The person with depression usually can’t see a way forward. They may fervently believe that nobody can help them, and life is pointless. That doesn’t mean that they’re right, and there are plenty of things that you can do to help.

The type and amount of care that you can give will depend on your relationship with the person, but here are some ideas.

1. Understand the illness.

Learn all that you can about depression. The better you grasp the illness, the more effective you will be in giving your care and understanding. It will help you to understand why the person behaves the way they do, and better equip you to respond appropriately.

2. Seek Appropriate Treatment

This is such a far-reaching, wide-ranging topic that I would be foolish to give advice. Suffice to say that it will be helpful for you to explore the treatment options available in your area and suggest to the person that they need professional help. It might be helpful for them if you go along to the first or subsequent appointments. Often a person actually feels relieved to hear a diagnosis and know that they are sick and that they can be helped. This was really true for me.

If he or she won’t admit they need help then explain why you are concerned and perhaps provide them with some helpful written information to chew over.

3. Provide Emotional Support

Your partner or friend needs patience, care and understanding. They have a real illness, and just like someone with cancer they can’t just “snap out of it”. If they could, they would. Saying things that show ignorance about the illness is counterproductive and will reinforce their negative thinking.

The best way to communicate is to empathise, listen more than talk, and ask questions like “How can I support you?” or “How can I help?”

4. Keep the Illness Separate

The illness and the person suffering the illness are not the same thing, so keep them separate. When they express pessimism, anger, frustration, or sadness, it is the illness talking not the person. If you separate the two you will find it easier to cope emotionally. It will help you to be a more effective caregiver.

5. Listen Non-Judgmentally

Don’t try to talk a depressed person out of their feelings, no matter how irrational they sound. This is likely to compound the problem. It is better to remain neutral and say something like “You are obviously really suffering with this. What can I do to help you feel better?” Keep your suggestions, solutions and advice for another time. My wife has also found that posing suggestions as a question helps me to have some ownership of the solutions. It stops me feeling nagged too!

6. Make a Plan

Help the person to make a plan for coping with depression. Identify things that trigger or worsen the depression and things that make it better. Think through and list the ideas formally on paper. Help them to put this plan into action. Some positive, helpful things to include are getting to bed early, having adequate sleep, exercising regularly, drinking plenty of water and eating healthy foods. The plan will be an evolving document as things change, so be prepared to re-visit it on  a regular basis. I often need my wife to remind me what works for my health as sometimes I go off track. This is a key role that the caregiver can play.

7. Look after yourself

As a caregiver you are likely to be under stress. You need to care for yourself by taking time out and recharging your batteries. Find other friends or relatives who you can talk to and rely on at a pinch. Sometimes you will need a sounding-board to keep things in perspective. Make sure you continue to live your own life as well, and spend time doing things you enjoy. My wife loves her part-time job for many reasons, but high on the list is escape. Although she is working, it’s a great mental break for her when home life is dominated by my illness. 

There are services that provide education and support for caregivers. Through information sessions and support groups, you can talk to people who are in a similar position.

8. Organize their medicines

If your partner or friend is taking medicine for depression then it is crucial for them to follow their prescription. Too many people go on and off their anti-depressants depending on how they feel. This all but eliminates their effectiveness.

I take medicine at night without any problems, but if it wasn’t for my wife handing the pills to me I would never take them in the mornings. She also fills my scripts and tells me when to go to the doctor for more. It’s not laziness; it’s just the nature of depression. More than once I have spent hours in bed staring at my pills, but not had the mental energy to actually take them. If your partner or friend is not complying with their prescription, try to find out how you can help.

9. Support network.

Introduce the idea of joining a support network for depression. This will give them an outlet for discussing their problems and receiving input, and help them to discover that there are other (normal) people experiencing similar problems. There are depression support groups everywhere. Make sure that you find one that is positive and focused on recovery. Inward looking, pessimistic groups can be unhelpful.

