| Home | Article Database | Resources | Tools & Just for Fun | Search HY |

Helping The Depressed Person Get Treatment

Helping the Depressed Child

The first step in helping the depressed child is to recognize that the child is, in fact, depressed. This can be challenging. For one thing, its difficult for adults to accept that young children- even infants-can suffer from depression. Childhood is supposed to be a happy, carefree time life. Only in recent years has scientific evidence convinced most mental health specialists that childhood depression exists.

Recognizing the symptoms of childhood depression can be difficult While some children display the classic symptoms-sadness, anxiety, restlessness, eating and sleeping problems-others express their depression through physical problems-various aches and pains that do not respond to treatment. Still others hide their feelings of hopelessness and worthlessness under a cover of irritability, aggression, hyperactivity, and misbehavior.

Complicating the recognition of depression are the developmental stages that children pass through on the way to adulthood. Negativism, clinginess, or rebellion may be normal and temporary expressions of a particular stage. In addition, children go through temporary depressed moods just as adults do. Careful observation of a child for several weeks may be required to determine if there is a problem. When symptoms of possible depression seem severe or continue for more than a few weeks, an evaluation by the child's pediatrician to rule out physical illness would be a good first step. A next step, if deemed necessary, would be consultation with a mental health professional who specializes in treating children.

While parents typically assume prime responsibility for getting treatment for their depressed child, other people-relatives, teachers or friends-can play a role. In the following case, school personnel were instrumental in getting help for a child.

Scott

Scott was not doing at all well in school. He was alternately disruptive and unresponsive in class. His third-grade teacher sought help from the school counselor, who observed Scott on and off for several weeks. She soon shared his teacher's concern. Scott was not learning. He seemed unable to follow instructions. Withdrawn for the most part, he also regularly lashed out at the other children either physically or verbally.

The counselor's efforts to win Scoffs confidence failed and her invitations to his mother brought no response. She therefore turned to Scott's sixth-grade brother for help. He explained that his parents were divorced and that all three children lived with their mother, who worked long hours outside the home. He commented that his mother seemed tired and stressed most of the time and that Scott was a special problem, causing her a great deal more trouble than did the other children.

The counselor reported the situation to a team of school officials-psychologist, principal caseworker, teacher-who regularly met to address problems such as Scott's. They recommended followup by the school caseworker, who met with Scott's father and arranged for Scott to receive psychological and physical evaluations. The evaluations indicated that Scott was physically all right, but quite depressed, angry, and emotionally confused. He missed his father very much, but was angry with him for leaving. He loved his mother, but blamed her for his fathers absence. Deep down he blamed himself for his parents' divorce.

The clinician who evaluated Scott recommended that he receive treatment for depression. It was also clear that Scott wanted and needed more contact with his father. His mother also needed some relief from the burdens she had been shouldering. Scots parents worked out an agreement to increase his father's visits with his children and to cover the cost of Scott's treatment with his father's health insurance.

While Scott was helped through the intervention of school staff, the important role played by his parents cannot be emphasized enough. Parents not only procure their child's treatment, it often is necessary for them to participate in it. Sometimes a parent may reap some personal benefit from a child' s treatment. Scott's mother, for instance, improved her own abilities to handle stress while she was learning how to help her son.

The major objectives of treatment, however, are to alleviate the child's depression and strengthen the child's coping and adaptive skills, possibly preventing future psychological problems. This is not to say that early treatment is the total answer. Some problems are not readily resolved and some reemerge later in life.

Helping the Depressed Ado1escent

Depression may be even harder to recognize in an adolescent than in a younger child. Feelings of sadness and hopelessness associated with depression may be perceived as the normal emotional stresses of growing up. Some depressed youngsters act out their distress, becoming inappropriately angry or aggressive, running away, or becoming delinquent. Such behaviors, too often dismissed as adolescent storminess, are signs or problems and sometimes cries for help or attention.

