May is Mental Health Awareness Month. According to The World Health Organization, there are more than 350 Million people around the world who struggle with Depression alone. It has come to my attention by many of my patients individually as well as in my Health and Wellness Intensive Outpatient Program that, “Others just don’t understand”. Although family, friends, loved ones and coworkers may mean well, they often may say things or engage in behaviors that are not very helpful for those struggling with depression, anxiety or other mental health issues. Although we all struggle at times and moods typically fluctuate within a given spectrum, a cluster of the following symptoms which present for a couple of weeks may be a sign that someone you care about struggles with Clinical Depression or Anxiety:
- significant changes in appetite/ eating / weight or sleeping patterns
- loss of interest in pleasurable activities
- loss of interest in sex or sexual problems
- decrease in motivation / energy / grades / work productivity
- extreme tiredness
- withdrawal from others and decreased social contacts
- feelings of sadness / unhappiness or increased tearfulness
- overwhelming feelings of anxiety / fear / rapid heartbeat / shortness of breath / sweating / dry mouth/ lightheadedness / dizziness
- physical symptoms such as back pain / muscle pain and tension / chest pains / stiff neck / general aches and pains / headaches / stomach issues / constipation / diarrhea
- high blood pressure
- feelings of hopelessness / helplessness / despair
- thoughts of self harm or suicide
- trouble concentrating / slowed thinking and decision making
- decreased accomplishments
- increased anger / irritability / frustration / guilt feelings
- self-medicating with alcohol, drugs, gambling or sex
If you have concerns about someone you care about, please keep the following in mind:
Gently Point out Concerns. It is important to gently point out your concerns to them, possibly presenting them with the aforementioned list of symptoms and ask them what they think. You may want to lovingly point out that there is hope and help for those struggling with depression and anxiety and that they do not have to suffer in silence.
Educate Yourself and Them. In addition to being aware of the symptoms of depression and anxiety, it would also be helpful to educate yourself and your loved one as to different levels of care in mental health. There is individual treatment usually on a weekly or biweekly basis or there is intensive outpatient treatment for those who need more than they are able to achieve individually. This level of care typically consists of attendance 3 days per week, 3 hours per day for approximately 7 weeks. Partial Hospitalization is even more intense, where an individual will attend 5 days per week and return home at night. Inpatient or Residential treatment involves 24 hour care for a period of time.
Know Where To Turn. It would be extremely helpful to educate yourself about centers where your loved one can receive effective help in a safe, comfortable setting. Check out their websites. Look at patient testimonials. Those centers and facilities should be able to provide information regarding improvement and success rates. Share these with your loved one.
Encourage. We often tell patients that action begets motivation; that sometimes we need to lean in, act opposite, get moving and acquire a sense of accomplishment and mastery. However, many patients state that others with good intentions force them or get angry when they will not comply with suggestions or recommendations. It is important to realize that although it is important to gently encourage these things, it is not as easy as you may think. When someone is struggling with Clinical Depression or Anxiety, it can actually feel as though they are weighed down by an elephant. A simple task to you may be extremely difficult to them. Gently support and encourage activity and mastery while simultaneously being realistic about potential limitations. Avoid telling them what they “Should” be doing. Set realistic expectations for yourself as well as your loved one. Notice their strengths. Point out when something has gone well.
Communicate. We all often ignore the “elephant in the room”. It is important not only to openly communicate and express your needs but also encourage the same. Don’t walk on eggshells. Let your loved one know what you are thinking, feeling and needing. At the same time, keep in mind that although they need to know these things, they may not be able to effectively meet your needs. Be open to hearing and asking about their thoughts, feelings and needs as well.
Don’t Blame. It is important as you become educated about depression and anxiety that you don’t blame yourself for things that you could have done differently. Don’t feel guilty. Likewise, don’t blame your loved one or impose guilt on them. Give them the sense that we are all in this together and that through small but significant steps, one at a time, improvements in quality of life definitely will occur.
Reach Out. Many who struggle with Clinical Depression and Anxiety withdraw and do not reach out. Reach out to them and don’t give up if they don’t respond right away or if you are the one doing most of the initiating. Include them in events and plans even if they decline. Remember, it is very difficult due to very low energy, interest and motivation levels for them to initiate many things on a consistent basis. As they do receive effective help at the appropriate level of care and at effective treatment centers, it is OK to hold them progressively more responsible.
Don’t Tell Them They Have No Reason. Because it is difficult to understand depression and anxiety, many who suffer with such disorders are often told that they have the world by the tail; they have everything going for them; there is no need for them to be depressed or anxious. Please remember that Clinical Depression and Anxiety are biochemical imbalances. Although those imbalances can be triggered by life stressors and poor coping skills to deal with those life stressors, those imbalances are inherent and genetically predisposed.
Understand Irritability. Many will feel very irritable and frustrated. As such, reactions and interactions may include them being short, rude or hurtful. Please understand that they do not have tolerance that most others have during imbalanced periods. Do tell them how you feel and what you need, but know that they do not necessarily intend to hurt you.
In conclusion, know the signs that someone you care about is struggling with Clinical Depression or Anxiety. Reach out and support them. Educate yourself as well as your loved one as to where to get effective help and at the appropriate level of care.
John A. Glovan, Psy.D. Director, Health and Wellness Program