10. Get out and About

One of the most therapeutic things that a depressed person can do is step out the front door. Natural light is very beneficial, especially early in the day. Exercise also has proven benefits. Something as simple as taking a walk or gardening should lift the person’s mood. Anything low-key that involves going out can also help; seeing a movie, meeting friends, or going out to eat, just to name a few ideas. The most effective way for me to get up and out the door is to take the kids to school. There is a set time to go, which gives me routine, and the kids are great company.

11. Help with daily tasks

When your body is heavy and your mind is dark, there is nothing harder than the burdens of everyday life. Something that seems minor to you may be an insurmountable task to your friend or partner. Ease their burden by helping with the daily load – running errands, doing the shopping, cooking, taking the kids out for a couple of hours. You may be surprised to find that helping with a very simple chore could relieve them of a lot of stress. 

We had an old mattress that needed to go to the tip. My wife asked me to take it there for months, and over time it became a source of tension. But my thinking wasn’t rational and the thought of going to the tip overwhelmed me. When she understood what was really going on she asked a friend to take it. That was a huge relief to both of us. 

12. Spend normal time together

Just spending time with the person lets them know that you care and want to understand their problems. Enjoy the reasons for being their companion in the first place. It’s important that they live as normal a life as possible. Help them to do this by carrying on your relationship with them in a normal fashion. Don’t let everything get dark and serious. Find some positive things and try to enjoy them together.

The points above are general by necessity. They don’t fit all circumstances, but I hope that you find at least a few helpful ideas.

I spent 16 hours in a row to get an animated graphic to work properly on a website. That’s very sad. I’m a perfectionist, and on that occasion I was out of control.

Perfectionism is tricky. A little bit can make you strive hard; too much and you’re susceptible to stress, anxiety and even depression. Where is the line between the two?

Here is a comparison from the University of Texas Counseling and Mental Health Center.

A perfectionist:
- sets standards beyond reach and reason
- is never satisfied by less than perfection
- becomes dysfunctionally depressed when experiences failure
- is preoccupied with fear of failure and disapproval
- sees mistakes as evidence of unworthiness
- becomes overly defensive when criticized

A healthy striver:
- sets high standards, just beyond reach
- enjoys the process as well as the outcome
- bounces back from failure and disappointment quickly and with energy
- keeps normal anxiety and fear of failure and disapproval within normal bounds
- sees mistakes as opportunities for growth and learning
- reacts positively to helpful criticism.

Perfectionism is destructive and people seek and receive treatment for it. CBT is the norm. To me the hardest thing is seeing when aiming high is getting out of hand and becoming destructive.

Writing this post is a good case in point. I should have a stopwatch on.

There are questionnaires at the BBC and Discovery Health that can give you an indication of where you lie on the scale. If you do just one then I think the shorter Discovery Health is better.

The best thing about the book is the practical ideas for helping an ill person. They are not platitudes like “If there is anything I can do…” but ways to be proactive with providing your support.

The book is focused on the chronically ill, and applies to the whole range of mental illnesses, but it would also be relevant to helping friends in any kind of need.

With the author’s permission I’m listing my favorite twenty.

3. Put meals into disposable containers and attach a note saying “This doesn’t need to be returned.”

5. Arrange for your friend’s kids to have a night with your children.

15. Treat her to a gift of movie rentals via postal mail through a service ($7-15 a month).

18. Mop the floors.

21. Ask, “Do you have an errand I can run for you before coming over?”

42. Don’t say, “Let me know if there is anything I can do.” People rarely feel comfortable saying, “Yes, my laundry”. Instead pick something you are willing to do and then ask her permission.

