Your Family Tree

The behaviors and mood of a depressed person affect the whole family. There's the irritability, which sets off conflicts and derails family dynamics. The negative thought patterns, which become a prism of pessimism for everyone. The withdrawal that literally disrupts relationships and breeds wholesale feelings of rejection. There are major responsibilities that get displaced. There is a general burden of stress.

And yet, families can be major forces of care, comfort, even cure. They are crucial to proper recognition and treatment of the disorder, not just at the beginning but throughout. They are the de facto caregivers, willingly or not. They contribute powerfully to the emotional atmosphere the depressed person inhabits, and so can be agents of recovery. Or not.

Yes, depression has a huge impact on families. And families have a huge impact on depression.

Nassir Ghaemi, assistant professor of psychiatry at Harvard, contends it's not even desirable to make the correct diagnosis of depression without the family. For one thing, many people—particularly those at either end of the age spectrum and those with medical conditions—don't realize they are depressed or may attribute symptoms to other things. The perspective of family members is useful.

But it's downright essential for prescribing. "To treat any depression accurately, you have to know whether it is unipolar or bipolar—in other words, whether the person has been manic in the past, " says Ghaemi. "Our research shows that 50 percent of patients are not even aware they are manic when experiencing mania. Family members recognize manic symptoms twice as often."

Then there's the need for continuing diagnosis, because one episode of depression doesn't eliminate the possibility that mania will develop, especially in persons under 30. Bipolar disorder typically begins with a depressive episode, and the average age of onset is 19. But a first manic episode does not occur until age 25, on average.

The younger the patient, the greater the risk they will end up having bipolar disorder. Standard antidepressants could precipitate mania. In those cases, Ghaemi considers it essential to warn patients and family about manic symptoms. Even in established cases of bipolar disorder managed with mood stabilizers, the Harvard psychiatrist considers family members indispensable for the early recognition of manic symptoms.

When prospective patients first call for an evaluation, Ghaemi asks that they bring in a family member. "Then I ask the family to feel free to call me any time the patient is developing mood symptoms of any variety."

Confidentiality is not a problem. "There's no confidentiality constraints against my ear being open, " says Ghaemi. "I can't say anything, but I can listen to what they say."