DEAR MAYO CLINIC: My brother has been diagnosed with depression. I want to help him, but I do not know what to do. Can you give me ideas for how best to support him?

ANSWER: When a loved one is affected by depression, it can be difficult to understand what is happening or what you can do to help. It is OK to be confused and wonder how you can assist.

Clinical depression is an incredibly complex and individualized process. Understanding depression spans multiple levels of knowledge, from genetics and brain biology to culture and situational stress. Yet despite all the information, universal truths or simple solutions do not exist.

Downward spiral of depression

Gaining perspective on what your brother is experiencing can be critical to the support process. Visualizing depression as a downward spiral is one way to simplify and understand clinical depression.

The downward spiral may begin with the person feeling worse than usual from physical, social or psychological stressors. A worsened mood may lead to taking part in fewer meaningful day-to-day activities. Self-criticism and stress increase due to mounting responsibilities or missed opportunities. Depressive thinking may encompass guilty thoughts, pessimism and irritable behavior.

As the spiral develops, a complex dynamic emerges. Your loved one becomes increasingly stressed while simultaneously less capable of coping with this stress. The response of the brain to this dynamic is to slow, stop and depress. A person can get stuck at the bottom of the spiral for weeks, months or years.

The silver lining is that if people can spiral down, they can spiral back up. However, depression affects the motivation, energy and curiosity needed to spiral up.

It is challenging not to be able to fix a loved one's depression. But you can help them get started to move on an upward path and support them in their journey.

Here are some suggestions to offer support and understanding:

Learn the symptoms of depression

Depression signs and symptoms vary from person to person and can include:

• Feelings of sadness, tearfulness, emptiness or hopelessness.
• Angry outbursts, irritability or frustration, even over small matters.
• Loss of interest or pleasure in most or all normal activities.
• Insomnia or sleeping too much.
• Tiredness and lack of energy. Even small tasks take extra effort.
• Changes in appetite — reduced appetite and weight loss or increased cravings for food and weight gain.
• Anxiety, agitation or restlessness.
• Slowed thinking, speaking or body movements.
• Feelings of worthlessness or guilt, fixating on past failures or taking unnecessary blame for things.
• Trouble thinking, concentrating, making decisions and remembering things.
• Frequent or recurrent mention of death, suicidal thoughts or attempts.

Symptoms can be severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships. Other people may generally feel miserable or unhappy without knowing why.

Children and teens may show depression by being irritable or cranky rather than sad. Clinical depression does not require profound sadness or intensely negative feelings. Rather it can be a lack of positive emotion.

Encourage treatment for symptoms

People with depression may not recognize or acknowledge their symptoms. They may have difficulty seeing the point of getting treatment. This is where you can be most helpful.

Consider the following:

• Talk to your brother about what you've noticed and why you're concerned.
• Explain that depression is a complex condition — not a personal flaw or weakness — and that effective treatment exists.
• Suggest seeking help from a health care or a mental health professional, such as a licensed counselor, psychologist or psychiatrist.
• Express your willingness to help by setting up appointments, going to them and attending family therapy sessions.

Provide support to reinforce healing

You can assist your loved one in the healing process.

Consider these ideas:

• Encourage sticking with treatment.
  Help your brother to take prescribed medications and keep appointments.
• Be willing to listen — when desired.
  When your brother wants to talk, listen carefully and intently. Avoid giving too much advice or too many opinions, or making judgments. Just listening can be a powerful tool.
• Give positive reinforcement.
  Remind your brother about his positive qualities and how much he means to you and others.
• Offer assistance.
  Certain tasks for your brother may be hard to do. Suggest specific tasks you'd be willing to take on.
• Help establish a routine.
  Someone who's depressed can benefit from having a routine or increased structure. This is because it can be difficult for a person with depression to make spontaneous healthy choices, so advance plans or everyday habits become crucial. Offer to make a schedule for meals, medication, physical activity, sleep, outside time or time in nature, and household chores.
• Locate helpful local organizations.
  Access and affordability for mental health treatment can be burdensome. You may be able to use help from resources such as the National Alliance on Mental Illness, employee assistance programs, or other community-based groups or programs.
• Make plans together.
  Ask your brother to join you on a walk, see a movie, or work together on a hobby or other activity. But don't try to force him into doing something.
• Be patient.
  For some people, symptoms can quickly improve after starting treatment. For others, it will take much longer.

Be aware of suicide risk

People with depression are at an increased risk of suicide. If you believe your brother's illness is severe or in a potentially life-threatening emergency, you may need to:

• Contact a health care professional or hospital.
• Call 911.
• Call the National Suicide Prevention Lifeline at 988. To reach the Veterans Crisis Line, use the same number and press "1."

What you can do for yourself

Supporting someone with depression is challenging. Part of the challenge is witnessing a loved one's struggle and knowing you cannot complete the path for that person. Understand that emotions such as frustration, helplessness or anger may be natural responses to a loved one having depression.

Practice acceptance and coping with difficult emotions by permitting yourself to prioritize your mental health. Devote time for hobbies, meaningful experiences, physical activity and other valued relationships. — Dr. Erik Wing, Psychology, Mayo Clinic Health System, La Crosse, Wisconsin

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