the Complex Dynamics of Family Support for Depression Patients

The collateral relatives of patients with depression can vary significantly?

I would like to ask about my family member who is currently diagnosed with depression and bipolar disorder.
The psychological stress stems from "family factors." Over the past five years, they have intermittently visited a "neurology department" for treatment, taking medication irregularly.
Two years ago, they moved to another city to live with their boyfriend, but recently returned home after their boyfriend was drafted into military service.
Initially, during the first week, they still had many negative thoughts and felt unusually (?) sad about their boyfriend's departure, showing a significant dependency on him, yet they appeared to be the same "person" I remembered and were able to work.
However, starting in the second week, they quit their job and began to exhibit "obvious" symptoms of depression when talking to their parents.
They decided to seek medical help and returned sharing what the doctor had told them, starting to take their medication regularly under our close supervision.
In the third week, the effects of the medication may have started to kick in, and our family began a transition period for managing depression.
This week, they did not deny their symptoms as seen in online cases.
Instead, when discussing topics they found hard to accept, understand, or agree with, they would start "muttering to themselves, lost in their thoughts," repeatedly emphasizing their symptoms, what the doctor advised, or warning us about what might happen if things continued this way.
They are aware that the medication causes drowsiness and forgetfulness, and sometimes insomnia due to their condition.
In our conversations, they frequently attribute certain mistakes to the medication or their illness.
Their tone has become quite "childlike," constantly requesting us to "engage in conversation" rather than just "listen." If we do not engage, they feel neglected, unimportant, or like a burden.
Although they exhibit symptoms of wanting to avoid social interactions, they occasionally express a desire to go out.
This week, they have had multiple instances of "arguments," feeling "attacked by family," and experiencing "family disapproval" (all perceived by them, while the family's daily interactions are generally consistent).
They went for walks nearby and called their friends to share their feelings (all of this is based on their own accounts).
There have been several instances of self-harm in recent years, including a few occurrences after moving out (as per their own statements).
These various situations lead me to question whether they might be "faking" their illness or doing it "intentionally." Given the current state of our family, I believe this situation is quite concerning.
Therefore, I would like to inquire:
1.
Is she truly suffering from depression and bipolar disorder?
2.
Her psychological issues stem from family dynamics; despite our heartfelt advice and care, her friends and boyfriend's words seem to have more impact.
What should we do?
3.
If we suggest she move out, considering her current state of wanting to avoid social interactions, experiencing drowsiness due to medication, occasional loss of appetite, binge eating, and difficulties swallowing medication and food, I am genuinely worried about her living alone (she herself wants to move out) or living with friends...
Given that she may have had tendencies toward depression since adolescence and has few close friends, we are not very comfortable with her current friends.
I truly do not know what to do (other relatives also contribute to her psychological issues).
4.
What should family members of a depression patient pay attention to? Recently, our family has started to take this seriously.
We understand that we should not raise our voices, blame her, and should accompany her, etc.
Consequently, the home environment is gradually changing to become "the ideal family" she envisions—close and interactive.
However, I cannot change everything for her; our home may not be "ideal," but it has its own "character." I believe that is our "home," and not changing it while being accused of being uncaring or unsupportive makes her feel out of place.
I do not know how to interact with her, and I believe that only those who truly love the patient (parents, partners, spouses) or are saints can manage to interact with her "daily" in this way.
What should I do?
5.
She is currently seeing a neurologist.
I have researched the differences between neurology and psychiatry but am still unsure whether to change her specialty or continue as is (the nearby hospital does not have a psychiatry department but has a "mental health department," so I am uncertain).
Thank you for taking the time to read this lengthy message.
"Managing depression is a long-term battle; family members should understand, be tolerant, and learn emotional regulation.
They are ill, not acting intentionally." I believe knowing and understanding are two different things, and the varying degrees of "love" lead to not everyone being able to be that "family member." At the very least, I believe I cannot do it.
Until I have enough "understanding," I feel I would either have to develop depression myself or push her to her limits, but I do not want any regrets in the end.
Therefore, I am seeking advice.
Thank you.

