Supporting family member with severe depression?

[Hollybobs]

Hello everyone :). I'm Hollybobs and I work in an ICU currently. I'm pretty new to this forum and this may be the wrong part of the forum to post in? I'm sorry if so. I was hoping for advice from anyone with any personal or professional experience/knowledge of supporting a family member with severe clinical depression.

A brief bit of background..."Rosebobs" has a long standing history of depression and can experience troughs like the one she is currently in for years at a time. Her anti-depressants are not working, there is no difference after a year of increasing the dose. She also suffers from anxiety and struggles to leave the house. She is a very private individual and dislikes speaking about her feelings.

I'm aware of ways to help someone with mild-moderate depression e.g. exercise, CBT, counselling, diet changes but these are not possible/working at this point for the reasons mentioned above. Any ideas or guidance or insight appreciated.

Hollybobs.

[Hollybobs]

I feel for you and your family member, OP. I have friends in the UK with mental health struggles. It isn't usually easy to get good care for that promptly in your country.

As Viva said, your job is to be an unconditional source of caring about them. NOT their "fixer". If they ask for help contacting medical providers, that is one thing, but be careful taking it upon yourself to manage their health needs. And please don't speculate on diagnoses like bipolar disorder. For your part, it really doesnt/shouldnt matter what label her problems have, just be supportive. Leave the diagnosing to the doctor and they will decide which medicines are most appropriate. I hope that didn't come across too harshly. I mean it from a place of trying to be helpful in my suggestions.

I hope your family member can get in with someone who is able to help them better soon.

Thanks Janey for your kind thoughts, it IS hard in the UK. Nothing you said was harsh but I didn't speculate on a disorder, that was another poster :). "Rosie" has a diagnosis already and I know my limits -I'm neither an MD nor psych trained :). More of a worried relative at the end of her tether and asking for answers from a group of strangers thousands of miles away. I've been delighted that anyone has contributed and each thank you has been heart-felt.

[needlesmcgeeRN, ASN, RN]

Why are you reluctant to suggest the inpatient route? There is nothing wrong with inpatient treatment, and it could mean the type of focused care your friend/family needs, in order to address the myriad issues that surround depression.

[ms boogie, BSN, MSN]

Ummm, you just DID diagnose. Edit your response while you can, for your own sake.

Here is the Nursing police....next will be the "you are going to lose your license" threat.

[nurseactivist]

I think it is our nature as nurses to want to fix, manage, cure...

You mention that you have been close for a long time. Is there a favorite snack, meal or outing??? Re-visiting a more fun time?

[Esme12, ASN, BSN, RN]

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[honeyforasalteyfish]

Well as some one who has suffered from severe depression my best advice is to counsel them to devote their time to something constructive. I went through 3 psychs, two hospital visits, and numerous medication before my problem was correctly identified.

Now I am on a good cocktail of antidepressants, and my life and depression are slowly correcting themselves. Exercise is good advice, but the key for me and I cannot stress this enough CONSTRUCTIVE ACTIVITY, as much as possible. Without constructive activity the depression worsens, and the feeling of worthlessness that feeds depression will run rampant in their mind. If they are anything like I was.

I cannot give any other advice really except to try to get them to do constructive things they enjoy. That will be a huge simple factor, in overcoming depression. It was for me.

[VivaLasViejas, ASN, RN]

Why are you reluctant to suggest the inpatient route? There is nothing wrong with inpatient treatment, and it could mean the type of focused care your friend/family needs, in order to address the myriad issues that surround depression.

Inpatient saved my life in the fall of 2014. Up until then I'd been scared to death of the hospital, but when I became more frightened of the outside than what might be on the inside, it was time to go. I'm not saying your friend should go IP but the conversation should probably include it at some point, if it hasn't already. She may well refuse outright, and that's her right. It's just something to think about.

[verene, MSN]

I can't approach the care provider due to confidentiality and the care provider doesn't negotiate. I was open to any advice, not specifically meds, although am grateful for any responses.

Actually *you* can approach a care provider and provided them with relevant information, they however cannot provide you with any information unless your loved one has signed a release. I went through being a family caregiver to a loved one with severe depression/SI and when I hit a huge number of red-flags in their behavior around and towards me I called their primary provider of care and left a confidential voice mail detailing my concerns*. This led to a family meeting (with patient consent) and a voluntary psych stay on the part of the patient. Which ultimately was the start of recovery because the right meds for them were finally identified. It's been several years and while my loved on still receives ongoing treatment, they are again a fully functioning member of society.

