Brought to you by the Depression Is Real Coalition, The Down & Up Show is dedicated to the reality of depression. Each week our hosts will talk with some of the world's top experts on depression, as well as people who have been impacted by this illness. The reality of depression is that it is a debilitating and potentially deadly medical condition that affects more than 15 million Americans every year. The other reality of depression is that there is hope.

Down & Up Show #30: Depression Fallout

The Down and Up Show on Depression is Real.org, a talk show dedicated entirely to the subject of depression and the reality that there is hope for people living with this disease, now your host, Dr. Ellen Frank.

ELLEN FRANK INTRO:
Welcome to the Down and Up Show on Depression is Real.org. I'm your host Dr. Ellen Frank. Our guest today is Ann Sheffield, she's the author of three award winning books on depression: ÒHow You Can Survive When You're DepressedÓ, ÒSorrow's WebÓ, and ÒDepression Fallout, the Impact of Depression on Couples and What You Can Do to Preserve the BondÓ.

She also hosts a web site called Òdepressionfallout.comÓ which we will discuss and she currently runs her own consulting firm. Ann's personal experience with depressionÉ

Ann's personal experience with depression serves as the motivation for her books and her web site which focuses on support for those with loved ones who suffer from depression. Great to speak to you today, Ann.

ANNE SHEFFIELD ANSWER:
Oh I'm so glad to be here, thanks for asking me.

ELLEN FRANK QUESTION:
Tell us a little bit about your own experience with depression.

ANNE SHEFFIELD ANSWER:
WellÉ it never occurred to me that I had anything called depression. I actually thought I was just a little moodyÉ finally IÉ did go and see a psychiatrist, it's a long story and quite a funny one. And when he said, you have depression and you probably have had it for a long time, my reaction wasÉ oh my God, thank heavens it's not my fault I feel this way.

And ever since then I've been taking anti-depressants and have become something of an expertÉ and I still, sometimes events overwhelm me and my depression rises to the fore. And I've learned how to control it, but it isÉ a major factor in my life.

ELLEN FRANK QUESTION:
In your book, ÒHow You Can Survive When They're DepressedÓ, you use the term depression fallout, what do you mean by that phrase?

ANNE SHEFFIELD ANSWER:
WellÉ depression never takes place in a vacuum, it affects everybody around you, your family and your close friends. And IÉ define depression fallout as the emotional toll that depression imposes on family members and close friends who often are so focused on the depressed person's welfare and their demands, that they loose sight of their own needs.

ELLEN FRANK QUESTION:
You've certainly seen that happen. InÉ you often talk about five stages of depression fallout, would you describe those for our listeners?

ANNE SHEFFIELD ANSWER:
Well I certainly will and I'd love to make a tiny introductory statement to that. The fact that sad is the adjective which is principally used first to define depression, is very confusing becauseÉ people who are depressed very often act in ways that are notÉ that don't look like sadness.

So every often stage one is confusion because it really actually looks as though this person that you know so well has undergone some kind of personality transformationÉ not for the better. Kind people become unkind, accepting people become criticalÉ people with even temperaments loose their sense of humor and become very irritable, very critical.

So very often the last thing you think of in this apparent transformation is thatÉ this is an illness called depression. So not knowing what's caused it, stage two is self-blame because you figure well something I have done, has caused this. I haven't been paying enough attentionÉ I've been selfish or I've been flippantÉ

I've allowed my own problems to keep me from hearing their problems and so you just assume I've done something wrong, what can it be? AndÉ that goes on until you get to stage three which is the demoralization and demoralization is very much like depression without theÉ brain changes because you feelÉ that your self-esteem is shot and thatÉ whatever you do nothing seems to help, nothing seem to change this situation.

Very often you still of course have no idea that depression is what's causing all of this and your attitude is just everything I do, nothing worksÉ nothing I do seems to be right. And you know this is justÉ awful. Sooner or later stage four arrives which is resentment because you are not being treated well.

You've tried very hard as far as you can see to do everything right, nothing works and of course you become resentful. And very oftenÉ that turns into anger. And sooner or later comes stage five if nothing interrupts thisÉ five step process. Five stage isÉ stage number five is no matter how much you love this person, if nothing is done to change the dynamics, sooner or later you're going to want to escape the source of so much unhappiness.

AndÉ none of this need happen. It can go on for months, it can go on for years, but there are things that can be done and one of them I think that's very important is the depression is real campaign because people resist still the idea that depression is an illness and think it's a sign of weakness that they can fix themselves.

ELLEN FRANK QUESTION:
I think many family members feel that their love and their sympathies should be enough to cure their loved one's depression. What do you say to that?

ANNE SHEFFIELD ANSWER:
WellÉ unfortunatelyÉ it's not true. First of all a very, very common occurrence is for the depressed person to suddenly say, you know I think we shouldÉ separate, I need some space. Or I think we should get a divorce orÉ I love you but I love you as a friend. Now part of that is because depression usuallyÉ kills the libido and that causes a lot ofÉ guilt and it doesn't get talked about.

