When your loved one’s symptoms cause a chain reaction with your own mental health, it’s time to regroup and practice self-care.
Thirteen years after Daisy and Tony were married, Tony was diagnosed with treatment-resistant depression.
That depression has been at the forefront of their marriage for all but 10 months of the past three years. Episodes can last nearly three months without a break.
And while Tony tends to become agitated and angry, Daisy notices herself experiencing similar emotions—along with sadness and guilt.
“What this disease does for me is raise doubts about the relationship and raise doubts about myself,” she says. “It manipulates me, magnifying my lonely and hurt feelings. It makes me feel like I am inadequate as a wife.”
This sort of ripple effect is common. Some call it contagious. When a partner—or anyone close to you—is going through depression or anxiety, it’s easy to take on their emotional burden, causing added distress and other risks to your own mental health.
“Physiologically, human beings have a part of the brain that is intended—and built—to relate to others,” says Lawrence Dugan, PhD, a psychologist in Grand Rapids, Michigan. “That’s why we’re more likely to be negative when we’re around people who are negative, and why many therapists recommend spending time around positive people.”
We are literally wired to connect.
Neuroscientists have discovered, through functional magnetic resonance imaging (fMRI) research, that the brain has separate networks for non-social thinking and social thinking. When the brain is finished with any kind of non-social thinking, the network for social thinking switches on almost instantly.
“We have recently found that this reflex prepares us to walk into the next moment of our lives focused on the minds behind the actions that we see from others,” scientist Matthew Lieberman said in a 2013 interview with Scientific American. “Evolution has placed a bet that the best thing for our brain to do in any spare moment is to get ready to see the world socially.”
Results from a study published in 2010 in the Journal of Clinical Child and Adolescent Psychology suggested the depressive symptoms of their peers place adolescents at risk of developing depressive symptoms.
“I have never—and I rarely use the word never—in my 50 years of practicing, seen one person be depressed without at least one other person around them getting depressed,” Dugan says. “And the circle can become very, very wide.”
Kim, a music therapist from New York, says she can look objectively at her husband’s struggle with depression and complex post-traumatic stress disorder (C-PTSD) just by the nature of her work.
“In those toughest moments I’m able to separate myself and not get as emotionally attached,” she says.
That doesn’t mean it’s easy—for either of them. The more often her husband, Greg, has depressive lows, the less capacity Kim has to be there for him. And that makes Greg feel guilty.
“I feel her demeanor change,” Greg says. “I can see sadness in her face.”
The couple has a history of talking out problems before they escalate too far, which Kim ascribes to patience and trust.
“Sometimes I’ll say, ‘I don’t like feeling this way. Let’s just get through it,’” she says. “Our conversations can be 30 minutes or two hours or the whole night. They can be really hard and uncomfortable and awkward, but without fail we both feel better afterward—about each other and about ourselves.”
For Melissa of Oregon, open communication is vital for helping her 20-year-old son, Cole, understand her depression and anxiety.
The latter was a topic of discussion during a 12-day trip to Ireland the pair took last spring. On a group tour, they had to board a bus at a specific time every morning. Unable to find something she needed to pack or realizing she hadn’t left enough time to get ready, inevitably Melissa would start rushing around and sweating, and her anxiety would build from there.
“By the middle of the trip, I realized I was stressing him out, because he looked like a nervous wreck,” she recalls. “I asked if I was causing him anxiety, and he said, ‘Yeah, Mom, my stomach hurts.’ I told him he was not responsible for the way I was acting.”
Thinking back to the times when bouts of depression have kept her in bed all day, making Cole worry about her, she added one more bit of guidance: “I wanted him to know he was never responsible to make someone else’s depression or anxiety go away.”
COMPLICATIONS OF CODEPENDENCY
Codependency, an unhealthy relationship dynamic, can come to pass when a person—often driven by a fear of rejection and low self-esteem—becomes subsumed in caring for someone else.
