If depression affects 20% of our population, then the number of loved ones touched by this illness probably includes most of us.  So what can we do when a loved one is depressed and refusing treatment?  Case in point is "distraught mother" below who will be joining me on Tuesday's web chat.

Hi Dr Dan

I enjoyed reading your column, but your last one on "the depths of depression" spoke to me directly.  This subject is of particular importance to me because over this last weekend, I discovered that my eldest daughter has fallen again in a deep depression.

My husband & I struggled to communicate with her about her need to seek treatment. Then your article appeared in the paper. Very timely. She has 4 babies with the youngest one-year-old, and after each one, and she had a postpartum depression.  Her husband works long hours which I am sure adds to the stress.  We live in another state which makes us feel more helpless and frustrated. 

 Her situation is very stressful, but is compounded by the depression which has developed since she stopped taking her medication about 8 weeks ago. That's because she has a history of eating disorder and she feels the medication is making her put on weight. Lately she has been cutting herself off from everyone.  But the most frightening part occurred last week when she called me hysterically crying and said she did not want to be a mother anymore.  As she is an adult woman and I know I cannot force her to take antidepressants. My question is, what can I do to convince her to get treatment before she hurts herself or her children? The situation seems dire, please help. Distraught mother

Dear distraught mother,

Any good parent can understand the desperation you must feel.  After all, our primary instinct is to protect our children.  That only gets magnified when we have grandchildren.  Okay, by now you probably know my mantra about releasing our grasp on adult children, and not being reactive to our own anxiety and helplessness.  All of which is true -- until it happens in your family. 

Although you cannot control your daughter's behavior or even her thinking, you also cannot be passive as that last phone call sounded desperate and dangerous.  So I would suggest doing two things simultaneously.  I know she is seeing a therapist every other week, but he/she should be notified right away about your daughter's desperation.  I don't know the laws in the state where she lives, but in some states that threat might be enough for outside agencies to intervene and get her into treatment.  Her husband also must know how desperate the situation is and some things he can do.  For example, he can contact their local county office of mental health to find out what they have available.  Also national organizations like National Alliance of Mental Illnes(NAMI) and the national mental health Association (MHA).  In addition, it would help if friends and family could spend time in the home helping with child care as having four babies would tax anyone's emotional resources. 

So one route you can take his aggressive intervention with agencies and support networks.  But that is not the only route. I also have other suggestions.  And here I don't speak just as a family therapist, I speak as a father.   When my daughter experienced depression for the first time, she was a young adult and living independently.  Just like your daughter, her symptoms started in childhood when she would isolate herself.  And just like your daughter as she grew and the depression worsened, she began to engage in behaviors that were of concern to me and the rest of the family.  And like your daughter, whenever someone said anything about her behavior, she became defensive.  She lived within driving distance so I asked her if I could come up and just hang out for a day. This may or may not be a possibility for you.  But if it is, I urge you to consider it.  Anyway, as  I was driving to her home, I thought back to when I specialized in substance abuse.  I recalled that their families thought the problem was drugs or alcohol, and the abuser thought the problem was the family!  And then I realized that I had been thinking the problem was my daughters’ depression and her behavior while she was thinking that the problem was everyone else.We spent the whole day together exploring her new neighborhood, visiting her worksite and hanging out with her animals.  We didn't talk about her depression or the risky behaviors she was engaging in, we just talked about her (okay, and me also).  For the first time since the crisis began, I felt close to my child and I am sure she felt the same with me. It was then that I asked her about how she was feeling about her life and herself.  And then I listened for a long time.  When she was done, I told her that her suffering broke my heart and that the reason she suffered was because of her genetic-based illness called depression. I almost cried when she looked up at me wide-eyed and said "I thought everyone felt this way." 

Although medication and psychotherapy combined are the treatment of choice for depression, there is also plenty of evidence that family therapy helps.  If you or your spouse have had depression I am sure an open discussion about your experiences, your impulses and your coping strategies would help diminish some of the shame your daughter feels.  And very often beginning with family therapy helps the person with the symptoms feel less like "the sick one".

Keep in mind that despite your terror, what she really needs from you is intimacy, safety, trust and love.