For example, bipolar disorder (also called manic-depressive illness) often emerges during adolescence. It is manifested by episodes of impulsivity, irritability, and loss of control, sometimes alternating with periods of withdrawal. This behavior also can be confused with the emotional ups and downs of adolescence.

The clue to depressive disorder in an adolescent is persistent signs of change or withdrawal. Has the once outgoing youngster become withdrawn and antisocial? Is the former good student failing subjects or skipping classes? Has the happy-go-lucky kid been moping around for weeks? Is the easy-going teenager inappropriately irritable? If the answer to any of these questions is "yes," it is time to ask more questions. Is the youngster feeling unable to cope, demoralized, friendless, possibly suicidal?

If so, it is important-vital, in fact-to get the youngster help. A depressed adolescent may or may not be willing to see a mental health professional often youngsters have mixed feelings about getting help and may resist treatment if they sense similar ambivalence in their parents. Or they may play on parental guilt. They seem to have an uncanny ability to know what makes parents feel guilty and are particularly adept at pushing "guilt buttons." It is all too easy for loving parents to give in to strong resistance, but this only does the youngster a disservice. Sometimes, it is wise for parents to seek advice on how best to help their depressed child. If the youngster is destructive of self or others, it is essential to get help. Leesha is a case in point.

Leesha

Once a happy child and good student, Leesha became withdrawn, listless, and disinterested in school during her junior high years. She could no longer summon the energy and enthusiasm she once took for granted. Her pervasive sadness discouraged friendship, and she found herself socially isolated. She began to skip classes and then, to avoid her mother's "nagging," started staying away from home until the in the evening.

Leesha' s mother became increasingly upset and eventually confided her concerns to her pastor, who had a doctorate in family counseling. After his invitation to Leesha and her father to meet with him was turned down, he encouraged Leesha's mother to seek help for herself; and she decided to accept his counseling. With his help, she 1earned much about herself and her relationship with her family. The pastor also convinced her that Leesha had an illness-probably a form of depression-that required appropriate treatment She then begged Leesha to see a psychiatrist recommended by the pastor. Leesha wanted help, but feared her father's disapproval. He , believed that only "crazy" people needed psychiatrists, that getting help was a sign of weakness and, besides, that Leesha was just going through a phase.

The tension between her parents mounted. Her father often stayed out late and came home drunk. One day, her parents received a call from the local hospital. Leesha had attempted suicide.

On the advice of the treating physician, Leesha' s parents admitted her to a psychiatric hospital As part of that hospital' s program, they were expected to join families of other patients in group counseling. Leesha's father, more frightened by his daughter's suicide attempt than the prospect of joining a therapy group, reluctantly participated. He was relieved to find that his problems were not unique, but shared by others in the group. Also, the help and understanding he received from the group enabled him to give Leesha needed love and support during her treatment and after her recovery.

Leesha and her parents were lucky that she survived her suicide attempt. Perhaps, if both parents had strongly insisted she get treatment earlier, a good deal of guilt and pain could have been avoided. However some teenagers resist treatment no matter what. This is when mental health professionals advise parents to get tough, particularly if the child is using alcohol or drugs, running away, getting into trouble, or is suicidal.

Getting tough does not mean physically or verbally abusing children or putting them on the street. In fact, if a youngster runs away, efforts to find the child should begin as soon as possible. Sometimes parents are tempted to "teach the runaway a lesson" by not looking for the youngster for a day or two. This is not wise. If youngsters manage to avoid danger, they will not avoid feeling rejected, an emotion that only exacerbates depression.

Getting tough with youngsters means seeing to it that they get appropriate treatment. Such treatment may be provided on an outpatient basis while the child lives at home or with a relative. Or the youngster may be better off in a psychiatric hospital, drug rehabilitation program, behavior modification program, or a residential treatment center. Sometimes, various treatments have to be tried to find the one that works best.

Finding the right treatment is usually predicated upon a complete psychiatric and physical diagnostic assessment. A depressive disorder is not a passing bad mood, but rather an illness that should and can be treated. For information about treatment programs, see Helping Resources.

