“Too many times I’ve seen children who have suffered for years living with a depressed parent ignorant of what was going on confused and frightened ” says London-based psychotherapist Rabbi Yaakov Barr MSc PGDip who specializes in treating severe depression

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y husband Moish* is one of those people who’s laidback happy positive really in touch with himself ” says Shoshana an upbeat mother of five. “He and depression wouldn’t even be in the same dictionary.”

But after the birth of their fifth child Shoshana experienced a major medical trauma that landed her in the hospital for several months leaving Moish home with a newborn and four other children to care for. With his wife’s future uncertain Moish tried valiantly to hold down the fort but he wasn’t eating or sleeping well and was crying a lot. At a family member’s insistence he consulted with a psychologist who diagnosed him with major depression resulting from the stress of their medical crisis.

“At first he was surprised” Shoshana says. “It was the farthest thing from his mind that he could be depressed. Once I got home from the hospital he just crumbled. I was so grateful to be alive and he was crashing retreating. He could barely manage his daily routine. Even though I was still healing physically I felt our kids needed at least one functional parent. I had no choice but to step up to the plate and take care of the kids and our home.”

Diagnosing Depression

Does a cloud of unhappiness surround your husband interfering with his regular functioning? Or is it your parent — or child — who can’t shake their misery and is withdrawing from the world? It’s no secret that depression is on the rise in the Western world. According to the Centers for Disease Control and Prevention (CDC) about nine percent of American adults have feelings of hopelessness despondency and/or guilt that lead to a diagnosis of depression and about three percent have major depression also known as major depressive disorder. While many studies have explored why depression affects modern society so greatly the effect of depression on the sufferer’s immediate family has surprisingly escaped such scrutiny.

Yet if one’s spouse is moody and nonfunctional unable to hold down a job or attend his regular shiurim there’s sure to be a trickledown effect on the healthier member of the couple. Even for a parent or child watching one’s flesh and blood become anxious withdrawn and despondent can be devastating. Is it possible to support a loved one in crisis without being affected by his or her emotional landscape? First it’s important to understand what depression is — and what it isn’t. “Depression isn’t a temporary low mood which we all have at times but a biological event that affects thoughts feelings and behaviors ” says Dr. Barbara Unger a clinical psychologist in private practice in Denver and associate professor at the University of Colorado Health Sciences Center. “It can be triggered by a stressful event — such as the death of someone meaningful a serious illness the loss of a job financial reversal divorce or natural disasters — or it can be due to the combination of a series of events.”

This was the case for Esther’s mother, who experience major depression after losing a son in a car accident. “Although I understood that she needed to mourn, close to a year later she was still totally broken,” recalls Esther, who has always been close to her mother. “She was afraid to leave the house and started losing a lot of weight. When I’d try to encourage her to go out, she’d refuse, making up one excuse after another. She even missed my daughter’s bas mitzvah! Eventually we got her to a psychiatrist, who prescribed an antidepressant and recommended psychotherapy.”

Others, in contrast, may experience chronic low-grade depression for years with no dramatic interference with their ability to function. Instead, explains Dr. Unger, they feel a lack of wellbeing, low energy level, a negative outlook on life, and/or difficulty in experiencing joy or pleasure. Rinat’s husband, for example, complained regularly about feeling spacey and not having energy. After the couple tried a number of alternative medicines, Rinat, a health professional, encouraged him to see his primary care doctor to consider a diagnosis of depression.

“I asked that he be put on an antidepressant, and the doctor agreed on a trial basis,” she says. “It helped, but not dramatically, and I felt very frustrated. Over the years, he’s seen multiple therapists and psychiatrists who have all suggested different treatments, but there’s never been any long-term solution.”