Huàshí, 10~19 year old female. Ask Date: 2015/11/09

Dr. Liang Sunyuan reply Psychiatry

Hello, the family members of patients with depression face significant challenges, and their emotions are inevitably affected.
Therefore, the first step is to take care of one's own emotional well-being.
Only when you are in a better state can you be more understanding, supportive, and provide warmth.
If more family members can share the burden, it allows everyone a chance to breathe.
Thus, your contributions and efforts are not only for the patient but also to alleviate the stress on parents and other family members.
The support and understanding from family members serve as a protective factor for patients with depression.
However, patients often have a tendency toward pessimism and sensitivity, which may lead them to verbally attack family members.
Typically, once their depression improves, they may regret their past impulsive words and actions.
I believe that the mental health department is essentially the psychiatry department, and for issues related to depression, it is advisable to consult a psychiatrist.
As for whether it is bipolar disorder, a face-to-face evaluation by a physician is necessary.
Wishing you all the best.

Reply Date: 2015/11/09

More Info

Understanding the complex dynamics of family support for individuals suffering from depression, particularly when compounded by bipolar disorder, is crucial for both the patient and their loved ones. Your family member's situation is indeed challenging, and it is commendable that you are seeking to understand how best to support her.

1. Diagnosis of Depression and Bipolar Disorder: It is essential to have a clear diagnosis from a qualified mental health professional. Depression and bipolar disorder can present with overlapping symptoms, but they require different treatment approaches. A psychiatrist or a clinical psychologist can provide a thorough evaluation to determine the correct diagnosis. If your family member has been diagnosed with both conditions, it is vital to follow a treatment plan that addresses both.

2. Family Dynamics and Support: Family dynamics play a significant role in the recovery of individuals with mental health issues. It is common for patients to feel more understood and supported by friends or partners than by family members. This can lead to feelings of isolation or resentment within the family. Open communication is key. Encourage your family member to express her feelings and thoughts without fear of judgment. It may help to establish a routine of family meetings where everyone can share their feelings and concerns in a safe environment.

3. Living Arrangements: The question of whether your family member should live independently is complex. Given her current state, where she experiences symptoms such as sleep disturbances, appetite changes, and social withdrawal, it may not be advisable for her to live alone at this time. Instead, consider a supportive living arrangement where she can have some independence but also have family members nearby for support. This could help her feel less isolated while still providing a safety net.

4. Understanding and Patience: It is crucial for family members to educate themselves about depression and bipolar disorder. Understanding that these conditions are not a reflection of the person's character or willpower can foster compassion and patience. Family members should strive to create a supportive environment that minimizes stress and promotes open dialogue. Avoiding criticism and instead offering encouragement can significantly impact her recovery.

5. Professional Help: Since your family member is currently seeing a neurologist, it may be beneficial to consider a referral to a psychiatrist or a mental health specialist who can provide targeted treatment for her mental health conditions. While neurologists can address neurological issues, psychiatrists specialize in mental health and can offer medication management, therapy, and other interventions tailored to her needs.

6. Self-Care for Family Members: Caring for someone with depression or bipolar disorder can be emotionally taxing. It is essential for family members to take care of their mental health as well. This might involve seeking support from friends, family, or even professional counseling. Support groups for families of individuals with mental health issues can also provide valuable insights and coping strategies.

7. Encouraging Treatment Compliance: Encourage your family member to adhere to her treatment plan, including medication and therapy. This can be challenging, especially if she experiences side effects or feels that the treatment is not helping. Regular check-ins about her feelings regarding her treatment can help her feel supported and understood.

In conclusion, supporting a family member with depression and bipolar disorder requires a multifaceted approach that includes understanding, patience, open communication, and professional guidance. It is a journey that involves both the patient and their family, and while it can be challenging, it is also an opportunity for growth and deeper connections. Remember, recovery is possible, and with the right support, your family member can navigate through this difficult time.

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