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Dear Mayo Clinic: My brother has been diagnosed with depression. I want to help him, but I don’t know what to do. Can you give me ideas for how best to support him?

A: When a loved one is affected by depression, it can be difficult to understand what is happening or what you can do to help. Clinical depression is an incredibly complex and individualized process.

Understanding depression spans multiple levels of knowledge, from genetics and brain biology to culture and situational stress. Yet despite all the information, universal truths or simple solutions do not exist.

Gaining perspective on what your brother is experiencing can be critical to the support process. Visualizing depression as a downward spiral is one way to simplify and understand clinical depression.

The downward spiral may begin with the person feeling worse than usual from physical, social or psychological stressors. A worsened mood may lead to taking part in fewer meaningful day-to-day activities.

Self-criticism and stress increase due to mounting responsibilities or missed opportunities. Depressive thinking may encompass guilty thoughts, pessimism and irritable behavior.

As the spiral develops, a complex dynamic emerges. Your loved one becomes increasingly stressed while simultaneously less capable of coping with this stress.

The brain’s response to this dynamic is to slow, stop and depress. A person can get stuck at the bottom of the spiral for weeks, months or years.

The silver lining is that if people can spiral down, they can spiral back up. However, depression affects the motivation, energy and curiosity needed to do so.

It is challenging not to be able to fix a loved one’s depression. But you can help them start to move on an upward path and support them in their journey.

Here are some suggestions to offer support and understanding:

Learn the symptoms

Depression signs and symptoms vary from person to person and can include:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities
• Insomnia or sleeping too much
• Tiredness and lack of energy. Even small tasks take extra effort
• Changes in appetite — reduced appetite and weight loss or increased cravings for food and weight gain
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or taking unnecessary blame for things
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent mention of death, suicidal thoughts or attempts

Symptoms can be severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships.

Clinical depression does not require profound sadness or intensely negative feelings. Rather, it can be a lack of positive emotion. People may generally feel miserable or unhappy without knowing why.

Encourage treatment

People with depression may not recognize or acknowledge their symptoms. They may have difficulty seeing the point of getting treatment. This is where you can be most helpful.

Consider the following:

• Talk to your brother about what you’ve noticed and why you’re concerned.
• Explain that depression is a complex condition — not a personal flaw or weakness — and that effective treatment exists.
• Suggest seeking help from a healthcare or mental health professional, such as a licensed counselor, psychologist or psychiatrist.
• Express your willingness to help by setting up appointments, going to them with him, and attending family therapy sessions.

Reinforce healing with support

You can assist your loved one in the healing process. Consider these ideas:

• Encourage sticking with treatment. Help your brother to take prescribed medications and keep appointments.
• When your brother wants to talk, listen carefully and intently. Avoid giving too much advice or too many opinions, or making judgments. Just listening can be a powerful tool.
• Give positive reinforcement. Remind your brother about his positive qualities and how much he means to you and others.
• Offer assistance. Certain tasks for your brother may be hard to do. Suggest specific tasks you’d be willing to take on.
• Help establish a routine. Someone who’s depressed can benefit from having a routine or increased structure. Offer to make a schedule for meals, medication, physical activity, sleep, outside time or time in nature and household chores.
• Locate helpful local organizations. Finding mental health treatment can be burdensome. You may be able to obtain help from resources such as the National Alliance on Mental Illness, employee assistance programs and other community-based groups or programs.
• Make plans together. Ask your brother to join you on a walk, see a movie, or work together on a hobby or other activity. But don’t try to force him into doing something.
• Be patient. For some people, symptoms can quickly improve after starting treatment. For others, it will take much longer.

Be aware of suicide risk

People with depression are at an increased risk of suicide. If you believe your brother’s illness is severe or that he is in a potentially life-threatening emergency, you may need to contact a healthcare professional or hospital. You can also call the National Suicide Prevention Lifeline at 988. To reach the Veterans Crisis Line, use the same number and press “1.”

Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. Email a question to MayoClinicQ&A@mayo.edu. For more information, visit mayoclinic.org.

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