When a friend or family member develops a mental health condition, it’s important to know that you’re not alone. Many Americans have experienced caring for a person with mental illness. 1 in 25 Americans lives with a serious mental health condition. Mental health professionals have effective treatments for most of these conditions, yet in any given year, only 60% of people with a mental illness get mental health care. As a result, family members and caregivers often play a large role in helping and supporting them. (From the National Alliance on Mental Illness)

I lack the words to express my deep gratitude and thankfulness for my wife, Summer. The lavishness of her care for me during my most recent depressive episode was a blessing that not all depressives enjoy. I’m humbled how in my sickness she worked for my health. What follows are some suggestions for caregivers from a depressive in remission. My suggestions are not exhaustive and I welcome your comments and suggestions.

1.) Educate: One of the most meaningful gestures I received during my last depressive episode was when a person took the time to learn about treatment-resistant clinical depression. Education is an undeniable sign of support. Summer’s being an educated caregiver was a crucial part of my recovery. By learning about my disease she could more quickly identify when my depression was deepening or moving towards remission. She was able to comment on what treatments I was or was not responding to. For instance—and this is a common occurrence—she was the first to notice my improvement after numerous ECT treatments. Educating one’s self about a loved one’s disease would appear to be an obvious way to care. And yet, I repeatedly had to explain depression to my family and friends. Some sources that I use include NAMI (National Alliance on Mental Illness), NIMH (National Institute of Mental Health), and the Mood Treatment Center. (As a rule, I use peer-reviewed materials instead of pop-psychology resources.) I found Andrew Solomon’s “The Noonday Demon: An Atlas of Depression” helpful for my understanding of my depression and how to explain it to others.

2.) Advocate: There is an overlap between education and advocacy. Here, I mean advocacy at the patient-to-medical professional level. (Yes, there is a dire need to demand better overall mental health care at the national-level.) Advocacy at that level, for me, was recognizing that I not only lived with treatment-resistant clinical depression, but also acute anxiety. Literally, my mind was so preoccupied with anxiety that it prevented me from asking for help. My caregiver in the role of advocate became something like an interpreter between me and my treatment teams. My wife, who by far observed me the most, thankfully answered my doctor’s questions when I couldn’t verbalize what was going on in my body. Summer shared how I was/wasn’t responding to my medications. She passed along any observable symptoms (e.g., weight change, appetite, sleep patterns, activity levels, etc.). She was also present to hear what the doctors needed me to do as a patient between visits (e.g., take my meds, exercise, sleep on a regular schedule, eat a proper diet, etc.). My wife recognized that my memory, due to my depression and its treatment, was unreliable. So, she held me accountable between such visits. Another aspect of patient-medical professional advocacy is demanding care and services equal to those offered to other potentially life-threatening diseases. Advocacy can also protect the patient from his/her self. I had devised a system of seeing both a psychiatrist and primary care physician to stay on benzodiazepines (e.g., Xanax, Klonopin). When Summer became more involved in my psychiatric care, I was able to end a burgeoning benzo addiction.

3.) Tolerate: Here, I am talking about hating the depression, but tolerate the depressive, more so love the depressive. (There are definite limits to what any caregiver should tolerate and that will vary from person-to-person and diagnosis-to-diagnosis.) Always remember that depression is not a choice. There is nothing more hurtful than when a well-meaning person says, “Have you thought about just cheering up?” I recognize how hard it can be to separate a person from his/her disease, but it is necessary as people are more than their diagnosis. I sympathize with those caregivers who want a sign like a shrinking tumor, a decreased fever, or a healthy white-cell count to signal that his/her loved one is getting better. Depressives exhibit signs of recovery, but not ones that can then be calculated in terms of “he/she should be better in a week or so.” Depression’s not having a visible and consistent “finishing line” can be maddening. Be patient knowing that most depression is episodic, potentially lasting only a few months. Also, most depression can be treated by medication and/or talk therapy. Be patient and be persistent. Do not be afraid to push us to take our meds, go to our doctors appointments, eat, bathe, get out of bed, or get dressed. Do not feel bad about experiencing negative emotions. You may resent having to remind us to take our medication, then feel guilty. It’s natural to think things like “a better person wouldn’t be annoyed with his/her spouse,” but that kind of guilt is both untrue and unproductive. When you allow yourself to notice your feelings without judging them as good or bad, you dial down the stress and feel more in control.

4.) Self-Care: If I compared my depression to me being in a deep hole where I could see the top edge, but could not reach it; it doesn’t help either of us if you too jump into the same hole to help me. Jump in and my metaphoric hole and my real depression has us both. The best way to stay out of my hole is self-care. Imagine that deep hole again. And lets say that you alone can feed me. So each meal you bring me food, feed me, and never take a morsel for yourself. While that is a commendable sacrifice, but if you never eat what happens to me when you inevitably starve to death? Self-Care even if it is difficult to do, is a paramount. I urge caregivers to establish/enforce boundaries between you and your depressive. As a chaplain I often find myself encouraging caregivers to take breaks, eat well, get some sleep, and stretch your legs (exercise). The same practices suggested for the health and well-being of your depressive are also good suggestions for you too. And do not go it alone! Find and benefit from person(s) that can be a caregiver to you.