Helping the Depressed Young Adult

When does parental responsibility end? In most States, when children reach 18, they are considered legally independent adults who are responsible for their own welfare. In reality, many children require parental assistance beyond age 18. Depressed children, regardless of age, often need a helping hand, but there are limits to what parents can and, at times, should do.

Parents can help their grown children recognize that they are depressed by familiarizing them with the symptoms. They can encourage treatment and provide information about available resources. Parents can also help their child fight the isolation often associated with depression by calling, visiting, and extending invitations to dinner, to a movie, or to spend a night or weekend. If the depression is interfering with the young adult's ability to function, parents can provide transportation to treatment and offer shelter, food, and money until the symptoms subside.

If the young adult refuses treatment, parents have even fewer options. They can ask individuals whom the depressed' person trusts and respects to intercede. Friends are often more influential than parents. Sometimes, it takes a combination of several persons and the right strategy--actually recommending or taking the depressed person to a therapist.. to get the individual' s illness evaluated and appropriately treated.

Some people learn to live with depression. They can get up, go to work, and do their chores. They do not know there is a better way to feel and are not motivated to get treatment. Without treatment, however, they can spend a lifetime feeling miserable and making those around them feel almost as bad. Parents (or others) who have a depressed adult living with them who refuses to get treatment will find it useful to consult with a mental health specialist on how best to deal with this situation.

If the depressed child is suicidal, stops eating, or becomes psychotic (loses touch with reality, has delusions or hallucinations), parents can best show their love and concern by hospitalizing their child, even if involuntarily, as was the case with Marta's parents.

Marta

Marta was in her early 20s the first time her parents hospitalized her some 5 years ago. She was diagnosed as having bipolar disorder (also known as manic-depressive illness). At that time, she was placed on lithium by the hospital psychiatrist. Much to her parent's relief, the medication controlled Marta' s extreme mood changes, her frightening ups and downs.

However, Marta would not stay on the lithium She didn't want to give up the "highs" that made her feel unbelievably elated, energetic, and invincible. In reality, the extreme things she did during these periods-uncontrolled spending, nonstop talking, nighttime wanderings, and sexual promiscuity-caused serious problems. She lost a husband, friends, and several jobs.

Even more frightening were the terrible lows that alternated with the highs. During these periods, Marta felt worthless, helpless, and hopeless to such an extent that she attempted suicide on several occasions. Each suicide attempt was followed by hospitalization and a return to lithium, but she seemed unable to stay on the medication.

Marta's emotional roller coaster was shared by her parents. Each time Marta went back on lithium, their hopes were raised that she would lead a stable, predictable life, and each time she went off the medication, their hopes were dashed. They also lived with uncertainty and fear, never knowing if Malta might turn up on their doorstep, in jail, or in the morgue.

Following one of Malta' s suicide attempts, her parents confessed to a hospital social worker that they were so emotionally and physically drained that they no longer wanted contact with their daughter. Although sympathetic, the social worker encouraged them to take a different and less drastic approach to alleviating their situation. Parents, she explained, often find it hard to differentiate between caring about and taking care of a child, even a grown child.

"Tell Marta that you love her and want her to live, but make it just as dear that you will not and cannot assume responsibility for the way she lives or even whether she lives," the social worker told them. "You can control your behavior-express your wishes and act on them-but you cannot control Marta's.

Like many parents in this situation, Marta's parents found that actually "giving up" responsibility for Marta was not easy. At the social workers suggestion, they joined a group of parents who discussed problems such as theirs under the team guidance of the social worker and a psychiatrist. In addition, they joined a consumer organization that sponsored mutual support groups and information-sharing seminars.

At the end of the year, Marta was still taking the lithium prescribed during her last hospitalization. She had a new job in another city and was living on her own. She was taking responsibility for her health, regularly seeing a psychiatrist who monitored her mediation and helped with any problems she was having.

