Involvement of Family Members in Treatment of Depressed Individuals

Abstract

Sir: The negative impact depression has on family relations is mentioned several times by Pincus and Pettit in their recent Editor's Choice supplement article on chronic major depression.1 However, nowhere in the discussion of treatment in the articles that follow in that special supplement on depression is it pointed out that it is vitally important to involve family members, employers, and others who have frequent contact with the depressed person in the treatment plan. Since the Companion addresses family physicians, emphasis needs to be placed on the preventive work a family doctor can perform for the relatives of depressed patients. Chronic depressive illness can be classified as contagious in that family members as well as coworkers frequently will become depressed secondary to the stress of living and working with a depressed person. On reviewing the symptoms of chronic depression—anhedonia, insomnia, irritability—it becomes clear how difficult it would be to live with someone thus afflicted. Talking to the family of any depressed person and explaining—demystifying—the illness, illustrating how the disease affects those involved with the patient and why the patient acts the way he or she does, always lifts guilt, decreases anger, and facilitates coping with the difficulties chronic depression presents every day. Families need to understand the etiology, signs and symptoms, treatment, and prognosis of this illness, as well as the effect depression has on relationships. The primary doctor is the logical person to dispense this information. When given simple examples of how each of the symptoms of major depression can result in rejection, anger, frustration, and hopelessness, family members will display a smile of recognition. The explanation will elicit responses such as this one from a wife and mother: “I found a new recipe and used it to bake him a beautiful birthday cake. He pushed it away and said: ‘You know I don't like chocolate!' He has always eaten chocolate cake! My feelings were hurt, and I was angry. He didn't even say thank you. He had been really down and I was trying to cheer him up.” The teenager in the family chimes in, “He always sleeps till noon, his business is slipping because he never gets to work till after lunch. If I sleep in on Saturdays he wakes me up, even if I don't have anywhere to go. If I ask him to help me with my math homework, he doesn't concentrate and gets me all mixed up. He used to be good at math.” The younger brother of this teenager states, “He never plays ball with me anymore, he always says he is tired. He can't decide anything, not even what to wear. He is no fun to be around.” The family eventually loses patience and rejects the depressed person, who then becomes more depressed because he thinks that nobody cares about him or loves him—a vicious circle! Each one of these family members is suffering. They question themselves: What have I done or not done to contribute to the withdrawal, the unhappiness of the person I love? How can I help that person? The lack of success in healing the depression leads to burdens of guilt, rejection, and anger, and eventually depression. The joy and energy most of us feel every day is at risk and has to be defended when living with chronic pessimism. A family physician can help families understand and accept chronic depression as an incurable illness, which they did not cause and cannot improve. This preventive work may decrease the number of secondary depressions among those close to the chronically depressed individual and make it possible for family members to live with and come to terms with a tragic situation.