Beating the blues

How to help a woman recover from depression.

Depression is one of the most misunderstood medical conditions, with caregivers often as lost as the sufferers. Ms. T tells you how to take care of women with depression.

“Namaz parho, Quran parho. Kis cheez ka depression. Ghar kay kamon main dil lagao.” Ishrat’s* brother told her, as she sat downcast on the sofa, fighting back tears. She knew her brother was losing patience with her, and this guilt added to her burden.

It had been a few months since she had begun feeling down. Household chores felt like insurmountable tasks; her children ordered out most of the times as she could no longer bring herself to cook; she went to social gatherings only when her family badgered her.

Once, in the midst of joyful festivities at a mehndi, Ishrat broke down into tears for no apparent reason. Her in-laws were not at all pleased when they had to deflect questions from the other guests and give excuses for her sudden outburst.

Her family knew she was going through a rough patch due to menopause, but Ishrat felt nobody really understood her condition. Her loneliness and guilt, arising from a feeling of isolation, and her loss of control over her body, built up to become major depression.

She never went to a doctor, because, well, it was just depression — everyone thought that it would just pass.

Dr Nargis Asad, consultant psychologist at the Aga Khan University Hospital in Karachi, would fiercely disagree. She has been helping women like Ishrat for over two decades now and feels that depression is taken too lightly in our society.

While it is common for a person to be depressed at some point in her life (due, perhaps, to the loss of a loved one, academic or professional pressures, or family issues) and every bout of the blues does not mean that you run to a shrink, helping and supporting a person through the depressive phase is crucial, because most of the time, she cannot deal with it all by herself.

And if depression starts hampering the sufferer’s life significantly as well as that of those around her, or if its symptoms do not subside, know that it is time to get professional help.

In Pakistan, the prevalence of depression among women is “two to three folds” higher than in men, says Dr Asad. Women are more prone to depression than men because of their fluctuating levels of hormones associated with monthly cycles and childbirth. Many women have ‘mood swings’ just before and during their menstruation, while some plunge into major depression after childbirth or during menopause.

You would think that the family system in our society would provide the best support system to cushion us from psychological stresses but Dr Asad believes otherwise. According to her, this support system may be hugely taxing upon a woman. The pressure to perform in her roles as wife, mother and daughter-in-law proves overwhelming at times. Criticism upon failure is often scathing, and is expected to be taken without a word of complaint. This might be the reason why most of Dr Asad’s female patients are young, married women.

A woman’s depression affects the entire household and is detrimental to herself. Very often, family and friends don’t know how to take care of a depressive woman. Here are a few tips on how to lift her out of the blues without losing your patience aand how not to lose your own head in the process (these tips may be helpful in dealing with men suffering from depression as well):

• Understand depression. Dr Asad says that when families bring a woman suffering from depression for treatment, they think that her behaviour is a result of her wanting to make things difficult for them, or that she is not trying hard enough to pull herself out of it. “‘Usko apni life, apnay kaamon mein dil lagana chahiye’ they say,” says Dr Asad. “But these things are easier said than done.”

The first step in helping someone with depression is to understand this: Depression is a medical condition, much like flu, cancer or a broken leg. She cannot ‘snap out of it’ by herself. The problem is that a depression patient will rarely seek help on her own. If your wife or mother is showing signs of depression, read up on the symptoms and care of a depression patient, and talk to people who have been through similar situations. This will require considerable time and effort on your part, but bringing her out of depression is going to be worth it because, left untreated, depression can lead to serious consequences, such as suicidal tendencies.

• Look for a doctor. For a woman to pull herself out of clinical depression without medical help, she needs a “very supportive environment and understanding people around her,” says Dr Asad.  “But very often, the family does not know how to deal with such patients and this aggravates the woman’s condition.”

If you think that your help alone is not making a difference to her condition, do look up mental health practitioners in your city, and decide if her situation is serious enough to require psychiatric help. This can guide you in choosing a psychiatrist (a medical doctor who can prescribe medicines and treat serious mental disorders) or a psychologist (a mental health scientist who usually treats mood and anxiety disorders with psychotherapy).

• Convince her. Many women will put up resistance in going to a doctor. The shame of being branded a “mental patient” or the guilt for having troubled the family with her behaviour could possibly put her down further. Talk to her and help her understand why you are concerned for her. For most people, the first encounter with a shrink could be a frightening prospect. Assure her that you will be there with her all along, and if she wants to keep her session with the doctor confidential, that is also fine by you. Usually the resistance of the patient wanes once she visits the doctor, says Dr Asad.

Should the patient be brought to the doctor without telling her if one senses potential resistance? “That never works,” says Dr Asad. “It should be with the consent of the patient, and in a very non-threatening manner, unless the condition is such that a home visit by a psychiatrist is required.”

• Be empathetic and talk to her tactfully. One rash comment or thoughtless act can plunge her further into guilt and depression. When you sit down for conversation, maintain eye contact with her to show that you are genuinely interested in her problem. Sit in a relaxed position, particularly when she is nervous or guarded, as this will relax her too.