If a person notices a family member exhibiting symptoms that indicate depression, it’s worth commenting on the changes, expressing concern in a caring way, and suggesting a visit with the family doctor, says Dr. Unger. Depending on the severity of the symptoms, a doctor may recommend medication and psychotherapy, as this combination is considered the most effective approach. This is what helped Shoshana’s husband, who ended up on medication, as well as in therapy, while his wife recuperated from her illness.

Relationship Wear and Tear

Getting the diagnosis is just the first step. Afterward comes the hard part: living with a relative who’s experiencing major depression. Family members may find themselves saddled with extra responsibilities that had been handled by the depressed person. In addition, the withdrawal, negativity, and hopelessness that manifest in depression can strain even the closest relationships.

“If the condition is severe, it disrupts overall family functioning — including dinners, laundry, finances, getting to and from appointments in a timely manner, Shabbos and Yom Tov preparations,” explains Dr. Unger. “Children may avoid spending time at home and stop inviting friends over. The marital relationship may be negatively impacted in a variety of ways.”

Yet for some couples, remarkably, depression brings them together. “My role was to be encouraging,” shares Shoshana seven years after her husband’s crisis. “Every time my husband went to therapy, he’d come back so drained — he’d be completely zoned out for the next two days. It wasn’t an easy process, but he learned so much about himself in therapy that it really improved our marriage.”

The key to helping a relative with depression is knowing your own limitations, says London-based psychotherapist Rabbi Yaakov Barr, MSc, PGDip, who specializes in treating severe depression. “You can’t fix someone else’s depression. It’s common for people to tell a sufferer to ‘snap out of it’ or ‘pull yourself together.’ Depression is an illness. It can’t just be ‘snapped out of.’ What you can do is be supportive.”

If a specific event triggered the depression, it often follows a trajectory, with the worst of the symptoms early on, and gradual improvement with time. “While initially a relative may need to encourage the sufferer to go to therapy and take their medications, the relative should be able to reduce his or her involvement as the sufferer progresses,” explains Rabbi Barr.

Rinat’s husband, who suffers from chronic depression, has been in various forms of treatment over the years, and her level of involvement has varied. “I sometimes wish I could be more involved,” she says. “I’m the one who has to deal with his depression on a daily basis and the emotional toll can be high. But recently things have improved slightly, so I’ve made peace with the fact that I’m not always wanted at his therapy sessions.”

For parents and adult children, too, awareness is important, even if the situation can’t be changed. “I feel terribly selfish admitting it, but it’s hard having a mother who’s struggling emotionally,” Esther says frankly. “I have a lot to juggle as it is, and I don’t always want to hear about her nightmares or how excruciating it is for her to get in a car to go down the block. Sometimes she’ll describe the blackness, the emptiness she feels when she wakes up in the morning. If it’s affecting me too much, I try to gently end the conversation — but I also feel guilty.

“In the year after my brother’s petirah, though, it was much worse. She would start crying uncontrollably several times a day, and tell me she felt no reason to continue living. I felt like such a worm. How could I tell her that this kid had a run-in with a teacher and that one had a fever and my boss was so nasty to me, when her life had narrowed to the four walls of her home? Now, baruch Hashem, it’s several years later and much more the normal mother/daughter dynamic again.”

Riding the Waves

With a steady background atmosphere of gloom and melancholy, how can relatives of those suffering from depression avoid getting sucked in?

Rabbi Barr shares the well-known analogy of the airline safety video. “If there’s a lack of oxygen in the cabin, we’re told to first put on our own oxygen mask before helping someone else,” he says. “Is this selfish? No. You can only help others if you look after yourself first.

“Likewise, if you’re living with someone suffering from depression, you need to monitor your own emotional ‘oxygen’ levels. Make time for yourself. Continue to do the things you enjoy. Get support for yourself. Accept help in any way you can. Learn about depression. The more knowledgeable you are, the more understanding you can be. Be patient. Reach out to the One Above.”