And there is this idea that somehow if the whole circumstances would change, the depression would go away. SoÉ one of the things thatÉ people really need to do is to find out what depression looks like. I have, in my books, a list of what I call the unofficial symptoms so that when suddenly a marriage, a relationship goes awry or a child suddenly starts behaving in a way that is far different from just the average teen rebellion.

Or a parent becomes grasping, demanding, critical, to consider that it's possible that depression has caused that change.

ELLEN FRANK QUESTION:
Would you say some other things, say something abut other things that family members can do to help those they love and at the same time take care of themselves?

ANNE SHEFFIELD ANSWER:
Yes, now one of the things that of course you want to do when someone you love is obviously in such pain, is you want to be your arms around them and kiss them and say, I'm here for you, we love each other, everything is going to be alright. The trouble is thatÉ very often what will happen is that the person with the depression will flinch andÉ that kind of intimacy is very hard for people with depression.

SoÉ if you're the family member, to take a kind of what I call brisk, matter-of-fact approach is very good. So instead of sayingÉ you know, do you love me, sayÉ you know how much I love you, nothing is ever going to change that andÉ I've got to go out to lunch but I'll back at three, that kind ofÉ brisk, definitive, matter-of-fact is actually very reassuring to someone who is depressed.

It'sÉ it's also very importantÉ if the person is unwilling to accept that this is depression and unwilling to see a doctor, you have the whole issue of overcoming denial. And one of the ways to do that is to not do the obvious, do not say you know, I think you're depressed, why don't you go to the doctor?

Instead say, you know, usually you have so much energyÉ and you're a really good sleeper and now you justÉ you knowÉ you seem kind of beat all the time. I don't know whether it's the office or what, but I think you just go to the doctor and get it checked out.

In other words, focus on the physical aspects of depression, of which there are many and use that to encourage this depressed person that you love to go and see the doctor. Keep your fingers crossedÉ and hope that the doctor's going to say, look, you know, I think you're depressed.

When a doctor says it, it's not nearly as difficult to accept as when your wife, your mother or your child tells you or your husband.

ELLEN FRANK QUESTION:
Once the depressed person is in treatment, what kinds of things can family members do to support their continuing in treatment?

ANNE SHEFFIELD ANSWER:
WellÉ try to keep things again on an even keel, not to get emotionalÉ even people that are in treatment, they certainly are not always in total regression. TheyÉ you know the dosage may not be right, it may not be exactly the right anti-depressant for them.

Perhaps they haven't started any kind ofÉ practical therapyÉ and for some people it takes a long time. SoÉ oneÉ oneÉ at the top of a set of rule is, never get in an argument with someone who has depression because it's impossible to win that argument. DepressionÉ people, most people don't realize, totally changes the way you view the world.

And soÉ you are, if you are depressed and you get in an argumentÉ you think you are logical, but in fact you are very illogical and you will probably, I'm talking about myself and plenty of people that I know with depression, you will probably loose your temper.

So the best thing to do if an argument starts is just to say, oh my God, I forgot, if it starts to intoÉ into a fight. I forget I told George I'd call him, you know, I'm already overdue. Leave the room, let the person calm down. Once the situation is well known and everybody is aware of the fact that depression is the troublemaker, then it's important to have a set of agreed upon rules to keep the depression from causing a lot of troubles.

AndÉ I call this setting boundariesÉ because just because someone is depressedÉ depressedÉ doesn't mean that they have the right to be criticalÉ to get in angry, loud fights, particularly when this may often be in front of kids. Depressed people learn that they have responsibilities.

And their major responsibility is to know and understand their depression, to do everything they can to find the right medication, find the right therapy and to understandÉ how their depression causes them to behave. And make this set of rules so that the household, the family, can go on and cope with the depression as though it's a third member of the family, an uninvited and unwanted guest, but one that can be kept under control.

ELLEN FRANK QUESTION:
So Ann, is there any final word of wisdom you would like to leave with our listeners?

ANNE SHEFFIELD ANSWER:
Well one thing I'dÉ IÉ you asked the question and I didn't really answer itÉ people who live with someone who is depressed, their self-esteem usually goes out the window. And very often and I've seen this happen thousands of timesÉ what happen is that their life really is taken over by the other person's depression.

SoÉ in my last book I have a chapter which says, the virtues of being selfish and you have to hold onto your self-esteem, keep your own life, do everything you can to help this person you love who has depression but don't give up your own life.

ELLEN FRANK:
Good one, thank you. Thank you for talking with us today. Depression affects so many people including families and loved ones and so it's important to have a better understanding of how to help and support one another. For the Depression is Real Coalition, I'm Dr. Ellen Frank, join us next time for another edition of the Down and Up Show on Depression is Real.org.

Thanks for listening to the Down and Up Show. For more information log onto www.depressionisreal.org. You can find us there and at I-tunes and remember, stay subscribed.