common in women, though exactly why isn't known. One theory that I've heard from more than one therapist is that women tend to turn their anger inward, while men tend to turn it outward, which might account for why men are more prone to explosive rage disorders, which are chemically quite similar to depression in how they operate in the brain. Women are generally better at expressing most emotions, but are taught to suppress anger and related aggressive emotions, which may also be a contributing factor.

Gilda

[Psycho Dad]

Two of my sister-in-laws suffer from depression with one of them being bi-polar. The bi-polar one has caused so much pain for others it is unbelievable. We all know that she can't help but do most of the things she does, but it still wrecks many family relationships. Were our family not as strong as it is, I'd hate to think where we may be.

I can only imagine what it is like for those who don't have loving and supportive families to depend on.

[magictoy]

I wonder if someone is interested in explaining the difference between bipolar and unipolar depression, and for that matter, what the "clinical" part of "clinical depression" means.

Yes, I could Google it, but with this much up-close experience, I have a feeling that something from one of the posters might be better.

[snowy]

Originally Posted by magictoy

I wonder if someone is interested in explaining the difference between bipolar and unipolar depression, and for that matter, what the "clinical" part of "clinical depression" means.

Yes, I could Google it, but with this much up-close experience, I have a feeling that something from one of the posters might be better.

First off, most depression is episodic.

Bipolar disorder is, in the most essential terms, when someone cycles between being manic and being depressive. With my mother, it was like watching someone on a roller coaster--sometimes the highest highs and other times the lowest lows. Some people cycle more quickly than others, and can go through several cycles between manic and depressive rapidly. Some people are more manic or more depressive. There is a huge variety.

Unipolar depression is when there is no mania--the person is only experiencing episodes of depression. It's another term used for clinical depression. "Clinical" means the depression is severe enough to warrant treatment, such as medication.

[Toaster126]

Originally Posted by ngdawg

Whether it's just a female thing or not, I can't say.

All women are crazy. It's just a matter of degrees. :P

But seriously, I only have one family member that I know of that is depressed. I think it's more a self-esteem thing than a sadness about life thing, though. I just try and give her positive mojo and she knows that I love her. That's about all I can do.

As far as depression along gender lines, I wonder how much of that is from men and women dealing with emotions differently, and how much of that is from how much we are allowed to express. Men learn very early that we "can't" express certain emotions. I truely think a lot of the gender disparity is simply because society doesn't allow for \ accept depressed males as much.

[Elphaba]

Clinical depression is found in my family also, and my youngest sister and I are unable to function without medication.

There are a couple of issues that I have regarding the article and the term "mental illness."

"Mental" is a meaningless term given the current understanding of brain chemistry disorders and likely explains the disparity between men and women in reported depression. "Mental" implies a personal weakness that is rejected by men of my cohort. You simply "pull yourself up by the boot straps" and be a "man." It should be no surprise that older men make up the group most at risk for suicide. Older women are often told by their general physicians to just put on a happy face, get a hobby, etc.

The "mind" is nothing more than a construct and doesn't exist in reality. The brain and how it functions is very real. "Love," often associated with the heart, is another construct, but no one refers to a "love illness."

I was impressed that the article emphasized the importance of family dynamics in regards to a depressed family member. The article is not intended to be inclusive of all research concerning family/illness dynamics, so I feel compelled to point out the cause/effect fallacy that may be in play. I am a proponent of Family Systems Theory for psych interventions. I recommend attention should be focused upon the family dynamics prior to the diagnosis of depression. The basic question is whether the family has an invested interest in the member being "sick?"

I would appreciate Gilda's thoughts on this in that she has looked deeply into her family dynamics through therapy.

[la petite moi]

My mother was severely depressed all her life. She got worse when she was diagnosed with breast cancer, and at age 17, I had to hear about how she just wanted to "excuse herself from life"- something my great aunt wrote in her diary before she committed suicide.

Her depressed and cruel comments have definitely affected me, and unfortunately, I haven't had the courage to get therapy yet.

Yes, I would definitely say that this study is TRUE. Depression DOES affect the whole family, and friends, and life situations.

[Gilda]

Well, since I was asked nicely .

Originally Posted by Elphaba

Clinical depression is found in my family also, and my youngest sister and I are unable to function without medication.

There are a couple of issues that I have regarding the article and the term "mental illness."

"Mental" is a meaningless term given the current understanding of brain chemistry disorders and likely explains the disparity between men and women in reported depression. "Mental" implies a personal weakness that is rejected by men of my cohort. You simply "pull yourself up by the boot straps" and be a "man." It should be no surprise that older men make up the group most at risk for suicide. Older women are often told by their general physicians to just put on a happy face, get a hobby, etc.