Yet even with all the knowledge and patience in the world, day-to-day life with a person suffering from depression leaves its mark. “You know rationally that the person isn’t choosing to be this way, but when you’re around it every day, it’s really difficult,” says Shoshana. “My husband found it a challenge to connect spiritually, and even putting on tefillin daily was a struggle. He felt like a hypocrite, teaching classes and inspiring others when he didn’t feel inspired himself. Even though I knew he couldn’t help it, it still took a lot of balancing to be patient and accepting.”

Similarly, Esther had to cope not only with her own grief over the loss of her brother, but also her mother’s. Since her mother lives only a few blocks away and they see each other regularly, this can be very taxing. “Sometimes she’ll go into one of her vents against the doctors who ‘mishandled’ my brother, or the police officers who didn’t reach the scene in time, or the people who said all the wrong things, and I need to remind myself not to take her words to heart and start seeing her perception as reality,” Esther says.

When necessary, it may be useful to have a family session with a professional to share concerns and develop coping strategies, suggests Dr. Unger. “Some family members may benefit from counseling sessions of their own. Support groups are often helpful, because they allow the family members to discuss challenges openly. Spending time with friends, getting sufficient sleep, eating properly, exercising, and participating in enjoyable and meaningful activities are all beneficial.”

Seeing a therapist was a game-changer for Rinat, who struggled with feelings of helplessness engendered by her husband’s depression for years. “It can be a very lonely journey,” she says. “My therapist helped me understand my husband and my reactions to him, and helped me realize that while some areas will hopefully improve, some parts of him and his illness will be there forever, and I am learning to live with them.

“Despite everything we’ve tried, my husband still has feelings of dissatisfaction with life,” she adds. “For years I tried to make things better for him, but now I realize that I’m not responsible for his happiness. I can be a good and supportive wife, but I can’t force him to be happy if he doesn’t want to be.”

“Shhhh, Don’t Tell”

One inherent challenge in dealing with a close relative’s depression is the secrecy that often accompanies this condition. In our stigma-driven world, mental health issues are taboo, which may result in the sufferer’s family not getting the necessary support.

“My husband prefers to keep his depression quiet,” Rinat acknowledges. “Although he has told some of his family, he prefers that I don’t tell mine, which means I can never unburden to my mother or my sisters. Since he holds down a job and generally appears at community functions, most people don’t realize what we’re going through.”

While the desire for secrecy may be understandable, it’s never recommended, especially when children are involved, says Rabbi Barr. “Too many times, I’ve seen children who have suffered for years living with a depressed parent, ignorant of what was going on, confused and frightened. The consequences of these secrets can last a lifetime. With wisdom and guidance, families can be made aware of the meaning of depression, to understand it, to cope with it, and to ensure that it has minimal impact on a sufferer’s nearest and dearest.”

One helpful approach is to view the situation as something that isn’t shared, but isn’t shameful either, offers Roxanne Abrams, a Chicago therapist in private practice. “It doesn’t have to be embarrassing; it just doesn’t belong in the public sphere. Parents can explain to their kids in age-appropriate ways the specific situations that will impact them. For example, ‘Things are hard for Mommy or Daddy right now. We’ll try to keep doing the things we always do, and sometimes Mommy or Daddy will join in and sometimes not.’ Describe the condition in terms of how it will affect the child’s life, without labeling.”

Dr. Unger recommends weighing the pros and cons of keeping the information quiet and taking into account the various factors involved, such as how obvious it is to neighbors and relatives that something is amiss; to what extent the situation impacts the children’s behavior and school performance; and whether a trusted neighbor, relative, or friend can provide the children with chizuk or support. “Discussing things with the family’s rav, with or without the depressed family member present, can help the family gain clarity,” she says.

With time, the decision can be revisited, especially if the crisis has been resolved. “During that first year, we kept it quiet,” Shoshana says. “Especially since my husband’s in the public eye [in his capacity as a shul rabbi], we didn’t want the whole world to know about it. Once he started feeling better, though, he started speaking about it, and so did I. I don’t go around talking about it on a daily basis, but if there’s a purpose to it, we share what we went through.”

