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Expert Q&A

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How can I get my brother help for depression?

Asked by Iris, New England

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Here is a question my extended family has that I'm sure many families have today: Do you have any suggestions on how to get someone to go for help with depression?

My brother lost a great job -- his dream job -- this past year due to the economic downturn. He is currently working, but in a job that is in no way fulfilling -- either financially or personally.

Although we are all very proud of him in his willingness to do what he must to support his family, he now thinks of himself as a failure. He has isolated himself and will not return phone calls. For example, he always returned my call within a few hours; I have not spoken with him for more than a few minutes since November, although I've called numerous times.

We are all very concerned, but he won't talk to anyone. His wife has given up, and they seem to live as strangers in the same house. Compounding the problem, he must work 10 to 12 hours a day just to make ends meet; he takes extra shifts to make more money.

Since our family has a history of depression, we are very worried about this situation. He has worked very hard and was very proud of his success but never boastful. He is young enough to bounce back financially, but not if he continues this downward emotional spiral.

Although we are spread out across the country several of us are willing to travel to his home to help.

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Iris,

Couched within your question are a number of powerful insights about depression; your understanding of the situation is itself a powerful reason for hope, despite the bad situation your brother is in. Let me start with your trenchant observation that he is young enough to bounce back financially but will lose the opportunity of his youth if his depression continues to worsen. How true this is!

One of the roughest things about depression is that it is like an invasive species of the mind. Out in the natural world, when an invasive species is introduced into a new environment, it typically spreads everywhere and chokes out all the native life because it has no natural predators. Once established it usually creates what's called a mono-culture, meaning it makes the environment good for itself and bad for everything else so that, at the end of the day, it is the only species left.

Because of the way we are wired by evolution, our brains and bodies are ripe environments for the spread of depression. Once it has gained a foothold in our lives, it tends to spread rapidly, choke out native happiness and make life good for itself and bad for almost all else. So time is of the essence in a case like your brother's. Jobs come and go, but depression typically worsens with time, damaging the brain and body as it grows and spreads. This we know.

I wish I could be as definite in my advice for how to help your brother recognize that he needs treatment. Some people are best approached directly and forcefully; others are better approached in the most roundabout way possible.

For people who are highly resistant to the idea of depression, I often find it helpful to reframe the issue in more general terms. For example, I might tell someone like your brother that he is under the type of stress that, over time, will damage his brain and body, and that if he wants to hang in there with this type of adversity, he should protect himself by taking a medication such as antidepressant that will be stress-protective and help him be more effective in coping with all that's on his plate.

Although I do not know the best way to specifically address the issue with your brother, I do know that it is of greatest importance that you -- and/or other family members -- try your hardest to get him help. Because depression isn't something concrete like a tumor or a blocked artery, we sometimes let it slide. But this is literally a lethal mistake.

In addition to massively increasing the risk for suicide, the stress-related physiological changes that manifest as depression are lethal in their own right. For example, studies in older people have shown that depression is as likely as a stroke or a heart attack to kill someone over a certain number of years. It's hard to believe, but it has been shown so often that it's got to be true.

I would recommend traveling to him and doing all you can, for his sake but also for the sake of his family.

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