Marta was not able to take responsibility for her own health and life until it was clear that such responsibility belonged to her and not her parents. But it took 5 years of crises to bring Marta's parents to the point where they could deal realistically with their daughter's illness. This, too, is not uncommon. It often takes crises and time to motivate people to seek and attain the help they need.

Helping Your Spouse

Living with a depressed person is difficult under any circumstances. When the person is your wife or husband, the problems escalate. The role of spouse carries with it expectations of love, companionship, parental partnership, economic support, and all-round helpmate. But depression reduces sexual desire, energy levels, sociability, and productivity. It can destroy a relationship.

Even if the depressed spouse is getting treatment, the situation can be stressful. Depression can cause people to become withdrawn, rejecting, and irritable and to say hurtful things to those they care about. If nondepressed spouses realize that the illness muses these behaviors, they may find it easier not to feel 'hurt and to respond in a nonrejecting and reality-orienting manner. For instance, if the depressed spouse says something like, "You never loved me," or "I don't love you anymore" the nondepressed spouse might respond, "That's your depression talking. Your illness is hurting both of us, but when you get better, you will feel differently."

Until symptoms are alleviated, depressed people need patience, understanding encouragement, and assistance; however, they should not be made to feel totally helpless or inadequate. Sometimes it requires walking a rather fine line, and nondepressed spouses may find it useful to get counseling to learn more about depression and how best to help their depressed spouses as well as themselves.

In fact, counseling may be even more useful for the nondepressed spouse if the depressed spouse refuses treatment. For one thing, counseling can help the nondepressed spouse avoid becoming depressed. . It is all too easy to be overcome with feelings of isolation, helplessness, and hopelessness if you are living with a depressed person, particularly one who refuses help. Also, counseling can clarify alternatives, offer solutions, and "stiffen spines"-for it is time to get tough when a depressed spouse refuses treatment.

Although more women than men get depressed, getting tough with a recalcitrant, depressed spouse is more often a wife's problem, because men are often less willing than women to seek treatment for any health problem, including depression. It requires a challenging combination of sensitivity and self-confidence to be caringly forceful with a man-or woman-whose self-esteem has already been undermined by a depressive illness.

Sometimes it pays to ask others to intervene. For example, close relatives or friends, who understand that depression is an illness and not a weakness, can often convince the depressed spouse to seek treatment. A family doctor or religious leader knowledgeable about the symptoms and treatments of depression may also be helpful Sometimes, if enough people say often enough, "We care about you, but you need professional care to feel better," the message gets through. In some cases, it is most helpful to have several people speak privately to the depressed person, and in others, a group approach is more successful.

If all efforts to get the depressed spouse to seek treatment have failed, nondepressed spouses will need to consider how well they are coping and, if there are children, whether they are being affected. Consultation with a mental health specialist may be particularly useful in this situation.

But depressive illnesses are not always recognized. In fact, it is not unusual for families to be unaware that a loved one is suffering from a depressive illness. They may react inappropriately or suffer unnecessarily as a consequence. Such was the case with Alice and Charles.

Alice and Charles

At first, Alice couldn't believe what was happening. Her once considerate and loving husband had changed dramatically over the past year. She kept expecting him to get over whatever was making him withdrawn hostile and antisocial but on the rare occasions that Charles was willing to discuss his feelings with her, he just kept saying that he was tired of everything and everyone-his job their kids and especially her.

Initially, Alice attempted to placate him, but nothing she did made him happy. In fact the harder she tried, the angrier and more withdrawn he seemed to get. Eventually, she lost patience and returned his anger with her own. Their relationship deteriorated, and Alice contemplated leaving Charles.

Before taking such a desperate step, Alice confided her feelings to a friend, who suggested that Charles might be ill and should see a doctor. Alice then began to take a different approach in dealing with Charles. She spoke to him about her feelings of frustration and concern about their relationship. She told him that she still cared about him very much and was worried about his health. Eventually, she convinced him to visit their family doctor.