A Hopeful Future

As devastating as a diagnosis of depression is, the condition can be overcome, and the future can be hopeful.

“Depression affects millions of people, and it can affect anyone,” notes Rabbi Barr. “That’s why it’s called the ‘common cold’ of emotional disorders. Its impact can be huge and dangerous, but in the age when therapy is becoming ever more effective, most people, given the right treatment and support, can overcome this debilitating disorder.”

Even when the situation doesn’t resolve completely, it can still become more manageable. “It’s a tough challenge and not something I would have asked for,” says Rinat. “However, baruch Hashem, I am able to see all the wonderful things about my husband, even though my daily workload isn’t easy. I know there are so many other difficulties people struggle with, and I’m grateful that his condition is somewhat treatable.”

If you’re in the position of dealing with a relative with depression, it’s important to realize that there are many practical strategies that aid in recovery. “Don’t exclude the exploration of any tools out there — medication, self-help books, talk therapy,” says Roxanne Abrams. “The more tools the depressed person has in the toolkit, the more possible it is to make the wisest choice at any given moment.”

Healthy lifestyle changes can augment treatment, notes Dr. Unger. “Keeping a daily gratitude list, reaching out to others, spending time outdoors, feeling useful and valued — all of these behaviors have proven to be helpful.”

Many depression patients and their families agree that the right medication, together with psychotherapy, is one of the keys to recovery. “I’m very grateful to the pharmaceutical industry — and to Hashem for granting scientists the wisdom to create these medicines,” says Esther. “The difference between my mother’s life before and after medication is huge. Baruch Hashem a million times over that it’s available.”

Medication may not need to be taken long-term, and its effects can be tangible. “My husband wasn’t on medication forever, but he used it for a while and I don’t think he would have gotten better without it,” says Shoshana. “It’s definitely not a quick fix. It takes time, and the recovery can be gradual. Occasionally he might feel some of the symptoms and has to be careful to take care of himself, but we all grew a lot from what happened.”

Although Shoshana’s husband is now back to his regular activity levels, she acknowledges that his depression left its mark. “It’s like when you sprain an ankle, that’s the weakest place in your body, and it can get hurt again if you put too much pressure on it. When you go through depression, you may be more vulnerable to it later. But you can be vigilant. Recognize the symptoms so you can take care of it right away, because it’s something that can be taken care of.

Information, Please

Looking for a therapist or attending a therapy session with your depressed family member? Here are some questions you may want to ask:

• What types of patients and conditions do you currently treat in your practice?
• To what extent do you involve families and friends in treatment?
• What is your recommended treatment (e.g., medication, psychotherapy)?
• What are the expected results of treatment?
• What will you recommend if this course of therapy does not work?
• If a particular medication is prescribed: Why have you chosen this medication, and what are its risks and side effects?
• Are there any warning signs that I need to look out for?
• What should I do if I am concerned about my relative’s safety?
• When is the best time to reach you?
• Is there anything else I need to know?

Steer Clear -- Unless It’s an Emergency

A person in your immediate environment seems withdrawn for an extended period of time or isn’t functioning normally, but he’s not your spouse or immediate relative. What can you do?

“Most friends and neighbors aren’t trained in diagnosis,” says therapist Roxanne Abrams. “It’s not necessarily useful or appropriate to make assumptions about what’s going on in someone else’s life. If you notice specific things that can be described objectively, you can bring them up, but don’t jump to conclusions. Stay within what is appropriate in the context of the relationship.”

On the other hand, if it seems like someone is at risk of hurting himself or others, speak up — and do so quickly. Steps must be taken, either by consulting a rav or therapist or by turning to the person’s immediate family members. In extreme cases, call 911 or Hatzalah.

*Names and identifying details have been changed to protect confidentiality.

(Originally featured in Family First issue 504)