"Mental illness" isn't really accurate for depression and related anxiety disorders, at least in their milder forms. "Emotional disorder" is a better way of describing things. In most cases, it's a matter of brain chemistry being a bit off in such a way that incoming data aren't processed the way they should be. There is a cognitive element to it, but the cognitive element tends to reflect an exaggerated reaction to ordinary stimuli.

The "mind" is nothing more than a construct and doesn't exist in reality. The brain and how it functions is very real. "Love," often associated with the heart, is another construct, but no one refers to a "love illness."

No, but there are emotional disorders that can intefere with one's ability to connect with others and maintain those connections in a healthy way.

I was impressed that the article emphasized the importance of family dynamics in regards to a depressed family member. The article is not intended to be inclusive of all research concerning family/illness dynamics, so I feel compelled to point out the cause/effect fallacy that may be in play. I am a proponent of Family Systems Theory for psych interventions. I recommend attention should be focused upon the family dynamics prior to the diagnosis of depression. The basic question is whether the family has an invested interest in the member being "sick?"

I would appreciate Gilda's thoughts on this in that she has looked deeply into her family dynamics through therapy.

Well, let's see. I can recount far more incidents that I care to admit over the past few years (the most recent recounted in my journal) in which my depression and anxiety disorders (which are closely linked) have managed to impair not only my ability to function, but that of my family. We've cancelled any number of social engagements because I was feeling too down or too anxious to go, and I've managed to be a black hole that sucks all the fun out of the room on some occasions when I have gone. I know that worrying about me, or walking on eggshells around me when I'm in one of my really severe PMS bouts (another related condition, PMDD) it can make things difficult for those around me because they're afraid to be themselves for fear of setting me off, not in anger, but in bouts of deep sadness.

At the same time, fixing me and helping me cope became a family project. Grace has held my hand through a great many dinners and trips to the theater or to go dancing or to a restaurant, while at the same time continually pushing me to move beyond my current comfort zone. It's probably not what you're looking for in a partner, a job as a life coach, but Grace thinks of it as a phase. We're in the early stages of our marriage, together five years, and we have decades. It's like an investment in our emotional future.

It's not all been smooth sailing. Sometimes I've managed to suck her into a cycle of dependancy with me, and sometimes she's pushed too hard and it's backfired on both of us, and we've left social engagements I wasn't ready for more times than I'd really like to admit.

It's better than with my boyfriends, though. It would drive them nuts to find me unwilling to do anything but stay home and brood or to have their girlfriend suddenly get quiet and even moody and sullen in a social situation.

With Sissy it was a bit different. Her problems when she came to live with us were so much bigger than mine (or so I saw it) that when dealing with her, I had to set aside my problems, which usually meant bottling them up, so I could support her, and that at time gave me strength, and at times drained me. It helped me to learn to center my attention on someone else in my private life

Now the situation is somewhat reversed in some ways. Her transition is finished and she fully assimilated and she has become part of my treatment team. My family, strange as it is, is so functional and supportive that it's almost like the anti version of my birth family.

I'm not sure if that makes sense or not. My mind goes off on its own sometimes when I start to write.

Gilda

[Painted]

I think all this "clinical depression" is a ruse to get pills and/or attention. Call me closed minded, inexperienced, whatever. I don't care. Someone who is depressed their whole life simply doesn't have the courage and willpower to change their life for the better.

I get blue a lot of times too, but when I do I don't just sit around and mope and let it get worse. I take walks, drive around in my car, strum the old guitar, drink sixteen beers, all sorts of stuff. When someone in my family or a friend gets sad, I don't let them sit on the couch all day. We talk about what bothers them (or I get someone to go talk to them), and if they refuse, well...not my problem. I don't let people make me sad if they are.

Criticism is welcome, but no insults to my knowledge of the subject please. I went through a lot of therapy and Ritalin in my past. Didn't solve any of my problems. I solved them on my own.

[Jinn]

I think all this "clinical depression" is a ruse to get pills and/or attention. Call me closed minded, inexperienced, whatever. I don't care. Someone who is depressed their whole life simply doesn't have the courage and willpower to change their life for the better.

Nothing but props here. I couldn't agree more, and I'm glad the "other" voice in depression is at least represented. I would've said it myself, but no one likes to be told how many crutches they're using. The blue in my sig might as well be an echo of your sentiments.

[Psycho Dad]

All this "clinical depression" is not a ruse. Some of it is misdiagnosis I suspect, but there are people who are truly in a state of mind that we cannot understand. While we all have bad days, get sad and may not see the point in living, there are those who live like that daily. Probably what is worse than those who have been misdiagnosed, are those who have to live this way without the help they need.