A correlational study between codependency and depression that was published in 2008 in the Journal of Couples Therapy indicated that people who self-reported as highly codependent are likely to experience an elevated level of depression.
In fact, research published in the Archives of Psychiatric Nursing found that in a sample of 105 women with depression, 36 percent were moderately to severely codependent.
“Codependency is complicated because we’re inherently dependent on one another to help regulate our moods and emotions in a relationship,” says Emily Horowitz, a licensed professional counselor in Boulder, Colorado.
In her practice, Horowitz tries to help clients to feel impacted by another person’s mood without being completely influenced by it, so resentment doesn’t build. When someone is having difficulty with this, she asks a few questions: Are you replicating family patterns? Is it easier to deal with someone else’s pain and be a problem-solver than to look inward at what is happening for you?
Says Horowitz: “‘How did I get here?’ is the question I’d ask myself.”
Adam B. Hill, MD, a physician from Indiana, can relate to this topic. He has a history of major depressive disorder that he ties to a past alcohol addiction, though he hasn’t had an episode in years. He and his wife, Lauren, learned about their codependence through years of counseling.
“There was this push and pull and reliance on trying to influence the other person’s happiness, or sometimes trump each other’s sadness,” he says. “There was this interplay of our emotions all the time. It fractured our relationship pretty deeply. We didn’t know if our marriage would survive.”
It has survived, in large part because they got help, with both joint and individual therapy. They don’t have to go as often anymore, but they do visit each other’s counselor once or twice a year to find out how they can improve the way they work together.
Hill wants to offer support to others as well. He recently published a memoir, Long Walk Out of the Woods: A Physician’s Story of Addiction, Depression, Hope, and Recovery, which chronicles his stress and disillusionment with the culture of medicine and the vulnerability to burnout (and its mental health challenges and crises) that physicians face.
“A lot of my work now is about being open about my mental health history,” he says, “to open up honest conversations to combat this fear-based culture.”
When supporting loved ones with depression and anxiety, individuals frequently neglect their own emotional and physical health. If the drain and isolation of being in that situation is not addressed, it is not uncommon for people to mirror symptoms of anxiety, hopelessness, and low self-esteem.
“You’re taking this huge thing on that’s often a physical and emotional toll,” says Beth Salcedo, MD, president of the Anxiety and Depression Association of America. “You can have all kinds of mixed feelings about that, which puts your mental health in a precarious position.”
Take, for example, a parent who used to be a big support and now acts like someone you don’t recognize.
“You can feel angry and helpless and guilty,” Salcedo adds. “You haven’t lost her, but in a way you have, and you haven’t had a chance to grieve that loss. It’s a strange place to be in.”
According to a survey published in 2015 by the National Alliance for Caregiving and AARP, approximately 34.2 million Americans provided unpaid care to an adult aged 50 or older—with or without depression/anxiety—in the last 12 months, while 43.5 million provided unpaid care to an adult or child during the same 12-month period. Typically, women take on that supporting role more often than do men.
An Ohio State University study showed that the negative psychological impact of caring for a spouse with Alzheimer’s disease or other forms of dementia continues for years after the spouse’s death. Forty-one percent of former caregivers showed mild to severe depression at two to three years after the death of their spouse—which is not significantly lower than the 43 percent depression rate among those currently providing such support, according to the study.
Research published in the journal Clinical Gerontologist found that those who provide care and have higher levels of self-compassion report lower levels of burden. It can also be helpful for individuals in supporting roles to remind themselves to remain compassionate for the person with depression and anxiety.
Retired psychiatric nurse Deborah had trouble recognizing symptoms of depression in herself this past June, when she started having trouble sleeping, neglecting the gym, overeating, and avoiding conversations with friends.
Deborah has been caring for her husband, Hank, who has dementia. Late last year, he began having more depressive moods that made him angry at times. To focus on something else, Deborah, who lives in Webster, New York, got a part-time job. But she still found herself losing patience more easily than usual and responding with more irritation and agitation. She adds: “It’s not like I didn’t feel any compassion.”
