Sometimes, even before I meet a patient, I can nearly diagnose them with depression. When a family member calls me to arrange a consultation for their spouse, parent, or adult child, I can see that they are exasperated, which is a surefire sign that significant depression is present. These folks have good intentions and are kind, but they are exhausted from attempting to cheer up their loved ones who are depressed.
Depression Runs in the Family
Depression doesn’t merely have an impact on the patient. There are effects of persistent depression. Close relatives and friends frequently experience anxiety, fear, helplessness, annoyance, frustration, and guilt when unable to uplift or energize their loved ones. They often won’t admit they need outside assistance until they are completely worn out, feel they “can’t do it anymore,” and have given up hope of saving their loved one.
Ruth was an example of this. She and her husband had reached their breaking point by the time her adult daughter gave me a call. As she detailed Ruth’s ongoing sluggishness, I could hear the desperation in her voice. Ruth used to be a vibrant, active woman, but by the time she was in her 60s, she was emotionally and physically reliant on her kids. They were close by, took care of her shopping, and coordinated her meals, housekeeping, and home care. They called me for advice out of fear that they couldn’t handle the load much longer and shame at feeling overburdened.
Ruth’s first words to me when we first met were, “I’m a mess.” She appeared messy, depressed, and anxious and shared her children’s confusion regarding her situation.
“I have no idea what occurred to me.”
Ten years had passed since Ruth’s husband’s passing. Up until two years ago, when she suddenly lost her appetite, couldn’t sleep, and started to get anxious about “everything,” she had gotten used to being a widow and had liked spending time with a lover. Without apparent reason, she started feeling terrified to leave the house. She struggled to fall asleep, and waking up in the morning was even more complex. She claimed that her children’s love for her and that doing anything to herself would kill them were the only reasons she was still alive. She had debated calling off the appointment her kids had made for us. She whispered, “There is nothing or anyone that can help me. “This is like something my mum had. It will simply be how I pass away.
Traditional Symptoms of Major Depression
Everybody experiences occasional lows. But “the blues” are not severe depression. Ruth displayed typical signs of the illness. She lost the desire to eat and to live. She no longer desired to go out and mingle with people. She struggled to sleep, didn’t have the motivation or energy to get out of bed in the morning, experienced anxiety, and her connections with her family and other people were deteriorating. She was feeling hopeless and powerless. She had suicidal ideas.
Ruth’s children were running out of patience and sympathy, like many family members who are loving yet exhausted by a loved one who starts acting dysfunctionally.
Her daughter said, “My mother is more than she always was.” She is merely engaging in passive-aggressive behavior to monopolize our time and attention. From the perspective of her children, there was no logical explanation for Ruth’s sluggishness, lack of initiative, and dependence. They could not comprehend Ruth’s sudden inability to care for herself without a medical condition, and they wondered why she didn’t immediately “snap out of it.” However, individuals who experience severe depression—often brought on by genetic, biochemical, hormonal, and environmental factors—act immobilized because that is how they feel. Their desperation is so overwhelming that it almost seems physical. Pure willpower alone cannot lift them out of their sadness.
Ruth would benefit from exploring her unresolved emotions in psychotherapy if she hadn’t properly grieved the loss of her husband. But first, we had to deal with Ruth’s depressive symptoms. I told Ruth that her various symptoms resulted from severe depression, a very treatable condition. She was energetically interested for the first time during our meeting as she sat straight in her chair, eyes wide open.
I provided some drug possibilities and suggested an energetic antidepressant after confirming that no underlying medical disease was causing Ruth’s depression. I assured her that to reduce potential side effects, we would begin with a shallow dose and gradually increase it to a therapeutic level. I advised her that while it would take a few weeks for the medication to “kick in,” she might initially experience a little mood lift, which typically portends well for a positive outcome. We agreed to meet in two weeks to discuss how things were going, and I instructed her to phone me if she had any questions or concerns. We’d begin setting objectives as soon as she had some energy again. She resumed her normal activities, including grocery shopping, housecleaning, and contacting old friends.
Ruth permitted me to bring her daughter into the consultation room, and when I explained the diagnosis and recommended a course of action, Ruth and her daughter both showed signs of relief. They had just been given a rehabilitation road map. The end of the tunnel was visible to them.