[Gilda]

Originally Posted by Painted

I think all this "clinical depression" is a ruse to get pills and/or attention.

"All" pretty much invalidates your argument at the start. There are drug and attention seeking hypochondriacs, and I don't doubt that some of the former will use depression as an attention getting device, but to say that everyone so diagnosed is faking it is both flat out wrong and frankly more than a little insulting.

The drug seeking I don't quite understand. How exactly would that work, faking depression to get pills? The most common classes of medication given to depressives aren't the type of drug that make you high. The only positive effects generally seen are on people with depression or related disorders, they're expensive, and they come with a host of possible negative side effects. There is no pleasant narcotic or stimulant effect, and the newer, more powerful versions tend to be more specific to the disorders. The sole positive effect for most is the relief of symptoms the person with the deprssion or anxiety disorders is feeling.

What happens with depression is that, regardless of the initial cause, stress, a history of abuse, problems with biochemistry, once it's gone on long enough, it throws the neurochemical processing in the brain out of balance and the medication helps to put it back where it's supposed to be.

Call me closed minded, inexperienced, whatever. I don't care. Someone who is depressed their whole life simply doesn't have the courage and willpower to change their life for the better.

Even if we accept your assertion that it's simply a matter of not having the will power or courage to get past it, wouldn't that indicate that outside help is necessary, in the form of family support, therapy and/or medication? If someone doesn't have the willpower to get past it on her own, and I agree, many don't, then it can't reasonably be said to be her fault.

That is a close-minded attitude towards this particular subject. Clinical depression and related disorders are caused in the long term by a neurochemical dysfunction in the brain. Willpower and courage are helpful, but they won't change the neurochemical functioning of the brain or undo dysfuntional thought patterns. Some people are incapable of functioning at an ordinary level without medications. Others can function, but do much better with professional help and/or medication.

I get blue a lot of times too, but when I do I don't just sit around and mope and let it get worse. I take walks, drive around in my car, strum the old guitar, drink sixteen beers, all sorts of stuff.

Wonderful. You've found ways of coping with everyday situational depression. Everyone gets that sometimes, and knowing coping skills is a big help. Excercise, music, talking to family members, meditation, all of those can be good ways of coping.

You do realize, I hope, that there is a big difference in degree between feeling a little blue at times and clinical depression. Everyone gets a little down now and then. Not everyone has long lasting, intense, recurring cycles of it. They're similar in kind, but not in degree. Any disorder has lesser and greater degrees that require different interventions.

When someone in my family or a friend gets sad, I don't let them sit on the couch all day. We talk about what bothers them (or I get someone to go talk to them), and if they refuse, well...not my problem. I don't let people make me sad if they are.

In other words, you help them work through their problems. Good for you! There would probably be fewer depressed people if more family members/friends were aware of what was going on and did what they could to make the situation better. That was even one of the points of the article posted.

If you're talking to them about what's bothering them (and with depression, it really doesn't have to be anything specific), I assume you do this because you think that talking about their problems will make them feel better, or you can offer advice that might help them feel better. That's what a therapist does, with the difference being that the therapist has extensive training in how best to deal with specific types of problems and in how to teach others specific coping strategies.

If the type of amateur talk therapy you offer can be helpful, and I agree that it can, what's wrong with a professional doing the same basic thing, but with the benefit of extensive training and professional distance? What about those who don't have someone supportive around to talk to, or whose family/social circle is toxic rather than supportive?

Criticism is welcome, but no insults to my knowledge of the subject please. I went through a lot of therapy and Ritalin in my past. Didn't solve any of my problems. I solved them on my own.

Ritalin isn't an anti-depressant, so your experience with it is hardly relevant to the subject, and if a therapist was prescribing it for depression, he's an idiot. I'm sorry that the therapy wasn't helpful to you, and happy to see that you've apparently managed to solve your problems on your own. Not everyone is capable of that, and many, myself included, do benefit from therapy.

Your personal experiences are helpful and illustrative, but you're making a hasty generalization, which is a logical fallacy in which you argue from too small a sample to a general population. In this case, because therapy wasn't helpful for you, you assume it won't be for anyone, and because you were able to overcome your problems without professional help, everyone can.

It's a very common argument, and one that makes powerful emotional sense: If I can do this, anyone can. You can do anything if you only work hard enough at it. Those make good for good motivation, but they aren't universal truths.

Not everyone is the same. Some can find peace and a way out by themselves and through family and friends. Others need professional help, or benefit better and get quicker or better results from professional help and/or medication.

There is no "one size fits all" was to deal with depression.

And when I talk about therapy
I know what people think
That it only makes you selfish
And in love with your shrink
But oh how I loved
Everybody else
When I finally got to talk
So much about myself

--Dar Williams

Gilda