*Do use caution in contacting your family member's providers though, as you don't want them to feel you are going behind their back. In my case I informed my family member before I made the phone call that I was going to do it, and also felt that even if they didn't consent that it was a crisis situation where I either needed to have a provider on board with what was going on or I would very shortly have police/ems involved in the situation instead.

Supporting a loved one with any kind of chronic illness can be incredibly draining. Please make sure that you are able to take care of yourself, and that you have a good support system around you. Bring in additional individuals to support your loved one as your loved one is able to accept them - sharing the load helps a lot and can help alleviate some of the isolation for both of you. Also consider getting counseling for yourself. Ultimately this journey is a journey your loved one has to make on their own you cannot fix them unless they want to be fixed. Counseling for you however can help you work through your emotions and role in the situation as well as provide access to someone who can help in understanding more of the mental health world.

I would also suggest contacting (or encouraging your family member to contact) mental health professionals/psychiatrists for advice and/or second opinion on treatment options if the current course of action is not working.

[Hollybobs]

Why are you reluctant to suggest the inpatient route? There is nothing wrong with inpatient treatment, and it could mean the type of focused care your friend/family needs, in order to address the myriad issues that surround depression.

A number of reasons.

1)I can suggest it if I thought it would help but I can't see the benefits currently. Surely the ideal with any patient is to try through other means to help them recover and re-adapt to everyday life in their own surroundings if that is their preference? Unless someone more qualified than myself thought it medically necessary or clinically indicated it would not be the first choice of ways in which to help someone.

This may be a UK vs US thing here, inpatient stays in the UK are generally restricted to if the patient is in immediate danger of harming themselves or another and even then they are sometimes managed in the community with "crisis' teams. It's similar with physical health needs and social care, if someone can be managed in the community in their own home with an exacerbation of, say, a respiratory difficulty, unless certain criteria were met it wouldn't warrant an inpatient stay. We have free healthcare and resources are allocated carefully, also assisting someone to manage within their own environment can be beneficial (separate discussion).

2)My loved one would not agree to this even if deemed medically necessary. Their decisions would need to be overridden with all the inherent problems involved in doing that. Such an assault to someone's dignity and rights would be a last resort. If it were necessary I would support them but as they would refuse consent I hope it doesn't come to this.

3)"Rosie" hates talking to strangers, is VERY private and there is a real possibility such an environment could traumatise her in the full sense of the word and prolong this depression. i know it can be very beneficial but not everyone is the same. It may be inevitable at some point and I am prepared for this, I'd just like to avoid it if we can. Her opinions more than mine, I haven't said any of that to her. Your post is making me me think it through more thoroughly, that's for certain, thank you.

[Hollybobs]

Nurse Activist, it is!

In the UK we choose whether to specialise in adult, mental health, learning disability or child nursing. I was tempted by mental health nursing but eventually chose the adult branch route as although i consider myself to be holistic in approach and have had some listening/communications skills training i loved physically being able to fix people too. Wound care! Respiratory support! Pain management! I like having equipment and medications that give results pretty fast in addition to building a therapeutic relationship and nursing someone on a spiritual/emotional level.

There are favourite things and outings i can consider, a seaside trip would be nice, thinking about it, or to a lake. I am building a list as a result of the suggestions given so i can slowly and gently start to incorporate these into the support I am giving.

[Hollybobs]

Well as some one who has suffered from severe depression my best advice is to counsel them to devote their time to something constructive. I went through 3 psychs, two hospital visits, and numerous medication before my problem was correctly identified.

Now I am on a good cocktail of antidepressants, and my life and depression are slowly correcting themselves. Exercise is good advice, but the key for me and I cannot stress this enough CONSTRUCTIVE ACTIVITY, as much as possible. Without constructive activity the depression worsens, and the feeling of worthlessness that feeds depression will run rampant in their mind. If they are anything like I was.

I cannot give any other advice really except to try to get them to do constructive things they enjoy. That will be a huge simple factor, in overcoming depression. It was for me.

I will. I am glad you managed to overcome your depression and I'm sorry that you went through it. Thank you for sharing your experience. I will remember that.

[Hollybobs]

Inpatient saved my life in the fall of 2014. Up until then I'd been scared to death of the hospital, but when I became more frightened of the outside than what might be on the inside, it was time to go. I'm not saying your friend should go IP but the conversation should probably include it at some point, if it hasn't already. She may well refuse outright, and that's her right. It's just something to think about.

It might come to that, probably at the point you mention (more scared of outside than inside). It is good to hear that it can be life-saving and life-changing both because it helped you and it could help "Rosie". I am struggling to feel positive about the idea but am trying to be more open. Thanks for sharing, Viva, i hope that things have much improved.