How do I help my sister with deep, lifelong depression?
December 9, 2019 2:47 PM Subscribe
My sister is in her 20's and has been depressed her entire life. She's gone through pscyhologists, psychiatrists, inpatient treatment, shock therapy, etc without real benefit. Her emotions are extremely volatile and while she has some good days, they are few and far between. She'll ask me for help quite frequently, sometimes in anger and sometimes in tears, and I really don't know what to say anymore. Saying "it'll get better" for the thousandth time doesn't really mean much anymore.
It doesn't help that I also have deep issues with depression; I only have so much energy in me to begin with.
It doesn't help that I also have deep issues with depression; I only have so much energy in me to begin with.
This is such a tough place to be. There's no good answer, and that's part of the problem. Some of the things that have helped me as someone who has bipolar (not the same thing, I understand). It'll get better is hard to say, and hard to hear.
Some things that family members have suggested to me:
-Journaling
-Taking walks. When I'm at my worst, my wife will take me by hand and get me out of the house.
-Meditation
-Breathing
And something I'll say is that it will help you too as a caregiver even though it sounds hokey.
I know this be little comfort, but I wish the best for your sister and you.
posted by I_count_crows at 3:14 PM on December 9, 2019
Some things that family members have suggested to me:
-Journaling
-Taking walks. When I'm at my worst, my wife will take me by hand and get me out of the house.
-Meditation
-Breathing
And something I'll say is that it will help you too as a caregiver even though it sounds hokey.
I know this be little comfort, but I wish the best for your sister and you.
posted by I_count_crows at 3:14 PM on December 9, 2019
Ketamine has proven helpful for treatment-resistant depression. Has she ever been prescribed that?
posted by kate4914 at 3:53 PM on December 9, 2019 [4 favorites]
posted by kate4914 at 3:53 PM on December 9, 2019 [4 favorites]
The hardest part about loving someone with long term or intractable depression is learning to step back. There are no magic words that will make them not depressed. There is no guaranteed treatment (but surely this next thing.) and sometimes the best anyone can do is manage it. It sucks, but that's the way it is.
Assumptions I've made:
1. Your sister has a therapist.
2. Your sister's therapist has helped her establish some healthy coping mechanisms and exercises.
3. Your sister has explored/is trying pharmacological options as part of her ongoing treatment plan.
4. Your sister is not currently in crisis.
Here are some tips for helping a depressed loved one:
- Accept that you can't personally make the depression go away. In my experience people have a lot of trouble with this. Check in regularly, but try not to be a smothering presence. Obviously things are different if your sister is in crisis, but when she is doing okay let her be an adult.
- Make sure you aren't the only support. Help your sister establish more close relationships if she doesn't have them. She needs more than one person to lean on when it gets bad and she also needs other people that understand depression to commiserate with.
- Often it is better to suggest than to ask. If someone is having a rough day/week/whatever they might not have the mental capacity for decisions. Break things down to yes/no. For example, instead of asking what she would like to do for dinner simply suggest an option.
- Take care of them subtly. You know, ask her out or invite her over for dinner. Yes, you're socializing, but you're also making sure she gets at least one solid meal that day. If you need to grocery shop why not both of you do it at the same time. Both of you get a chore done and your sister gets that little push/support she needs to take care of one thing. Those kinds of things.
- Identify the little things your sister struggles with when particularly depressed and think of ways to tackle them without making your sister feel like an invalid. Remove as many barriers as you can to getting them done. Frozen meals? Direct withdrawal for bills? Cleaning service? These little life chores add up to a lot when you are depressed. Remove the speedbumps.
- Platitudes rarely help. You don't have to just give upbeat/happy/hopeful responses that ring hollow. You can commiserate. You can say that depression fucking sucks and you'd take it away if you could. You also don't have to address the depression directly. Do reinforce all of the good things your sister does, though. Depressed people are bad at recognizing their contributions or seeing their actions in a positive light. Tell your sister how you see her.
- Help distract! Sometimes the best you can do is distract someone until the existential dread/depression/self destructive thoughts pass. Anything that you can think of that your sister would normally like and keep some in reserve.
- A change of scenery can help a lot of your sister has a tendency to withdraw. Take a walk together or day trip out to somewhere different. That can go a long way towards getting unstuck.
