Few things in life are more painful than the feeling of helplessness we experience when a friend sinks into a serious depression. If only we could say exactly the right words or do just the right thing, could we lift them out of their emotional darkness?
Unfortunately, it’s not that simple. More than 17 million American adults have experienced at least one bout of clinical depression—almost twice as many of them female as male.
Dealing with someone who is suffering from major depression can be scary, frustrating and alienating. So what’s the best approach?
Act Sooner Rather than Later
Major depressive disorder, or clinical depression, is characterized by at least two weeks of loss of enthusiasm for work, hobbies and relationships. In fact, one of the first things you may notice about a friend who has slipped into a depression is their withdrawal from social interaction.
Other noticeable symptoms may include:
- Less communication
- Snappish, irritable moods
- Changes in eating habits
- Changes in self-image or self-worth
- Increased sleep or waking at odd hours
- Complaints about excessive fatigue
Before you jump to the conclusion your friend is depressed, encourage them to see their primary-care doctor, says Hisla Bates, M.D., a board-certified adult and pediatric psychiatrist. “It’s important to get a full medical assessment for conditions that may mimic depression such as thyroid dysfunction and anemia. Certain medications also can cause people to feel depressed,” she says.
“Once the diagnosis of depression is clear, address the symptoms early on,” says Dr. Bates. “Later in the course of the illness, they may be more difficult to engage.”
Be Direct, but Kind
Depression is an insidious disorder because it changes the person’s worldview in a way they may not fully recognize. “They may not be able to articulate that they’re feeling depressed,” says Dr. Bates. “They may attribute their symptoms to fatigue or lack of energy.” As someone close to the depressed person, you can help them gain insight, but do so gently and know help may not be accepted initially.
“Reassure the person you’re not criticizing them,” says Julia Frances Tybor, M.D., a board-certified psychiatrist with more than 40 years of private and institutional practice. “Explain that you’re concerned and that you’ve noticed they’re not their usual self. It’s very delicate to do.”
Start by asking open-ended questions like, “Is everything going okay for you?” or, “Are you sad about something?” If your friend says something like “Why are you asking?” it opens the door to explain you’ve noticed they seem troubled lately and you want to help. “Ask what they want you to do,” says Dr. Tybor, “and at what point they might want you to help them.”
Avoid ‘Tough Love’
Although some psychologists push “tough love” as the cure for behavioral problems, it’s a dangerous approach for someone who is seriously depressed.
Never urge a depressed person to:
- Snap out of it
- Suck it up
- Tough it out
- Just get over it
Don’t minimize the person’s feelings either. Telling someone their emotional state isn’t valid because there’s no objective cause—e.g., “You have a great job and a family that loves you!”—isn’t going to talk them out of their depression. Instead, it may distance you from them as someone who doesn’t understand and isn’t supportive. Instead, validate their experience, acknowledging that depression is real and challenging. Also, remind them treatment is available, and they deserve to be supported through this challenging time.
“There’s a really big change in personality with a depressed person,” says Dr. Tybor. “They don’t have the energy or the interests they had before. There can be a lot of irritability, especially in men.”
Although irritability and anger can be hurtful when directed at you, remind yourself it’s part of the disease and not a personal attack. Depression is often accompanied by feelings of self-loathing, which makes it difficult for the depressed person to empathize with others and to recognize how hurtful their words are.
Focus on what the person was like when they were well and remember they can get back there. You can’t control the symptoms of your friend’s disease, but you can make a conscious effort to control how you react to them.
If you think all of this sounds stressful and difficult, you’re right: You may want to consider getting psychological help yourself, especially if you live with a depressed person. “It’s important to take care of yourself,” says Dr. Bates, “so that you don’t end up feeling guilty and become depressed yourself.” Consider joining a support group and make an effort to get out and spend time with other friends and relatives.
Recovery from depression is a slow process for all involved, so make sure to support your own mental and physical health along the way.
Understand You Aren’t a Therapist
It’s important to encourage a depressed friend to seek qualified help. You can’t “cure” your friend by talking things out or giving great advice; major depression needs to be addressed by someone with professional training, who can prescribe antidepressants if appropriate. “Don’t think that you can manage their symptoms on your own,” says Dr. Bates. “Just be there in a supportive, nonjudgmental way.”
Suggest Shared Activities
Reassure the person they’re not alone and they’re important to you. Suggest shared physical activities, like going for a nature walk, since exercise combined with other treatments like antidepressants has consistently been shown to reduce depression. Walking, running or biking together will also give your friend an opportunity to talk in a different, possibly more neutral, environment. Dr. Bates also recommends creative activities like painting, drawing or knitting to elevate the person’s mood.
If your invitations are met with rejection, be patient, don’t scold and continue to show up for them with the offer to engage in shared activities.
Be Ready to Take Action
If your friend says they’re ready to seek help, that’s a big breakthrough and you can play a crucial role in supporting them. For a seriously depressed person, action often requires a large amount of emotional effort, since the illness can make them feel drained and hopeless.
Arranging a visit to the person’s primary-care physician can be a good way to get the process started, says Dr. Bates. “People may be averse to going for mental healthcare because of perceived stigma,” she says. “If you can engage the person around their physical complaints, you can say, ‘Why don’t we get this [pain] checked out?’ A lot of depressed people have body aches and pains; it’s called somatization.” Be aware, your friend may be more receptive to taking their doctor’s referral to a mental health professional than accepting a recommendation from you.
If their doctor assesses that your friend is not in immediate danger of self-harm then they will likely refer them to a psychologist or psychiatrist. You can offer to go along on the appointment, help them set a date and stick to it.
You will probably be able to stay with your friend for the introductory meeting, although the doctor or counselor will likely want to talk to the depressed person privately at some point. “Most psychiatrists won’t mind having a friend there for a few minutes or even the entire session if the individual doesn’t have much energy to speak,” says Dr. Tybor. A person who is seriously depressed may have difficulty naming their symptoms, so be prepared to help.
If your friend is expressing hopelessness, don’t be afraid to gently ask about suicidal thoughts and intentions; you need to know in order to help. If they are actively suicidal, call 911 or the National Suicide Prevention Lifeline (800-273-TALK), or accompany them to the emergency room. Be their advocate with the police, paramedics, admitting department, nurses and doctors. While this can be difficult to do, it can save their life.
- Major Depression. National Institute of Mental Health website. Accessed 8/27/2021.
- Trivedi MH, Greer TL, Church TS, Carmody TJ, Grannemann B, et at. Exercise as an augmentation treatment for nonremitted major depressive disorder: a randomized, parallel dose comparison. Journal of Clinical Psychiatry. 2011;72(5):677-84.