When you’re a psychiatrist, sometimes it happens. Outside the office, at your children’s school or at an entertaining book presentation, suddenly someone you know approaches you, a friend with whom you have little contact and wants to ask you something “personal”, and you see that look: scared, helpless, marked by pain. They usually tell you: “it’s horrible…, I’ve never seen him like this…, I don’t know how to help him”. They can refer to her husband, her sister, her father. They have been informed (as Martin Amis would say) that depression it’s not sadness, but empty. That the opposite of depression is not happiness, but vitality. They had never seen their loved one with so little ability or strength to love, that’s why they feel cold, loneliness, powerlessness and fear. Living with a person with depression can be an overwhelming experience, but there are actions that can help improve it:
1- Try not to panic and offer naturalness, affection and understanding. Create a calm climate in which the patient can talk about his terrible experience, if he wishes, avoiding reproaches, discussions and added stress. The humble daily routine acts can become heroically healers. Without forcing, try to maintain the old routines, the activities, the moments that were once happy.
2- Trust the professionals. Psychiatry and psychology are not hard scientific disciplines, like physics or mathematics, and they will not provide you with the objectivity and precision that you crave, and, as soon as you delve deeper, you will see that there are vast fields of ignorance in them. But that does not mean that in mental health anything goes. Science, with its great limitations, has taken important steps. Leave the illuminations and conspiracy theories for Twitter, now you need an anchor that provides you with security. International clinical practice guidelines recommend that the person be evaluated as soon as possible by an expert professional (a family doctor -in the event that the Primary Care system has not been strangled, of course-, a clinical psychologist or, in moderate or severe cases, a psychiatrist ). And they recommend administering empirically validated treatments: psychological therapies, drugs or both. Do not be prejudiced, now the important thing is to provide your loved one with the maximum help. You don’t have to pretend to be a psychologist or psychiatrist, your role -actually more important- is another: to be there, remind the patient that they are not alone.
3- Collaborate with the therapist. Make sure the doctor has ordered a blood test, as a percentage of depressed patients actually have hypothyroidism or anemia and improve when treated. Encourage your loved one to give up the use of toxins, such as alcohol, cannabis or cocaine. Many times they are desperate and erroneous self-treatment strategies. Alcohol provides an initial euphoric, intoxicating effect, but in reality it is a powerful depressant of the nervous system; specific, increases the risk of suicide of the depressed patient by 7. Cocaine produces, among many other ways to destroy the brain, a rebound effect that worsens the intensity of depressive symptoms. If necessary, you may need to reduce or eliminate your own toxic use to help your loved one. Tell your therapist if the patient had any episode, even brief, in which he was very talkative, outgoing, uninhibited: it could be type 2 bipolar disorder.
4- Do not drink the Depression of your loved one as a personal rejection, do not look for blame. Although your mind tends to compulsively search for causes and solutions -we are designed for it-, try to stop it, do not make drastic personal decisions. When the storm has subsided, there will be time. Convey to him that he is not guilty of having depression and that this is not a sign of weakness or lack of character, but that it is an illness. This can be liberating. Don’t tell him “play your part” (useless advice), he’s probably doing his best, but he’s short of breath.
5- Find out about depressive illness. read depressive writers testimonial booksrecommendations of scientific societiesinformation of patient and family associations. You will see that depression is one thing and discomfort, frustration, dissatisfaction with a more or less fair society is another. The trivialization and generalization of the term (“we are all wrong”, “society is sick”, etc) is cruel to seriously ill patients. Here we are talking about when the person does not even have the strength to take a shower, when picking up the phone is real torture, when in reality they would prefer not to continue living, because the a bankruptcy of meaning.
6-Instills hope. Your loved one doesn’t know it yet, but all this will pass. as it says Jorge Drexler in a beautiful song, “time goes, goes and does not return, and your heart will heal.” With proper treatment, major depressive episodes completely disappear in at least 2/3 of cases. In others, the so-called resistant depressions, fortunately we have tools to optimize the response, although it costs a little more time and effort. Of course, take note that, when it improves, there will be a risk of recurrence. To get an idea: after two episodes, 70% of patients will have a third. But relapse prevention and intervention on risk factors will be the next chapter, now we have to get out of it.
7- Take care. The Depression of your loved one can not drag you. We need your serenity and your health. To do this, do not take sole responsibility for the evolution, have the care distributed among several people, do not neglect your hobbies, your routines; Do not isolate yourself, share with others your experience of living with suffering, they will understand it.
The least expected day, the patient will recover the illusion of seeing you, talking to you, kissing you. do not despair When he does, he will know that you have been there and that you waited for him until his return. William Styron tells it in his moving testimonial book. In the middle of one of his deep depressions and with intense, almost definitive thoughts of suicide, he began to play on the radio a rhapsody by Brahms. Despite having been insensitive to any artistic pleasure for months, that melody “pierced his heart like a dagger” and made him think of all the joys that house had known: “the children who had raced in the rooms, the celebrations , love and work, rest honestly earned. There he decided, and it was the beginning of his ascent, that “all that was more than I was capable of giving up.”
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