Clinical depression can be a complex and individualized process. Understanding depression spans multiple levels of knowledge, from genetics and brain biology to culture and situational stress.

“When a loved one is affected by depression, it can be difficult to understand what is happening or what you can do to help. It’s OK to be confused,” says Erik Wing, Ph.D., psychology at Mayo Clinic Health System in La Crosse. “Gaining perspective on what your loved one is experiencing can be critical to the support process. Visualizing depression as a downward spiral is one way to simplify and understand clinical depression.”

The downward spiral, according to Dr. Wing, might begin with the person feeling worse than usual from physical, social or psychological stressors. A worsened mood may lead to taking part in fewer meaningful day-to-day activities. Self-criticism and stress increase due to mounting responsibilities or missed opportunities. Depressive thinking may encompass guilty thoughts, pessimism and irritable behavior.

“As the spiral develops, a complex dynamic emerges,” Dr. Wing explains. “Your loved one becomes increasingly stressed while simultaneously less capable of coping with this stress. The silver lining is that if people can spiral down, they can spiral back up.”

Although Dr. Wing emphasizes you cannot fix someone else’s depression or spiral up for them, you can help to get them started on an upward path.

Depression signs and symptoms vary from person to person. They can include:

Feelings of sadness, tearfulness, emptiness or hopelessness.
Angry outbursts, irritability or frustration, even over small matters.
Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports.
Insomnia or sleeping too much.
Tiredness and lack of energy, so even small tasks take extra effort.
Changes in appetite.
Anxiety, agitation or restlessness.
Slowed thinking, speaking or body movements.
Feelings of worthlessness or guilt, fixating on past failures or taking unnecessary blame for things.
Trouble thinking, concentrating, making decisions and remembering things.
Frequent or recurrent mention of death, suicidal thoughts, suicide attempts or suicide.

Children and teens may show depression by being irritable or cranky rather than sad. Clinical depression doesn’t require profound sadness. Rather it can be lack of positive emotion instead of intensely negative feelings.

“People with depression may not recognize or acknowledge their symptoms. They may have difficulty seeing the point of getting treatment. Your support and understanding can kick-start or reinforce the healing process,” says Dr. Wing.

Some ideas for helping someone with depression include:

Talking to the person about what you have noticed and why you’re concerned.
Encouraging discussion of symptoms with a health care professional and highlighting the existence of effective treatments, including both therapy and medication options.
Be willing to listen — when desired — without the need for practical advice.
Offer to help establish a routine or increase structure in the loved one’s life, especially in the areas of sleep, physical activity and nutritional habits.
Give positive reinforcement for participating in productive or pleasurable activities, and make plans together for such activities.
Be patient: reflect on your role as being there for the loved one, as compared to “fixing” the depression.

“Supporting someone with depression is challenging,” adds Dr. Wing. “Part of the challenge is witnessing a loved one’s struggle and knowing you cannot complete the path for that person. Permit yourself to prioritize your own mental health by devoting time for hobbies, meaningful experiences, physical activity and other valued relationships.”

If you believe a loved one’s illness is severe or in a potentially life-threatening emergency, you may need to call 911, contact a health care professional or hospital, or call 988 — the new national hotline for mental health crisis services.

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