The physician listened carefully to Charles, asking him questions about his life and symptoms. Following a complete physical examination and several tests to rule out other explanations for his symptoms, the doctor suggested that Clarles might be suffering from depression. He explained that Charles' symptoms we real and not "in his head." Depression, he told Charles, is a disorder that can and should be treated. He referred Charles to a psychiatrist for an evaluation, explaining that it was his practice to send patients to practioners he thought were expert in a particular azea. For instance, if Charles had a heart problem, he would refer him to a cardiologist or if he had a bladder problem to a urologist.

He also reassured Charles that he was not pushing him off onto another doctor, but that he needed a psychiatrist's expert opinion about Charles' condition and whether he needed therapy, antidepressant medication, or both.

Charles' depression was confirmed by the psychiatrist and successfully treated. Within several weeks, he was feeling much better. He also gained insight into some of the problems in his relationship with Alice. For ample, he realized that his behavior was due to his depression rather than her inadequacies. He also realized that while he could not control the pain of depression, he did not need to accept it either. Best of all, he recognized that his symptoms were not his fault and that he deserved to feel well again.

Charles had a lot going for him. He had a sophisticated family doctor and access to medical insurance that covered mental health treatment But even if Charles didn't have these advantages, he could have found help. Community mental health clinics and some private clinics and therapists adjust their treatment fees in accordance with a patient's ability to pay. Consumer organizations offer mutual support and assistance. Religious organizations provide social groups and day care, and local governments offer many kinds of help.

Unfortunately, many depressed people lack the energy and motivation to seek the services they need. Here again, friends, family members, religious leaders, and others can help get needed information and provide transportation and encouragement.

Helping the Depressed Older Person

Depression in the elderly is often manifested by memory problems, confusion, social withdrawal, loss of appetite, inability to sleep, irritability, and, in some cases, delusions and hallucinations. Feelings of sadness may or may not be acknowledged or shown. Thus, depression is often mistaken for dementia or the normal aging process and goes untreated.

Regardless of the cause of the depression-and there are many reasons why an elderly person can be depressed-appropriate treatment can alleviate symptoms and suffering. Even Alzheimer's patients, who are often severely depressed during the early stages of the disease, can gain extra years of function ing and pleasure with treatment for depression.

The first step in helping the older person who appears to have symptoms of depression is a complete physical checkup. Depression can be a side effect of a physical illness or of a medication to treat an illness. If patients are confused or withdrawn, it is important that they be accompanied by a per son who can give the doctor essential information about their medical history and receive instructions and recommendations. It is particularly important that the examining physician be told of all drugs used by the patient, including over-the-counter, prescribed, and borrowed drugs.

If the cause of the symptoms is not uncovered, the next step is an evaluation by a mental health specialist-preferably one with a geriatric specialty or experience in dealing with older people. Seeking consultations with specialists is a relatively common experience for older patients, who often have multiple clinical problems. Therefore, the need for referral to a expert to gain further diagnostic information can be readily understood by the older patient, particularly if care is taken to explain the interrelationship between physical health and emotional well-being.

A major issue for the older person wh3 has limited energy and financial resources is the length and t) e of treatment. Patients often believe that all mental health treatments involve many years of analysis, so they need to be told about the medications and relatively short-term psychosocial treatments now used successfully to help depressed adults of all ages. In fact, all aspects of the recommended treatment should be carefully explained by the mental health specialist.

If antidepressant medication is prescribed, the prescribing physician should be fully informed of all o' her drugs the patient is taking. Since drugs are metabolized more slowly in older people, antidepressants must be carefully prescribed and monitored.

If older depressed people refuse to see a mental health specialist, they may need assurances that treatment will reduce symptoms, improve functioning, and enhance well-being. This message may have to be repeated more than once by several different people. Sometimes close friends, siblings, or a religious leader can have more success in convincing the older depressed person to get help than a spouse or child.

In some cases, the older person who will not or cannot make an office visit may accept a phone call from a mental health specialist, who then might arrange to visit the patient at home, if the patient is willing. Phone contact can introduce and enhance patient/therapist interaction; however, it is not an appropriate substitute for the person-to-person contact needed by a therapist to properly evaluate and treat a patient.