- In my experience volunteering can really help. A few hours of visibly making a difference can be huge. I'm personally a big fan of beach and wilderness cleanups since it gets you outside, is lightly physical (yay exercise!), and at the end of it the world is unquestionably better than it was before. It doesn't have to be a regular thing, just a thing to do sometimes. Check your local volunteering calendars and see what drop in stuff you could try together. Side bonus of putting you in touch with community minded and supportive people.
- Reinforce that you love her and are there for her. Frequently. Make it easy for her to ask for help if she needs it.
posted by forbiddencabinet at 5:12 PM on December 9, 2019 [48 favorites]
Assumptions I've made:
1. Your sister has a therapist.
2. Your sister's therapist has helped her establish some healthy coping mechanisms and exercises.
3. Your sister has explored/is trying pharmacological options as part of her ongoing treatment plan.
4. Your sister is not currently in crisis.
Here are some tips for helping a depressed loved one:
- Accept that you can't personally make the depression go away. In my experience people have a lot of trouble with this. Check in regularly, but try not to be a smothering presence. Obviously things are different if your sister is in crisis, but when she is doing okay let her be an adult.
- Make sure you aren't the only support. Help your sister establish more close relationships if she doesn't have them. She needs more than one person to lean on when it gets bad and she also needs other people that understand depression to commiserate with.
- Often it is better to suggest than to ask. If someone is having a rough day/week/whatever they might not have the mental capacity for decisions. Break things down to yes/no. For example, instead of asking what she would like to do for dinner simply suggest an option.
- Take care of them subtly. You know, ask her out or invite her over for dinner. Yes, you're socializing, but you're also making sure she gets at least one solid meal that day. If you need to grocery shop why not both of you do it at the same time. Both of you get a chore done and your sister gets that little push/support she needs to take care of one thing. Those kinds of things.
- Identify the little things your sister struggles with when particularly depressed and think of ways to tackle them without making your sister feel like an invalid. Remove as many barriers as you can to getting them done. Frozen meals? Direct withdrawal for bills? Cleaning service? These little life chores add up to a lot when you are depressed. Remove the speedbumps.
- Platitudes rarely help. You don't have to just give upbeat/happy/hopeful responses that ring hollow. You can commiserate. You can say that depression fucking sucks and you'd take it away if you could. You also don't have to address the depression directly. Do reinforce all of the good things your sister does, though. Depressed people are bad at recognizing their contributions or seeing their actions in a positive light. Tell your sister how you see her.
- Help distract! Sometimes the best you can do is distract someone until the existential dread/depression/self destructive thoughts pass. Anything that you can think of that your sister would normally like and keep some in reserve.
- A change of scenery can help a lot of your sister has a tendency to withdraw. Take a walk together or day trip out to somewhere different. That can go a long way towards getting unstuck.
- In my experience volunteering can really help. A few hours of visibly making a difference can be huge. I'm personally a big fan of beach and wilderness cleanups since it gets you outside, is lightly physical (yay exercise!), and at the end of it the world is unquestionably better than it was before. It doesn't have to be a regular thing, just a thing to do sometimes. Check your local volunteering calendars and see what drop in stuff you could try together. Side bonus of putting you in touch with community minded and supportive people.
- Reinforce that you love her and are there for her. Frequently. Make it easy for her to ask for help if she needs it.
posted by forbiddencabinet at 5:12 PM on December 9, 2019 [48 favorites]
I absolutely agree with forbiddencabinet. Great list. The most important point he/she makes is: "There are no magic words that will make them not depressed. ... It sucks, but that's the way it is."
Protect yourself first.
posted by tmdonahue at 5:24 PM on December 9, 2019
Protect yourself first.
posted by tmdonahue at 5:24 PM on December 9, 2019
I can tell you what worked for me.
I didn't have a life-long problem with depression, but I did suffer from it for a period of about ten years, on and off. Psychotherapy didn't help (with one exception, that I'll describe below). Antidepressants and other psychiatric drugs made me worse -- and I tried a bunch of different ones, alone and in combination.
forbiddencabinet (up above) mentioned volunteer work. I agree 100%. Volunteering made a huge difference for me. I was an unemployed shut-in when my therapist suggested I do volunteer work (this was about the only good piece of advice I ever received in therapy). I resisted at first, but I finally gave in and tried it. The volunteer work initiated a cascade of positive events that resulted in a new job, new friends, and a marriage to someone I met while volunteering.