44. Buy a magazine subscription for her on her favorite topic.

59. Say, “I’d like to bring you dinner next week. Would Monday or Tuesday night be better?”

81. Ask her if she wants to house-sit when you are on vacation. New surroundings may feel like a mini-vacation.

116. Take her kids for a movie and ice cream.

152. Watch your friend’s children so she and her spouse can have a night out.

180. Ask her if she’d like you to help rearrange her furniture for a fresh feeling in her house.

197. If a massage would feel good (it doesn’t always), give her a gift certificate for one.

199. Help her with her children’s birthday parties – but don’t take over; let her make all the decisions.

304. Clip cartoons that will make her smile.

316. When you leave ask, “Do you have mail I could drop off for you?”

406. Talk about normal everyday things, not just the illness.

424. Help her children pick out gifts for her on special occasions like Mother’s Day.

462. Go with her to the doctor and then go get coffee or lunch afterward. Medical visits get lonely and depressing.

468. Teach her how to use the Internet so she can learn more about her illness from medical websites.

The book is available by direct purchase from the Rest Ministries website.

So we drove that way and the mattress stayed on for about a mile before sliding. We checked it, and checked it again, and continued like this until we were nearly there, when a truck passed us with speed and the mattress flew off altogether. (Queen size by the way.) The twine was still intact, but the mattress handles were shredded. So we eventually limped in to the dump, mattress carefully balanced on top and hazard lights on. It was a funny experience and we had a lot of laughs.

I’ve written about this because it says a couple of things about how I handle my role as a caregiver.

Know the limits of what your partner or friend can do
Removing a mattress was overwhelming for James. He put it off, and ignored it, and put it off some more. The reason was that the task – mental as much as physical – was insurmountable to him. It’s quite different from laziness, as anyone with depression will know. But the mattress was stopping me from getting to my wardrobe and it had to go. My frustration was building up, despite knowing what was going on in James’ mind. I decided to just do it myself rather than let it become a big issue. That’s not to say I’m being a doormat. When I stop and think about it I recognize what’s happening under the surface and take a practical approach.

My support network is crucial
I have a small network of friends who will help me in this sort of situation. Through bitter experience, I know that some people are understanding about mental illness and others are not. My close friends are. I also know not to wear them out, so I share my problems around. They give the emotional support I need when I’m not getting it at home. They let me vent, they help me in practical ways, and they still share good times with me. They also think highly of James even though they know how awful he can be. That’s very important to me. I’m very fortunate as a caregiver to have supportive people around me. I know that many people are struggling along without much help. I can’t emphasize enough how important it is to develop those supportive relationships, for friendship, for emotional support and for practical help for things like moving mattresses.

My mental health is crucial
I have to be proactive about having time out, having a break from the intense times, and even some fun. I used to feel guilty about this, but it’s actually wise to keep looking after your own health. My family are good with giving me practical help, like taking the kids, when I need to do something on my own.

Learn to forgive and grieve
It’s easy to feel sorry for myself, but I’ve learned to forgive and move on. James forgives me for a lot of things too; it’s not a one way street. I’ve had to mourn the life that I thought James and I were going to enjoy together. He is not at all like he was when we married. But I always remind myself that I should be thankful for what we have, and what I have, and not dwell on what we don’t have, and to pray on all occasions.

Click here for the fifth and final post in this series, Loving the Person You Care For.

In my last post I wrote about the diary I kept for 2 years; it was the key to working out what caused James’ mood swings. We made some breakthroughs just by reading it back from time to time, but most progress came from charting the data in an Excel spreadsheet. This gave us a clear, visual way to see the relationships between triggers and symptoms. We discovered a couple of major depression triggers this way, and also found that small things that were minor irritations would snowball with other events added in.

The trick for us was to discover which triggers were the most important ones, where the threshold was before they would have an impact, and what we could do to reduce their effects.

Here’s an example. We used to have a busy social life. Through my diary, I began to notice that 2 days after a meal out, James would spiral downwards very quickly and experience a period of depression for 5 or 6 days. It was a very strange, but consistent pattern. We eventually discovered that certain food additives were a trigger; things like preservatives, artificial colors and artificial flavors. Adjusting our lifestyles and upending our diets was difficult, but by doing so we pretty much eliminated one of his major triggers.