The following vignette illustrates how a phone call from a geriatric psychiatrist laid the groundwork for the treatment that helped Kai overcome his depression.

Kai

Kai had been a devoted family man and a hard worker. He hadn't had time for hobbies or other interests, but he was satisfied with his life. He possessed everything important a man could need-a good job, good health, and a loving family.

Then the first blow came: retirement .He was not ready to stop working when the company vice president suggested, not too subtlety that he should make room for a younger man who needed his job.

The next blow was the heart attack. Fun and relaxation were not what Kai had been used tot and he had tried to avoid his overwhelming feelings of uselessness by compulsively working around the house and yard. His heart attack took that option away. The damage to his heart made him a poor candidate for surgical repair, according to several cardiologists. His life became dependent on the miracle of drugs-many kinds, many times a day. Good health and worthwhile activity once taken for granted, were replaced by exhaustion, pain, fear, depression and inactivity.

While still recuperating in the hospital, Kai was told by his doctor about a psychotherapy group organized for heart patients, but Kai did not join. There was nothing wrong with his head, he thought at the time. Later, realizing that he was forgetful and sometimes outright confused, he began to wonder. He knew, however, that he wasn't crazy!

Nevertheless, Kai's bad mood was "driving his wife crazy" or so she said. She begged him to see another doctor, but he couldn't be bothered. Doctors just make you sicker, he proclaimed.

The final blow came from his heart doctor. After a checkup, he threatened to hospitalize Kai because of weight loss and the severe emotional withdrawal described by his wife. The cardiologist said that depression could be complicating Kai's recovery. He gave Kai the name of a psychiatrist who specialized in treating older people and said the psychiatrist would call Kai at home if that was all right. Kai agreed. He didn't want to be hospitalized.

Kai liked what the psychiatrist said when she called. She explained that the body and mind were inseparable, one affecting the other. Heart attacks are often followed by depression and depression affects health, she explained."If a heart attack caused a foot problem which kept you from walking wouldn't you get your feet treated?'' she asked. "Well, the depression is keeping you from walking away from disabling feelings. It's time to treat the depression and get on your feet again," she told Kai.

After the psychiatrist visited Kai at home several times, Kai agreed to continue meeting with her at her office. She also worked with Kai's cardiologist to adjust his medications and to develop an exercise regimen. Kai' s memory lapses and confusion abated. Eventually, he and his wife joined a support group for heart patients and their spouses. They found out their experience wasn't really unique.

It took a while for Kai to learn how to accept himself and his "broken" heart and to enjoy life once more. He also learned that lifetime habits do not change overnight. Work is a major force in the lives of many people. More than a source of income and social contact, it serves the ego and fills the days. Without work, people such as Kai, who have not developed other interests, become extremely vulnerable to depression.

Of course, Kai received a double whammy when he had a heart attack. The disability associated with serious illnesses, especially those prevalent among older people, and the medications used to treat them, can also contribute to depression.

Then, too, older people are often dealing with the death of a beloved person or the loss of a familiar home or way of life. Sometimes, there are too many losses, and unrelieved mourning evolves into a depression that is unshakable without treatment.

In many cases, psychiatric treatment will alleviate symptoms of derangement and confusion and thereby contribute to the older person's ability to live at home rather than in a long-term care facility.

While it makes absolute sense for people of all ages to check the credentials of all health practitioners before embarking on treatment, it is particularly important that homebound patients, who have limited access to health-care providers, take extra care. Although it is rare, there have been cases of improper and inadequate treatment foisted on the homebound by disreputable practitioners.

Ask for referrals from your doctor, or check with the psychiatric department of a local university hospital or community mental health center, or contact one of the professional or consumer groups listed under Helping Resources. For information about other services devoted to the elderly, call your local and State governments.