When I look back on those dark years now, I think what I needed was help with concrete problems of living, rather than talk therapy or something that messed around with my neurotransmitters.
posted by akk2014 at 6:48 PM on December 9, 2019 [7 favorites]
I didn't have a life-long problem with depression, but I did suffer from it for a period of about ten years, on and off. Psychotherapy didn't help (with one exception, that I'll describe below). Antidepressants and other psychiatric drugs made me worse -- and I tried a bunch of different ones, alone and in combination.
forbiddencabinet (up above) mentioned volunteer work. I agree 100%. Volunteering made a huge difference for me. I was an unemployed shut-in when my therapist suggested I do volunteer work (this was about the only good piece of advice I ever received in therapy). I resisted at first, but I finally gave in and tried it. The volunteer work initiated a cascade of positive events that resulted in a new job, new friends, and a marriage to someone I met while volunteering.
When I look back on those dark years now, I think what I needed was help with concrete problems of living, rather than talk therapy or something that messed around with my neurotransmitters.
- I had terrible sleep habits and would watch TV late into the night. I'd wake up around noon. That wasn't healthy.
- I ate crappy food, and lots of it.
- I didn't exercise, or even spend much time outdoors.
- I drank too much and smoked.
- I didn't pay my bills on time and otherwise mismanaged my finances.
- I held pointless, petty grudges against relatives (grudges that really took a toll on all concerned).
posted by akk2014 at 6:48 PM on December 9, 2019 [7 favorites]
I'm probably in the position of your sister, and you're in the position of my (younger) sister.
What I've appreciated most is that she (my sister) makes herself available (but I don't impose on her) and casually lets me know - once a month or two - that she's still there if I need her.
She wigged on that I get along with her dog, and her dog loves me, and lets/ encourages me take "time outs" with the dog when dealing with the rest of the family is stressing me out.
Another thing that I've appreciated is that my sister never tells me that "things will be better" but rather, that everyone's got troubles, herself included, and she's there if I need help with mine.
Asking me to help with hers gives me a little purpose, sometimes, and I'm happy if I am able to help. I'm effusive when I think I can.
Are there any troubles with your own life that you can invite your sister to be interested in (due to it being part of her wheelhouse/ domain knowledge)?
I have a wonderful sister.
posted by porpoise at 6:56 PM on December 9, 2019 [13 favorites]
What I've appreciated most is that she (my sister) makes herself available (but I don't impose on her) and casually lets me know - once a month or two - that she's still there if I need her.
She wigged on that I get along with her dog, and her dog loves me, and lets/ encourages me take "time outs" with the dog when dealing with the rest of the family is stressing me out.
Another thing that I've appreciated is that my sister never tells me that "things will be better" but rather, that everyone's got troubles, herself included, and she's there if I need help with mine.
Asking me to help with hers gives me a little purpose, sometimes, and I'm happy if I am able to help. I'm effusive when I think I can.
Are there any troubles with your own life that you can invite your sister to be interested in (due to it being part of her wheelhouse/ domain knowledge)?
I have a wonderful sister.
posted by porpoise at 6:56 PM on December 9, 2019 [13 favorites]
Is everyone extremely, positively sure that it’s not exhaustion and depression from coping with/compensating for and hiding ADHD? It presents in many different ways and emotional regulation issues are practically a hallmark of women who make it to adulthood with unidentified, untreated ADHD.
I don’t know anyone with serious treatment resistant depression who doesn’t have the underlying neurological dopamine regulation issues, and if your brain can’t make you do things you want to do then there is no resolving the depression issue.
posted by delezzo at 9:20 PM on December 9, 2019 [4 favorites]
I don’t know anyone with serious treatment resistant depression who doesn’t have the underlying neurological dopamine regulation issues, and if your brain can’t make you do things you want to do then there is no resolving the depression issue.
posted by delezzo at 9:20 PM on December 9, 2019 [4 favorites]
I think it's good to remember that helping doesn't mean getting her to a place you'd find tolerable. It just means making her situation better. Getting her from Mood Zero to Mood One is helping, even when the lowest mood you personally can cope with is a five. If she spends all her time between zero and two, helping her get herself up to a four for part of an afternoon is giving her an amazing reprieve that could be the best thing that's happened to her all month.
