There are times in all our lives when love, to paraphrase Bob Dylan, can feel like a four-letter word. Dealing with a depressed friend, spouse or family member definitely qualifies as one of those situations in which our emotional, physical and psychological endurance is tested, sometimes to the breaking point.

Rebecca, 50 (who asked that her last name be withheld to protect the privacy of her family), is well aware of the heartache of trying to cope with a depressed family member. A few years ago, her younger brother went through two significant depressive episodes while he was in his early 30s.

"One day he was unable to go to work and never went back," she explains. "He’d been showing signs of stress that worried me. He had physical problems — weight gain, heart palpitations and things. Immediately before his crisis, he seemed fairly normal. He was laughing the day before. And the next day he was virtually catatonic."

For Rebecca, who never married and is without children, attempts to help were made more complicated by established family patterns. As the oldest of four children, she’d often played a maternal role, and this instinct kicked into overdrive, particularly during the second episode.

"The second time, a lot just happened at once and I didn't realize I had a problem," she says." I was calling his wife and his physicians — just fielding all these phone calls, and feeling that I had to make these decisions and that if I didn't find him help, no one else would."

A variety of factors in her own life converged at once, including menopause and stress at work, and eventually led to her own subsequent breakdown.

"A lot of it was anxiety … I managed to cope in ways that my brother didn't, but when I look back on it now, I was nuts," she laughs.

Like her brother, Rebecca began seeing a therapist and started taking antidepressants, which gradually improved her frame of mind. "Oddly enough, when my brother started doing better, I started feeling awful," she wryly observes.

In retrospect, she feels she simply pushed herself beyond her limits. "I did the right thing by intervening and pointing out to others that he was behaving suspiciously, but I probably went too far in thinking that I was the only one who was paying attention and could fix things for him, which is not true."

Janet (who also asked her surname not be revealed), now in her late 20s, was only 15 when her older sister was diagnosed with clinical depression.

"It was a very confusing time, especially because of my age. [At] 15 your life is very dramatic and you're very focused on yourself," she says. "Also, your hormones are out of whack and you're ultra-sensitive … all of these factors make it extra difficult to deal with the depression of a loved one."

For Janet, dealing with her sister’s personality shift was most painful.

Their once close relationship disintegrated in the face of her sister's overwhelming sadness. "The memory that most sticks out in my mind was my sister telling me she was going to bed. I asked her when she wanted to be woken up, and she replied she never wanted to wake up."

Unlike Rebecca, Janet responded to her sister's depression by withdrawing completely.

"I avoided the house … I realize now this was the worst thing I could've done. It only hurt my sister's feelings more and gave my parents added stress," she says.

Rebecca and Janet's stories represent familiar responses to depression. According to Vancouver-based clinical psychologist Dr. Valerie Whiffen, author of A Secret Sadness: The Hidden Relationship Patterns That Make Women Depressed, most people cope with a depressed person by becoming overly involved or retreating from the situation altogether. Often friends and family alternate between these two extremes — even within the course of a day.

"At times they are in there, helping and talking — wanting to be supportive," explains Whiffen. "Then at some point, the non-depressed person just gets exhausted … nothing seems to change and so they withdraw to contain themselves emotionally."

This see-sawing between emotional extremes, though understandable, is the worst environment for all involved.

"It sends a mixed message to the depressed person that actually maintains their depression," Whiffen says.

Withdrawal can feel warranted, however — a depressed person can be very unpleasant company. The problem is that unpleasantness is a symptom of the illness.

"The critical thing about a depressed person," explains Whiffen, "is their hostility. They are really angry and they're easily irritated. At the same time, however, they are often very sensitive, so although they might be quite mean and nasty to you, if you respond in kind they get terribly hurt."

Dr. Raymond DePaulo, chairman of the Department of Psychology and Behavioral Sciences at Johns Hopkins University School of Medicine in Baltimore, Md., and author of several books on the subject, including Understanding Depression, encourages families to understand that harsh as they seem on the outside, the depressed person is often being much harder on themselves.

"The more severe the depression, the more that's true," DePaulo says. "For example, patients will often say to us, 'People say they like me, but I know they really don't like me.' And we'll say, 'Well, how do you know that?' And they'll answer, 'No one loves me, no one could love me and anyone who says they do is lying or a fool.' That's literally a quote I've heard 100 times."

In DePaulo's experience, patients often blame their spouse or work — even the city they live in — for their depression. Relatives must see this behaviour in the light of the illness, however, and not interpret symptoms such as withdrawal or irritability as rejection, advice that can feel like a tall order in the heat of emotional turmoil.

Though both doctors counsel people to guard against taking a loved one's behaviour personally, both DePaulo and Whiffen emphasize the importance of setting personal limits.

"I think the people who do best with a depressed partner — here I'm talking about a spouse and not a parent, a parent is a whole different ballgame — are those who are able to be warm and supportive and who are able to establish boundaries in non-angry ways, to say 'I don't like the way you are treating me right now,'" explains Whiffen. He also advises people to avoid the temptation to "therapize" their loved one.

"With a depressed person, to talk about the problem with someone who is close to them is not always helpful," he says. "Supporting them to get professional help is really important, because when people are depressed they are already down on themselves and they don't need to feel like a patient in their primary relationship."

The unforgiving reality is that caring for a depressed person can be an enormous test of personal strength, with few opportunities for reprieve. But martyrdom is not a necessary requirement — nor is it practical.

"You've got to take care of yourself. Even if your loved one is better now, you've got to be ready for another episode down the road," concludes DePaulo.

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