Helping the Depressed Employee

Enlightened employers are recognizing that it pays to help _ depressed employees. They have learned that many depressed people turn to alcohol or drugs in misguided attempts to alleviate their pain. Untreated depression, alcoholism, and drug abuse become very expensive in terms of lost productivity and accidents, so many employers are encouraging workers to get needed help.

In fact, the trend is growing among business, government, and educational organizations to provide onsite employee assistance programs (EAPs) that offer mental health, alcohol, and drug abuse counseling or, when appropriate, referral to outside resources. EAP services are free and convenient, yet many employees do not take advantage of them. Some only need encouragement from a supervisor to seek help; others need pressure. In some cases, EAP counselors help supervisors get help for their depressed employee, as happened in Jane's situation.

Jane

As sometimes happens when you supervise a depressed person, Jane found herself in a difficult position. In her efforts to deal with her employee, she became friend, parent figure, and confidante. Unfortunately, none of this helped get the work done. When she suggested he see an employee counselor, he refused, stating he could solve his own problems. Time did not prove this to be true and eventuality feeling angry, protective, sympathetic and stressed by turns, Jane sought advice herself.

During several sessions, the EAP counselor helped Jane sort out her emotions and responsibilities from those of her employee. The counselor explained the implications of depression and explored with her the limitations and options she had as a supervisor. Jane convinced that she could best help her employee that he needed help by clearly demonstrating, through careful recordkeeping, that his work performance had deteriorated.

Jane found the chore of documenting her employee' s performance annoying and time consuming. However, as she began to write down what was really happening each day, and sharing her observations with him, the situation became clearer to him as well as to her. He realized that he was not pulling his weight, and she recognized that she was not helping him get well by protecting him. Jane suggested that he come to a counseling session with her. He refused. She then pointed out that she would have no other choice but to take personnel action against him. He then agreed to visit the counselor with her.

Much to his surprise, he found the visit helpful and set up his own future appointments. After several visits, the counselor referred him to a psychiatrist for a complete diagnostic evaluation and then collaborated with the psychiatrist in working out a treatment regime: the psychiatrist prescribed an antidepressant medication and the counselor provided psychotherapy.

He continued to see the counselor regularly for several months and then on an as-needed basis. Within a few months, he was off mediation. His symptoms had abated, his work performance had improved dramatically, and he felt much better about himself. He now understands that his lack of energy and inability to concentrate were not personal defects, but rather due to his illness. He told Jane that in the future if the symptoms recur, he will seek help immediately.

While employee assistance programs are being widely adopted by large companies and government agencies, owners of small businesses who cannot afford their own EAPs can help troubled employees through other mechanisms. They can provide their employees with medical insurance that offers the best available coverage of mental health and substance abuse problems. They also may offer a depressed employee temporary flexible hours or a less demanding job until the symptoms of depression are alleviated. They can provide reassurance and reinforcement for those jobs that are well done or show improvement.

Perhaps most important, employers can encourage and, in fact, pressure employees to seek treatment. It is usually in the employer's interest to help depressed employees get appropriate treatment, for it is rarely cost effective to tram a new person or to replace an experienced worker whose performance is temporarily not up to muff. Helping the depressed employee pays off.

In Brief

Ways To Help a Depressed Person

  • Recognize the symptoms.

  • Convince the depressed person to get treatment or, in the case of a depressed child or adolescent, help the youngster get treatment.

  • Tell the depressed person that he or she is loved, deserves to feel better, and will feel better with appropriate

  • Recommend helping resources.

  • If the depressed person is not functioning, accompany him or her to treatment until normal function returns.

  • If the depressed person is too young or ill to provide needed information to the therapist, act as a go-between as long as needed.

  • If the depressed person is suicidal or having hallucinations or delusions, arrange for hospitalization.

  • If the depressed person is functional and refuses treatment, seek the assistance of others-friends, doctor, clergy, relatives-who might convince him or her that treatment is needed and will help.