Another example is our “feral hour”, around dinner time when the kids are tired, hungry and cranky. Very loud noise is another trigger, since it causes James to become very irritable. If it becomes all too much he will disappear until the kids are calm again. He can now recognize when his irritability is rising, and so takes preventative action. The key is that we have agreed that he can do this when needed, so I don’t feel resentful for lack of help. Leaving me to handle “feral hour” alone is better than suffering another bout of depression.

This knowledge continues to be very helpful to us. We know the little things that can snowball, and we take action when, or before, these little things happen. It’s a preemptive strike, so to speak. Whenever a trigger or potential trigger comes along we have a specific plan to remove its effects. As a result James’ depressive and manic episodes have become more intermittent.

Click here for the fourth post in this series, Keeping Your Mind Together.

• I’ve learned how to say no. If you are good at something, like work, then people ask you to do more. It builds up over time. I’ve learnt to say no. I can’t. I have bipolar. Sorry.
• I don’t worry about what I’m going to wear, and I don’t have to keep track of my clothes cycle. I don’t care what I’m going to eat for dinner, whether I need a bigger television or a new car. If I didn’t have bipolar these things might continue to consume me as they once did.
• My marriage is far stronger today than it would have been if I didn’t have bipolar. Apparently 90% of marriages where one partner has bipolar end in divorce. That is truly tragic and saddening. My wife had lots of reasons to leave me when I was ill for prolonged periods, but she stayed even though she didn’t understand what was wrong with me. Her perseverance has been a blessing to our marriage.
• I have great relationships with my kids and time with them is invaluable. Unfortunately most Dads don’t spend more than a few minutes a day giving their kids undivided attention. Learning that I had bipolar was a good wake-up call. I now spend more time on things that are important to me.
• I’ve slowed down a lot. I stopped wearing a watch some years ago and haven’t missed it. Losing track of time rarely causes problems; if I’m 10 or 15 minutes late for the doctor, it doesn’t matter. He works to the same system anyway.
• I take my physical health more seriously than I used to. I’m frustrated by my lack of action on exercise, but I’m thinking about physical health every day, even when its hard to follow through with action.
• I’ve always been very open about having a mental illness, and I’ve actually never felt the stigma that is so widespread. I’m fortunate in that respect. When I converted to Christianity about 20 years ago I lost most of my good friends who had an issue with it. Since I’ve been telling people that I have bipolar I’ve gained at least the same number. Go figure.
• I’ve learned to be thankful for what I have and not yearn for what I don’t.
• The best thing must be the ability to empathize with others who are facing the same problems.
• I was once very guarded with what I said, often checking myself from saying anything that could offend or impact a person’s view of me. I’ve really lightened up and feel liberated. I’m rarely inappropriate (except when ill), but even if I am, I sense that nobody really cares.
• In the Bible, in Romans 5:3-4 it says:
  “We rejoice in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope.”
• Being engaged with the world is good. I think more deeply about things like inequality, poverty, the environment and mental illness. (The downside of course is feeling let down by those in positions of power who continually fail us.)
• Life is absurd. My life is absurd. I’ve learned to laugh at both.

We have some friends who for many years had a very, very messy house. 3 young girls – cooking, dress-ups, paint, craft, clothes, toys – you know the rest. They would unashamedly invite friends over for meals, joking that they offered an important service to other parents. It helped their friends feel better about their own messy houses.

In a similar vein I found this in another blog:
“When you’re mentally ill you are constantly doing social work just by existing. I realize that often, when you’re crazy you actually need social services for yourself, but just by talking about yourself to people who aren’t feeling that great about themselves, you are able to instantly make them feel glad they aren’t you. That’s a great service to offer.”

A final word is that I definitely don’t have it all together, and I still have episodes now and then – although less severe – in both directions. I didn’t write this post to give a different impression, but just to put some ideas out there for looking at illness from a different angle.