Sometimes I can practically diagnose a patient with depression even before meeting them. Just hearing the exasperation of a family member who contacts me to schedule a consultation for their spouse, parent, or adult child is a telltale sign that major depression is at play. These are well-intentioned, caring people but they are worn out by trying to lift their loved one out of their depressive state.
Depression Is a Family Affair
Depression doesn’t just affect the sufferer. Chronic depression has a ripple effect. Close family and friends often feel worried, scared, helpless, annoyed, frustrated, and guilty that they can’t cheer up or energize their loved one. It’s often only when they are totally exhausted—when they feel they “can’t do it anymore” and have given up on the idea that they can rescue their loved one—that they acknowledge they need outside help.
This was the case with Ruth.* By the time Ruth’s adult daughter called me, she and her husband were at their wits’ end. I heard the desperation in her voice as she described Ruth’s chronic lethargy. She and her husband had been caring for her mom for two years as she became a virtual recluse at home. Ruth had been a vivacious, active woman but now, in her 60s, she was physically and psychologically dependent on her children. They lived nearby, did her shopping, and arranged for her meals, cleaning, and home care. Terrified that they couldn’t bear the load any longer and guilty about feeling overwhelmed, they called me for a consultation.
“I’m a mess” were the first words out of Ruth’s mouth when I met with her. She looked disheveled, sad, and anxious and was as confused as her children about her condition.
“I don’t know what happened to me.”
It had been 10 years since Ruth’s husband had died. She’d adjusted to being a widow and had enjoyed time with a boyfriend until two years ago when she suddenly lost her appetite, couldn’t sleep, and became anxiety-ridden about “everything.” She became afraid to leave the house—with no apparent cause for her fear. She had a hard time getting to sleep and an even harder time getting up in the morning. She told me she only stayed alive because her kids are so devoted to her and “it would kill them if I did anything to myself.” She had considered canceling the appointment her children had arranged with me. “There isn’t anything or anyone that can help me,” she said in a whisper. “My mother had something like this. It’s just going to be how I die.”
Classic Signs of Major Depression
Everyone gets down from time to time. But major depression is not “the blues.” Ruth had classic symptoms of the condition. She lost her appetite for food and for life. She no longer wanted to go out and socialize. She had trouble falling asleep, lacked the energy or desire to get out of bed in the morning, suffered from anxiety, and her relationships with family and others were disintegrating. She felt helpless and hopeless. She had thoughts of suicide.
Like many family members who are caring but worn out with a loved one who becomes dysfunctional, Ruth’s children were losing sympathy and patience.
“My mother is just more of what she always was,” her daughter told me. “She’s just being passive-aggressive, trying to get more and more of our attention and time.” From her children’s viewpoint, there was no rational reason why Ruth was being so lethargic, ineffectual, and dependent. With no medical ailment to explain Ruth’s sudden inability to care for herself, they couldn’t understand why she didn’t just “snap out of it.” But people who are severely depressed—usually due to genetic, biological, hormonal, and/or situational factors—act paralyzed because that is how they feel. Their despair is so heavy that it seems almost tangible. Their depression cannot be overcome by sheer force of will.
It was possible that Ruth hadn’t fully grieved her deceased husband and would benefit from exploring her unresolved feelings in psychotherapy. But, first, we needed to get Ruth’s depressive symptoms under control. I explained to Ruth that her disparate symptoms were all part of one condition: major depression, a condition that is very treatable. She sat up straight in her chair, eyes wide open, and, for the first time in our meeting, seemed energetically engaged. She seemed somewhat shocked but reassured to learn that there was a clear explanation for what she had been experiencing.
After establishing that there was no underlying medical condition contributing to Ruth’s depression, I presented some medication options and recommended an antidepressant that has an energizing effect. I told her we would start slowly, at a very low dose, and gradually increase to a therapeutic level to minimize any possible side effects. I explained that it can take a few weeks for the medication to “kick in” but she might see a slight lightening of mood early on, which usually bodes well for a successful outcome. I told her to call me if she had any questions and concerns and that we would meet in two weeks to review how things were going. Once she regained some energy, we’d start setting goals. Step by step, she would get back to grocery shopping, cleaning her home, and contacting old friends.
With Ruth’s permission, I invited her daughter into the consultation room and shared her diagnosis and treatment plan, Ruth and her daughter seemed visibly relieved. They had just been presented with a roadmap to recovery. They could see light at the end of the tunnel.