  • Don't give up too soon-the depressed person may have to hear more than once and from several people that he or she deserves to feel better and can, with proper treatment
If all efforts to encourage the depressed person to seek treatment have failed, and the depressed person is having a demoralizing impact on those around, further action is needed:
  • A supervisor might threaten personnel action unless the depressed employee gets treatment

  • A spouse, with the assistance of a mental health specialist, can explore separation from the depressed husband or wife who refuses treatment.

  • Parents of a depressed adult can clarify, with the help of a mental health specialist, how much assistance to give their depressed offspring.

  • Children, other relatives, friends, or doctors of a depressed older person can assist him or her to get help from a mental health specialist who has geriatric experience and who may be willing to reach out to the older person by telephone and home visits.
It isn't always easy to help the depressed person get treatment, but it can be done, and helping can make you both feel better.

Symptoms of Depression

  • Persistent sad, anxious, or "empty" mood
  • Decreased energy, fatigue, being "slowed down"
  • Loss of interest or pleasure in usual activities, including work or sex
  • Sleep disturbances (insomnia, early-morning waking, or oversleeping)
  • Appetite and weight changes (either gain or loss)
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Thoughts of death or suicide, suicide attempts
  • Difficulty concentrating, remembering, making decisions
  • Chronic aches or persistent bodily symptoms that are not caused by physical disease
Symptoms of Mania
  • Increased energy
  • Decreased need for sleep
  • Increased risk-taking
  • Unrealistic beliefs in own abilities
  • Increased talking and physical, social, and sexual activity
  • Feelings of great pleasure or irritability
  • Aggressive response to frustration
  • Racing and disconnected thoughts
If some or all of these symptoms of depression or mania persist for more than 2 weeks, or are causing impairment in usual functioning, treatment is needed.

Facts About Treatment for Depression That You Should Know

Them are different forms of depression and varying types of treatment. A complete diagnostic evaluation is an important first step for determining the type and severity or illness and which treatment(s) might be most helpful. Such an evaluation should include:

    1. A physical and neurological examination and laboratory tests to rule out other medical conditions that might be causing symptoms of depression,

    2. A history of patient's symptoms, past treatments, use of alcohol and/or drugs, suicidal thoughts or attempts, and occurrence of depressive illness in other family members, and

    3. A mental status examination to check the patient's speaking and thought patterns and memory.

Based on the evaluation, the treatment of choke may be a form of psychotherapy, antidepressant medication(s), or a combination of psychotherapy and medication. For some severely depressed individuals who are suicidal, or psychotic, or cannot take antidepressants, or who have not responded to other treatments, electroconvulsive therapy (ECT) can be extraordinarily helpful and even lifesaving.

There are many types of psychotherapy, including short term, 16-week therapies, that have proven useful for some depressive episodes.

There is also a wide choice of medications. It may be necessary for the patient to try several different medications to find the one most effective for him or her. Since most antidepressants take several weeks to begin working, patients may need encouragement to stick with the treatment.

If the patient doesn't start to feel better after several months of treatment (regardless of which treatment), a different treatment should be considered.

As with any form of health treatment, the credentials of the treating clinician should be checked. Ask for referrals from your doctor or check with the psychiatric department of a local university or hospital or with a community mental health center. Or contact one of the professional or consumer organizations listed in Helping Resources.

Helping Resources

General

  • Physicians
  • Mental health specialists
  • Health maintenance organizations
  • Community mental health centers
  • Hospital departments of psychiatry or outpatient psychiatric clinics
  • University or medical school-affiliated programs
  • State hospital outpatient clinics
  • Family service/social agencies
  • Private clinics and facilities
  • Employee assistance programs
  • Clergy
Professional Organizations
  • American Psychiatric Association
  • American Psychological Association
  • National Association for Social Workers
  • American Nurses Association
  • American Mental Health Counselors Association
  • American Orthopsychiatric Association
Consumer Organizations
  • National Mental Health Association
  • National Alliance for the Mentally Ill
  • National Foundation for Depressive Illness
  • National Depressive and Manic Depressive Association

Written by Marilyn Sargent, NIMH.
1990