Deborah knew she needed help after she and her husband came home one day early from a trip that she had been looking forward to for quite some time. Though on vacation in the Adirondacks, with the pressures and disappointments that accompany dementia, she simply wasn’t finding relief or having any fun.
“I cried every day and I’m not a crier, not that I’m proud of that,” she says. “Some of it was for him, some of it was for me, and some of it was just crying. That’s when I realized I didn’t just feel depressed. I had depression.”
While Deborah had been treated before for major depressive disorder, she had not had an episode in decades. Again on medication, she is back to monthly dinners with three separate groups of friends, and she enjoys volunteering with the local chapter of the National Alliance on Mental Illness (NAMI), where she teaches families effective ways of problem-solving.
“If I get angry at my husband and he gets defensive, I have to think about how he didn’t ask for dementia,” she says. “My overreacting is my unwillingness to accept the reality of his disease.”
IMPORTANCE OF SELF-CARE
Self-care, when dealing with depression and anxiety, is essential—for everyone involved. But people in supporting roles may not realize that they are physically and mentally exhausted and need to recharge for a while, because so much energy and focus is being channeled into the health of their loved one.
“There’s a lot of anger and tension because the person without depression wants the person with depression to do what they used to do,” explains Caryn DiLandro, PhD, a clinical psychologist in East Amherst, New York. “That causes more tension, which contributes to the person without depression starting to feel their own symptoms.”
DiLandro recommends keeping an eye out for early warning signs, particularly if an episode for those doing the supporting lasts longer than a month or two. Are you mirroring a diminished interest in activities? Or staying in bed or on the couch more often? If so, have compassion for yourself; perhaps seek out a support group. And do your best to maintain boundaries.
Daisy takes care to fully appreciate the gestures that make her feel loved, like when Tony unexpectedly gives her a kiss on the neck, or a card with the message: “Thanks for all you do, particularly at this time.”
“If I don’t take care of myself and keep my head in the right space, then there’s just havoc,” says Daisy, who serves as state director of the Depression and Bipolar Support Alliance in Fairview, Tennessee. She keeps flowers around the house—something she calls “things my eyes can fall on so I can remember beauty.”
And rituals help. Every morning, they have coffee together before holding each other on the couch and sharing things that make them feel grateful, such as the neighborhood potluck or discount night at the movies on Tuesdays.
“We are here, together, a strong couple, working daily to make our life as good as we can,” says Daisy. “I am ever so grateful for resilience, and all the good and love in my life.”*
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CALMING THE CHAIN REACTION
Schedule a consultation. “Everybody closely connected to a person with depression should consider at least one visit to a good therapist,” says Michigan psychologist Lawrence Dugan, PhD. Most insurances cover visits to some extent, and when people hide or dismiss their own symptoms, the cycle only continues.
Treat yourself. Do something every day that will lift your spirits. “It can be something as simple as listening to a song or calling somebody on the phone,” suggests Caryn DiLandro, PhD, a clinical psychologist in Western New York. “It doesn’t have to be anything extravagant.”
Practice self-compassion. “This may involve gently putting your hand on your heart to physically comfort yourself, and/or saying kind, supportive words to yourself, such as ‘This is so difficult right now … I’m sorry it’s so hard,’ or whatever feels natural,” recommends pioneering self-compassion researcher Kristin Neff, PhD, from the University of Texas at Austin. “Just think of the types of kind and supportive things you’d say to a close friend in your situation.”
Know that some things take time. “It can take 100 people to get somebody into treatment, and the third person is just as important as the 99th, so don’t put all the pressure on yourself to be the one who has to be miraculously responsible,” says Indiana’s Adam B. Hill, referring to someone trying to help a person with depression. “You can be an important part of the story by showing up and being patient and caring.”
Printed as “Depression & the Domino Effect,” Fall 2019
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