When you talk to her, know what to say. Often open-ended questions like “So tell me about...?” are cited as good conversation starters; these will prompt more than a “yes” or a “no” answer. It is advisable to let her to do most of the talking because a lot of the time women are looking to vent their emotions. Refrain from being overbearing and don’t force your solutions on her. Instead, try to ask her what she wants to do about her issues and ask, “How can I help?” And if she does not offer anything constructive or starts becoming unreasonable, don’t lose patience or your temper.

While giving company to a person who is depressed can work wonders to lift his or her mood, sometimes women would much rather be left alone. In such a scenario, helping her out with her daily chores will make it easier for her to get by, especially when mundane tasks such as cooking and cleaning weigh down on her. And perhaps, at the end of the day, she will appreciate the uninvited company.

It is important to realise that saying things such as “This happens to everyone”, “This is not a disease” or “You have everything to be grateful for” will not lift her mood, as is commonly believed and practiced. Undermining the symptoms of depression or denying them altogether adds to the person’s feelings of guilt and low self-esteem.

Sometimes, when families bring women to a doctor, they complain that there are so many other expenses and problems. “She should try and get out of it herself, they say” according to Dr Asad. This plunges the woman further into guilt for having spent her husband or her father’s money. She may start doubting whether she has depression or not. And when you put a woman in doubt about whether she is actually going through a medical condition, her compliance with treatment becomes irregular. Then she may leave treatment midway without recovering fully.

• Get her to follow a healthy lifestyle. People with depression tend to have sleep irregularities and often resort to bad eating habits, like not eating enough or bouts of binge eating. These play havoc with their minds and bodies. Encourage a woman with depression to go to bed early, eat healthy fruits and vegetables which pack in good carbs and anti-oxidants, and exercise regularly, which is known to trigger the release of ‘happy, feel-good’ chemicals in your body with more lasting effects than an anti-depressant drug. Something as simple as getting out in the sun can lift her spirits by giving her a vitamin D boost.

• Keep track of her medicines. Anti-depressants are prescribed by a doctor in moderate to high levels of depression. These ease symptoms, boost mood and energy levels and improve brain function by restoring a healthy amount of ‘brain chemicals’ in her body. Once the groundwork is laid, it is much easier for the mental health practitioner to bring about changes in behaviour through therapy. So make sure that she is following through with her medicines. The urge to leave treatment when depression symptoms ease is often strong. But don’t let her, or yourself, fall in this trap. It is imperative that she complete the whole course to make sure that depression doesn’t come back.

• Give her a sense of accomplishment. Get her involved in tasks that promote a sense of accomplishment and praise her for them, even if it is something as minor as finishing a lunch of healthy vegetables or going to bed early. Such appreciation will boost her confidence and rid her of feelings of worthlessness.

• Remove her from the depressive situation. This becomes difficult at times because women often derive depression from their homes and families. There may be need for some introspection on your part as well: are you contributing, even partly, to her depression? Is she not getting the necessary support from you during this time? If so, change your attitude. Talk to people who might be the reasons behind her gloominess. If you can afford to, take her out of the house, maybe on a vacation, to a restaurant, on a movie, or to a friend or relative’s place where you know she likes to hang out.

*Name has been changed to protect the confidentiality of the patient.

Code blue

What to (and what not to) say to her when she is depressed

DO SAY

1. You’re not alone in this.

2. You are important to me.

3. Do you want a hug?

4. You are not going mad.

5. I can’t really understand what you are feeling, but I can offer my compassion.

6. I’m not going to leave you or abandon you.

7. I love you (if you mean it).

8. I’m sorry that you’re in so much pain. I am not going to leave you. I am going to take care of myself, so you don’t need to worry that your pain might hurt me. 

DON’T SAY

1. There’s always someone worse off than you are.

2. No one ever said that life was fair.

3. Stop feeling sorry for yourself.

4. So, you’re depressed. Aren’t you always?

5. Try not to be so depressed.

6. It’s your own fault.

7. I think your depression is a way of punishing us.

8. Haven’t you grown tired of all this me, me, me stuff yet?

9. Believe me, I know how you feel. I was depressed once for several days.

How to tell she is suffering from depression: 

The typical clinical signs of depression are: sadness, crying, self-isolation, distractedness, irritability or aggression, sleep deprivation or oversleeping, loss of appetite or binge eating, lack of interest or motivation, low energy, state of anxiety and low self-esteem.

Severe forms of, or untreated, depression may lead to suicidal thoughts and attempts.

At times, depression may manifest as a physical discomfort such as headaches or pain elsewhere in the body when the person does not psychologically release anxiety.

Source: Depression Alliance
http://www.depressionalliance.org/help-and-information/friends-and-family.php

Published in The Express Tribune, Ms T, October 14^th, 2012.

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