Stunned by her brother’s suicide at age 26, Julie Totten started learning everything she could about what prompts some people to take their own lives.

She found clues in information about Depression. Totten read that her smart older brother’s aimlessness, fatigue and weight loss were classic symptoms of the mood disorder.

“I was really upset. He never got any treatment. We didn’t realize what was wrong with him,” Totten said. “Then I realized my father had a lot of these symptoms. He was talking about how he didn’t care whether he lived or died. It wasn’t anything new to me. But this time I realized he had Depression.”

Totten called her father’s primary care doctor and explained her brother had died recently, her dad was having suicidal thoughts, and it was an urgent situation.

“They responded, ‘Bring him in right away,’” and sent him immediately to a psychiatrist in the same building, Totten said.

“I felt good we were able to help my dad,” said Totten. “It was a terrible lesson to learn that we were supposed to get more involved with my brother.”

Totten says there wasn’t a lot of information available about recognizing Depression when her brother, Mark Totten, died 14 years ago. And there was almost nothing on what family and friends could do to help.

She set out to remedy that situation by founding Families for Depression Awareness, a non-profit organization aimed at helping families recognize and cope with a loved one’s Depression or bipolar illness.

The Waltham-based organization offers education seminars and outreach training on Depression, provides profiles of families coping with Depression, and publishes a pamphlet called “Helping Someone Who is Depressed.”

The pamphlet contains all the information Totten says she learned the hard way. It spells out symptoms of depression, warning signs of suicide and ways to get a loved one into treatment. The latter is particularly important, she says, because people with mental illness may deny their symptoms, blame someone else for their troubles or attribute them to a physical cause.

Her father did all three when Totten and her brother were growing up.

Recognizing the problem
Most of the time he was a good-natured father, the custodial parent since Totten was 8 years old. “He’s kind of an absent-minded professor type with lots of interests.” He enjoyed history - which he taught on the college level - travel and collecting Indian artifacts. “He also enjoyed working in the yard.”

But once a year or so, her dad would go through a bad spell. He’d have trouble getting grades in, paying the bills and sleeping. He’d be irritable and withdraw, avoiding phone conversations and social events. He’d drink more alcohol than usual and feel negative about almost everything.

“None of us realized depression was the problem,” Totten says. “He complained of physical problems and whatever was bothering him at school. He complained of aches and pains. He was sick or tired or his back was bothering him.”

As a child, there wasn’t much Totten could do except wait out the bad spells, which sometimes lasted as long as six months. She’d also intercept calls from her father’s employer and bill collectors, jotting down information so her father wouldn’t have to come to the phone.

“I didn’t really understand,” Totten says. “I felt unsure about what was happening in my family. I tried to get some control around my own life. I developed kind of strict regimens about keeping my weight in a certain range, running five miles a day.”

When her older brother had trouble in adolescence getting his homework done or cleaning his room, Totten felt exasperated. He was so bright, especially in math. He hardly had to study to ace a math exam. So why couldn’t he do the minimum required to keep his grades up? Why didn’t he call his friends back? Or keep up with his various collections? “I thought he was being lazy and just being difficult,” Totten says. “I could always force myself to do things I didn’t want to do.”

Totten’s parents, who are divorced, thought her brother was going through an adolescent rebellion.

Sometimes Totten would try to play the helpful little sister. “I’d say, ‘Why don’t we go do this or go do that and you’ll feel better?’ Of course, it didn’t work.’”

Seeking his own answers, her brother dropped out of college, moved to Iowa and turned vegetarian. He complained about weight loss, pains in his stomach, headaches. His family urged him to see a doctor, and he did. Shortly after the appointment, he committed suicide.

Totten found out that the doctor in Iowa, never having met her brother before, treated his physical symptoms at face value and didn’t see the emotional pain behind them. “Depression is very much a mind-body experience,” she says.

So when her father began complaining again about exhaustion and a loss of interest in life, Totten called her stepmother and got her support to phone the family doctor. “My father thought he had the flu,” Totten says. She told the doctor about the family history of depression.

Her father was referred to a psychiatrist who explained he had a treatable medical condition.

Getting help
The key to helping a mentally ill or depressed person is to emphasize the treatability of the illness, Totten says. Oftentimes the relief of hearing there is a diagnosis and treatment is enough to overcome the stigma that has been associated with mental illness.

Another problem is people just not realizing they are ill. It can be particularly tough encouraging people with bipolar illness, or manic-depression, to get help because 50 percent of bipolar patients do not realize they are ill, Totten says. They may believe they are just “a high-energy person.”

If a depressed person is reluctant to get help, talk about the ways treatment can make them feel better, Totten says. Agree on some wellness goals - getting consistent sleep and feeling less irritable - and make a plan to reach those goals. For instance, if the person isn’t feeling well after two weeks, the family member will set up a medical evaluation.

Totten advises the family member or friend to either accompany the depressed person to the appointment or phone the doctor with some of the person’s history and symptoms.

“A lot of people feel they can’t call the doctor because of patient confidentiality,” Totten says. “A doctor can’t tell you, but you can tell the doctor what symptoms you’ve noticed. Are they having trouble staying on medications? Are they drinking? If the family can explain and give the whole picture, the doctor can better recognize it as depression. We’re always encouraging families to get more involved. It’s just the amount of time a doctor has - 10 minutes.”

Only a clinician such as a primary care doctor, psychiatrist or psychologist can diagnose depression and rule out other causes, such as social anxiety or some more strictly physical ailment, Totten says. “However, since you see your depressed family member or friend often, you observe the person’s symptoms more than their medical professional may. You are invaluable in helping a clinician become aware of the depressed person’s symptoms.”