Boundaries

Depression can be very difficult — not just for people who experience it first-hand, but also for their loved ones. If you have a friend or family member with depression, you may be able to offer them social support. At the same time, it’s important to set boundaries and address your own needs too.

The Risks of Caregiving

When someone you love is depressed, you may want to help them any way you can. However, it’s also important to take steps to protect your own mental and physical health.

If you attempt to provide care for someone with depression, you’re at risk of experiencing some degree of psychological distress too. One study found that caregivers of people with major depressive disorder and bipolar disorder were more likely to report psychological distress than caregivers who provide assistance to persons with other healthcare needs in the general population. They also reported lower quality of life.

Everyone experiences and reacts to depression differently. Some people with depression become physically or verbally abusive, while others become agitated or act recklessly. Some people react to depression by indulging in drugs or binging on alcohol. Some become so lethargic, they can barely get dressed, feed themselves, or tend to their basic hygiene needs.

When you’re caring for someone with depression, these behaviors may pose a threat to your own wellbeing. You may find it stressful or physically challenging to help them meet their daily care needs. You may even become a target of physical or verbal abuse.

Setting Boundaries

When you’re caring for someone with depression, it’s important to talk about behaviors that are unacceptable or dangerous. For example, consider the following guidelines and strategies.

Stick to the Treatment Plan

Social support is important, but it’s generally not enough to treat depression. If someone you know is coping with depression, encourage them to get professional help. Depression is a medical condition that can be treated with therapy, medication, or a combination of both.

Tell the person you care about them, but you can’t help them alone. Explain why you think they need to seek professional treatment. Insist on them following their mental health practitioners’ advice. For example, they should agree to faithfully attend medical appointments. They should also take prescribed medications as directed. 

Stand Up to Abuse

If the person you’re caring for targets you with abusive language, tell them it’s unacceptable and they need to avoid that behavior.

If they’ve engaged in any sort of physical abuse or violence, insist that they stop. If you suspect your physical health is at risk, ask for help from family members or friends. If you live with this person, it may be necessary to involve local law enforcement officials. If you do not live with this person and you are being physically abused/assaulted, you may need to distance yourself until the person gets the help that they need.

Encourage Healthy Habits 

Encourage the person you’re caring for to channel their energy into constructive behaviors, such as exercise. Regular exercise lowers the risk of depression. It may also help them recover more quickly.

You should also encourage them to eat a healthy diet. Consider supplementing it with vitamin D and omega-3 fatty acids (commonly found in fish oil). Low levels of these nutrients may raise the risk of depression.

One study found that many participants with depression had low levels of vitamin D. Three months of vitamin D supplementation helped relieve their symptoms of depression.

Another review suggests that low levels of omega-3 fatty acids may play a role in some cases of depression. More research is needed to learn if omega-3 fatty acid supplements can effectively treat depression. The risks of taking omega-3 fatty acid supplements are low.

Keep Time for Yourself

Let the person you’re caring for know that you can’t be present 24 hours a day, seven days a week. You need some time for yourself.

Try to follow a healthy diet, exercise regularly, and get enough sleep. To manage your stress, make time for regular breaks and activities you enjoy.

The Takeaway

When you’re not healthy yourself, it can be hard to care for someone else. Take steps to prevent burnout, injury, and illness by setting realistic boundaries. Talk to the person you’re caring for about harmful behaviors. Encourage them to follow their recommended treatment plan, practice healthy habits, and respect your mental and physical health needs.

Depression is difficult for everyone involved. Obviously, even patients with mild depression suffer from the debilitating effects of the illness, while severe depression has been described as “dank joylessness...suffocation” and “a life and death struggle” by some who have experienced it.

Caring for the Caregiver

In the face of such despair and pain, it’s easy to lose sight of the fact that depression is also hard on the patient’s close friends and family, especially those tasked with caring for the depressed individual.

While you may want to help the patient in any way you can, it’s not unreasonable to take steps to ensure your own ongoing mental and physical health and safety. Studies show that people who provide care for a loved one with major depression are often at risk of suffering some degree of psychological distress themselves.

One study suggested that caregivers of people with major depressive disorder experienced reduced quality of life compared to similar people who were not caring for a depressed patient. This impact on quality of life is not unique, however. Distress among caregivers is common for a broad range of disabilities. If you find yourself assuming responsibility for the care of a depressed person, it may be wise to establish some ground rules regarding what is, and is not, acceptable behavior by the patient.

Setting Boundaries

Everyone experiences and reacts to depression differently. Some patients may become physically or verbally abusive, while others may become agitated, or act recklessly. Other people react to depression by indulging in drugs, or binging on alcohol. Still others may become so lethargic they can barely get dressed, feed themselves, or tend to basic hygiene. Some can barely generate the will to get out of bed, or dress for the day at all.

Any of the former behaviors may pose a threat to your own safety or wellbeing. In such cases, it’s advisable to establish what is acceptable behavior in light of the patient’s condition, and what is out of bounds.

The following are some guidelines for caregivers’ successful interactions with depressed patients:

Stick to Treatment

Explain to the patient that he or she must seek, and willingly participate in, treatment for the illness. Require that the patient follow their mental health practitioners’ advice. Insist that the patient agree to faithfully take any prescribed medications, as directed. Also make it clear that the patient must agree to attend any medical appointments without fail. 

No Abuse

If the patient has engaged in abusive language, explain that you will attempt to be patient and understanding, but insist that the patient make an effort to refrain from engaging in such behavior in the future.

If the patient has engaged in any sort of physical abuse or violence, insist that he or she stop. If you feel physically at risk, ask for help from other family members or friends. If necessary, call law enforcement.

Support Constructive Habits

Suggest that restless or agitated patients may wish to channel their energy into constructive behaviors, such as engaging in exercise. Exercise is significantly associated with a reduced risk of depression, and may help accelerate recovery.

Encourage Healthy Habits 

Insist that the patient make an effort to eat a healthy diet. Consider supplementing the diet with vitamin D and fish oil (omega-3 fatty acids). Studies suggest that people with depression are often deficient in these nutrients. Omega-3 fatty acid supplementation is associated with improved outcomes among patients taking antidepressant medications. Studies also show that people with higher levels of vitamin D and omega-3 fatty acids are less likely to become depressed. Some experts suggest taking from 2,000 to 10,000 IU vitamin D daily for the relief of vitamin D insufficiency or deficiency.

Keep Time for Yourself

Ensure that the patient understands that you cannot be present 24 hours a day, seven days a week. You need and deserve time to yourself. Insist that he or she realize that you must also be allowed sufficient time to care for your own needs.