For some people, receiving the diagnosis of depression is akin to receiving nearly any other diagnosis at the doctor’s office: the doc gives you the news, hands you a prescription, and your job is simply to do as he or she says and get better. In a certain percentage of cases of depression, this is exactly how it works; the medications work well and quickly, and your condition is resolved. For some people, the medications can be stopped after a certain amount of time and the depression never comes back. Sound utterly unfamiliar? That’s because for many people depression is a much more complex and “sticky” illness. For many people, the medications help a little, or they help for a period of time and then lose effectiveness, or the side effects are truly intolerable. Some people find that alternative or complementary treatment approaches work well, but again, many people find that yoga only helps for the half hour after class while you still have the endorphins coursing through your system, and meditation is too difficult to maintain as a regular habit, and the insurance doesn’t pay for a massage every week. In short, for many people suffering from depression, the fix is the beginning of a journey that is neither straightforward nor simple.
Treatment-Resistant Depression: Cold Hard Facts
At present there is no medically accepted definition for treatment resistant depression. Most mental health practitioners will consider depression that lingers after multiple treatment efforts (typically medication trials) have been tried “treatment resistant.” Most antidepressants require at least six weeks before they reach their full strength in your system, so by the time six months have rolled by, that adds up to several ineffective medications. That’s a lot of riding the roller coaster of hope and disappointment, thus making the treatment an exhausting companion to depression. In addition to psychotherapy, other efforts to alleviate depression include alternative approaches including dietary changes, exercise and stress reduction techniques. While many of these techniques do offer some relief, it is frequently not enough to lift the depression, and for many people struggling with this disease, the nature of your symptoms of depression make it incredibly difficult to follow through and keep up with these types of lifestyle changes. Old habits are more familiar and comfortable, and as depression is often accompanied by anxiety, developing new habits can be stressful and overwhelming for someone still swimming upstream against their depression. The cold hard facts about depression are sobering: left untreated (or in this case, treated unsuccessfully), depression can be fatal. Depression is understood to be a leading cause of suicide. In addition, when the medications don’t help, other substances are often employed to lift the spirits or ease the pain. Alcoholism and other addictions are frequently seen in people who struggle with depression and can be best understood as desperate efforts to self medicate the debilitating symptoms of depression.
What Can You Do? What Shouldn’t You Do?
The urge to be helpful and to ease your loved one’s suffering is both natural and honorable. For the partner or parent, depression looks so solvable: you just want to scream, “Snap out of it!” If your loved one is also abusing drugs or alcohol, you may well be at your wit’s end, struggling to balance tough love and refusing to enable, while at the same time understanding that your beloved is ill and needs help. What are some of the things you can do to help, or if helping isn’t possible, to do no harm?
- Acknowledge your own emotions. Be honest with yourself. You may feel extremely angry with your loved one—spouse, parent or child. You may feel like your loved one is lazy, isn’t making an effort, is taking the easy way out, etc. I’m not suggesting you discuss any of this with them, but I am suggesting that you own your feelings and deal with them. Find your own ways to release the anger and frustration, and develop your own network of friends and/or professionals to whom you can vent.
- Be present. Sometimes that is all that you can do, but don’t underestimate the healing power in doing so. Be present, physically and emotionally. You don’t have to do anything special or say anything at all. Just don’t run away and don’t argue. Stay connected to your loved one. It can make a huge difference to someone who feels terribly alone.
- Remember who you are, separate from your loved one, and stay true to that. Don’t let treating the disease or helping someone get better steal your life away from you. You’ll end up resentful and he or she will end up feeling disappointed and guilty. Whether you used to play tennis or play poker every Wednesday, it doesn’t matter. Just keep your “me time” sacred. The depression will likely still be there when you get home.
- Sometimes people dealing with treatment-resistant depression seem to become “help rejecting.” You make suggestions, you offer to drive them to the meeting, yoga class, therapy appointments, and you receive an argument or a flat out refusal. If this pattern is starting to take hold, point it out to your loved one once (nagging or “harping” on it won’t help), and then let it go.
- You may also see your loved one doing things that actively make the depression worse: drinking, overeating, choosing not to exercise, not following the treatment team’s advice, etc. Again, point it out once and leave it alone. Nagging or repeating yourself won’t help, and your loved one is not making good choices because he or she cannot. That’s a part of this disease.
- Your role might just be to hold hope when your partner can’t. When all else fails, soldier on. Continue to believe that this too shall pass; everything eventually does. Hope might be all you can offer, but when your loved one has lost hope, holding onto yours so he or she can borrow it can be powerful. And it will help you endure the sadness.