Be on the lookout for signs of depression

o Bethany Storro: Pity or punishment?

o Timeline of Storro story

o Was hearing loss a factor?

Sad facial expressions, withdrawal and irritability are all signs of depression, said Dr. Donald Rosen, an associate professor of psychiatry at Oregon Health & Science University in Portland.

In many cases, an appeal for help is ambivalent, he said.

“Many people in pain both want help and don’t want help,” said Rosen, “whether that is physical pain or psychiatric pain. If you come across somebody who’s injured and ask if they’re OK, they may say, ‘I’m fine, I’m fine, I’m fine.’”

Or, they may need help. And the appeal may not be as public and self-destructive as, say, blotting caustic drain cleaner on one’s own face.

Rosen has not interviewed Bethany Storro and agreed to comment not on her case, but generally on how family and friends can identify signs of depression and help someone in need.

“The advice I would give to family is speak about what you have observed,” Rosen said. “The more you know somebody, the more subtle the cues you can pick up on.”

He offered an example: One friend could say to another, “There have been a number of Fridays where you haven’t wanted to do things. Are you OK?”

“You start with the observation and then ask for elaboration,” Rosen said. “Invite the person to talk.”

Rosen, who is also the director of OHSU’s psychiatry residency training program, said family and friends are typically unsure about whether they should ask someone they care about if they’re OK.

That should not be the case, he said.

“It’s much better to inquire than to wish you had,” Rosen said. “If the other person sets the limit and says, ‘I don’t want to talk about it,’then OK. It’s always better to express concern.”

He suggests broaching the subject by saying something like, “I don’t want to intrude, but I also don’t want to ignore,” Rosen said. “That is what I would hope would be the most accessible route to a dialogue.”

He said someone who is depressed often feels alone.

You can help, he said, “by listening, by being reassuring and encouraging someone to get care.”

If your friend or relative declines to talk, then what?

Tell them, “if you do (need to talk), then I would encourage you to find someone professionally you can talk to,” Rosen said. “The parent (sibling or friend) can know they ought to facilitate a conversation they’re not a part of.”