Laura, what a tough situation. Sending your sister some good vibes.

The last time I was seriously depressed, my friends and family took turns calling me frequently to chat. They also recruited friends and acquaintances who might not otherwise call, to talk to me about their experiences with depression. It helped tide me over until the meds kicked in. This was at a time when I was living in Arizona, so no one was physically near enough to do much more. It did help. Their reminders that the problem was a physical one, taking place in the physical brain rather than just being "all in my head" helped. Knowing that I was not alone, that even if they were far away, they still cared, that helped.

If you are worried that she is suicidal, do talk to her directly about it. A reminder that it is far too permanent an action, and that things are going to get better if she can just hold on long enough, can be more useful than worrying that saying the "s" word might give her ideas.

This link [link] may be of some use, from the Depression and Bipolar Support Alliance.

Also, understand that if she does become determined to commit suicide, there may be nothing you can do to stop her. A determined person will find a way around all precautions, even the ones that the most skillful of professionals can come up with. I do not say this to discourage you. Do the best you can. But it is possible that your best may not be good enough. And that will not be your fault. One time to be especially mindful of suicidal intentions, is after treatment has started working. At its worst, depression is paralyzing. When it starts to lift, the patient may have the energy to act, before actually starting to feel enough better to stop wanting to. I am not trying to cause panic, so I hope this isn't too much.

On a lighter note, laughter can do a lot, in the moment and in the long term. If there is are comedians she likes, or a particular genre of comedies, finding some audio or video for her could be of some use.

ETA: I also remember a therapist telling me that listening to sad music makes a person feel sadder, except for the Blues. But listening to happier music can help too.

I am just feeling so completely helpless to do anything for her.

First, what others have said -- there's only so much you can do. But a few ideas that may help ease the situation.

Can cousin get her out of the house? Doesn't have to be anything big, just getting out and getting sun. Weather permitting, even sitting on the porch can help.

Breaking out of the routine can also help. Again, doesn't have to be a big deal. Even checking out a new TV show might break her out for a little bit.

Laura, it's hard to answer without knowing a bit of your sister's personality. Knowing what the person responds to and what they resist helps one develop an approach. However, there are definitely times when a depressed person needs some tough love. They're stuck in a hole and sometimes they won't see anything but the walls of that hole unless they're forced to stick their head above ground. When they say something that's relentlessly negative, it can be good to give them a reality check, preferably in a Socratic manner so they don't accuse you of being a Pollyanna.

There's an app I've used in when in my worst depression to try to track mood and what things might be making it worse. Just the act of tracking makes me have to examine my life instead of making assumptions about it. It's available for Mac, Windows and as a web app:

[link]

I think having someone there with her is a good thing. When depression is really really bad, many people have trouble even getting out of bed and they fall further and further into hermitry even though that can be exactly what they don't need. If your cousin can somehow go on walks with her or do something to get her moving, I think that would help some.

This season can be hard not only because of holiday family stuff but because the days are so short. Try to help her get on a schedule that she's not sleeping away any of those daylight hours. Candles can help make the early nights a bit cheerier.

Nutrition is important. Make sure she's not deficient in anything because some deficiencies can cause depression. Tryptophan is the pre-cursor for serotonin production. It's present in turkey, milk and other foods so if she's resistant to taking L-Tryptophan in pill form, maybe she'll eat foods that contain it. Stay away from things that bring on crashes like sugar, caffeine and alcohol.

Lisah, I would agree that a typed note with your signature should be just fine.

What everyone said about depression. Ask directly if she's suicidal, and if so, whether she has a plan. And if she's really determined, she will find a way. But it's one area where I've found directness to be most effective.

One of the most freeing things I found, and this is my experience, so her personality may not be the same (but I think this holds true for the majority of people suffering from depression) is just telling her what you understand about what's she's going through. That it's horrible, that it makes people with it feel like they are worthless, that things are hopeless, that they don't have the energy sometimes to even cry, that you can look ok from the outside when everything's shitty on the inside, that it's secretly something you feel you SHOULD be able to control, that it's your fault...

Tell her that these are what people you know who are depressed feel, and that you get that what she's going through sucks ass, and that you don't blame her, it's a chemical imbalance, and you are there and you love her.

I had to be told many, MANY times that severe depression is a disease, like diabetes, and like diabetes, you have to do certain things or you WILL get sick again.

Ask her what helps, if she needs to communicate via email vs. phone (because I found I could NOT talk to people sometimes F2F, but I could say stuff via email.)

Send her random, but SINCERE notes in the mail. Take her to get her hair cut or a pedi or a massage (feeling and looking better can be important little jolts when you are depressed.)

Ask her if she likes her therapist, what she hates about her meds, let her know you'll listen if she wants to talk about how she feels.

These are the things that I felt, that I know, and that work for me.

Let her know it goes in cycles. Tell her to educate herself about it. If you KNOW what your brain is doing is a pattern or a habit, and that it's a symptom, it can help.

Most of all, Laura, let her know that you love her, and will love her, no matter what. That was important to me when I felt like the world's biggest fuck-up and loser.

Man, it's no wonder I get misty when I read books or see films depicting what a healthy family is like. My eldest brother is crashing his family here while he spends his time in Altadena at my younger brother's Thanksgiving, to which I was not invited. So I've got one brother who is going to make a mess here, not clean up after himself if previous times are any indiction, and basically snub my parents. And I've got another brother who while he is friendly to my face, doesn't invite me to his T-day despite the fact he knows I just moved here this year and know no one in town. This really changes how I feel about him.

Spidra, that's is horrible. That's extremely rude, unless you slept with brother-in-town's wife, or stole his Bible or something. I'm sorry.

{{{{{Spidra}}}}}}

Wait, did younger brother invite your parents and other bro and not you?