Boundaries

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.