Or if you're trying to say things that help, you don't have to get her all the way up to "I believe I can find a treatment that works and have a bright happy future." If her current situation is "I see no reason to live for another week," helping her claw her way back up to "I see one reason to live for another week" is a huge help.
Things that have helped me, or helped other people I know with treatment-resistant mood disorders:
"What's your reason to live for the next week?"
"What are you grateful for?"
"Can I help with your [chores I was shamefully behind on]?"
"There's nothing wrong with eating on paper plates/living on pizza/just not folding your clean laundry."
"Oh jeez yeah, I had to deal with [tiny practical situation that was only a small part of my problem] and it sucked ass."
"Let's watch some more [trashy show that I could follow when I didn't have the brainpower for prestige TV]."
"You handled that situation really well even if it sucked a lot."
"[Embarrassing way I'm failing to pass as mentally healthy, but that doesn't hurt anyone else] isn't a moral issue."
"If I was [person I'm terrified I hurt or upset], I wouldn't even have minded much."
posted by nebulawindphone at 6:09 AM on December 10, 2019 [1 favorite]
Or if you're trying to say things that help, you don't have to get her all the way up to "I believe I can find a treatment that works and have a bright happy future." If her current situation is "I see no reason to live for another week," helping her claw her way back up to "I see one reason to live for another week" is a huge help.
Things that have helped me, or helped other people I know with treatment-resistant mood disorders:
"What's your reason to live for the next week?"
"What are you grateful for?"
"Can I help with your [chores I was shamefully behind on]?"
"There's nothing wrong with eating on paper plates/living on pizza/just not folding your clean laundry."
"Oh jeez yeah, I had to deal with [tiny practical situation that was only a small part of my problem] and it sucked ass."
"Let's watch some more [trashy show that I could follow when I didn't have the brainpower for prestige TV]."
"You handled that situation really well even if it sucked a lot."
"[Embarrassing way I'm failing to pass as mentally healthy, but that doesn't hurt anyone else] isn't a moral issue."
"If I was [person I'm terrified I hurt or upset], I wouldn't even have minded much."
posted by nebulawindphone at 6:09 AM on December 10, 2019 [1 favorite]
This might be something she's already tried, but there seems to be some positive implications for TMS (transmagnetic stimulation therapy), although it's hard to access. If she's close to a university she might be able to sign up for a research study and get paid to participate to get this treatment done.
posted by erattacorrige at 12:52 PM on December 10, 2019 [1 favorite]
posted by erattacorrige at 12:52 PM on December 10, 2019 [1 favorite]
Seconding erattacorrige, TMS is what finally cured my drug-resistant depression. It was available at a commercial facility for me, although I'm sure that varies wildly by location. It has something like a 75% response rate, with 25% reporting complete cures, and this is for people who have tried a whole bunch of other things.
posted by zug at 5:44 PM on December 10, 2019
posted by zug at 5:44 PM on December 10, 2019
I have treatment resistant depression. What helps me the most is seeing people who care about me regularly. If you're local to her and have the capacity for it, making a standing date to get together for a couple hours once a week might be helpful.
If she's able to identify anything that makes her even a tiny bit happy, helping her find ways to get more of that thing is a good idea.
If you think it might be useful for her to try ketamine, ayahuasca, etc. doing the research and helping with the logistics of that isn't a bad idea.
posted by metasarah at 8:09 AM on December 12, 2019
If she's able to identify anything that makes her even a tiny bit happy, helping her find ways to get more of that thing is a good idea.
If you think it might be useful for her to try ketamine, ayahuasca, etc. doing the research and helping with the logistics of that isn't a bad idea.
posted by metasarah at 8:09 AM on December 12, 2019
This thread is closed to new comments.
From their website:
NAMI Family-to-Family is a free, 12-session educational program for family, significant others and friends of people with mental health conditions. It is a designated evidenced-based program. This means that research shows that the program significantly improves the coping and problem-solving abilities of the people closest to a person with a mental health condition. ... NAMI Family-to-Family not only provides information and strategies for taking care of the person you love, but you'll also find out that you're not alone.
posted by bluedaisy at 3:12 PM on December 9, 2019 [6 favorites]