As with all mental disorders, depression exists on a spectrum, which is to say that on a scale of 0 to 100, with 100 being full blown psychosis and 0 being an absence of symptoms, every last one of us falls on that line somewhere. In other words, depression hits some far harder than it affects others.
The DSM-5, which is the manual that clinicians use to diagnose clients, also identifies several different types of depression, each with their own criteria. Dysthymic Disorder is basically low grade depression. Bipolar depression usually accompanies mania. Perhaps the most prevalent form is called Major Depressive Disorder, which is more of a chronic diagnosis, as opposed to Major Depressive Episode, which is more acute in nature. In general, the characteristics of depressed person are as follows: disruption in sleeping patterns, weight loss or weight gain, feelings of hopelessness and/or worthlessness, extreme fatigue, and most alarmingly, suicidal ideation or even active suicidal intent.
Being able to recognize symptoms is one thing, but what happens if you’re not a trained psychotherapist and a friend or loved one is battling a condition so severe that suicide is often a symptom? What can you do for a loved one to show them you care? Here are two things you can do (and two you should NEVER do) to support a loved one in their time of need.
DO: learn about clinical depression, particularly what it is and is not.
Say you have a friend whose dog was hit by a car and killed immediately. Your friend is sobbing, despondent, practically inconsolable. Is this depression? The answer is probably not. It is a normal reaction to the unexpected death of a loved one, in this case the family pet. Grief is both normal and natural. It is unpleasant and sad, but it is not depression.
Clinical depression, by definition, refers to a chemical imbalance in the brain. While it is possible that experiencing a death can eventually lead to clinical depression, in many cases depression is almost solely the cause of a chemical disruption in the brain. There are several chemicals that help us regulate our emotions, the most prominent of which is serotonin. Medications such a s Prozac, Zoloft and Paxi are all anti-depressants, but more specifically they are SSRIs, or Selective Serotonin Reuptake Inhibitors. These medications, in case it is not clear from that acronym, regulate the level of serotonin in the brain.
This is important to know, as people who are clinically depressed often do not know why, and they certainly have not made a choice to be that way. Diabetics need insulin in order to regulate their glucose levels. This is basically the same principle behind SSRIs like Prozac.
DO NOT: try to convince a loved one to “snap out of it.”
Depression is a terrible condition that precisely zero people want to endure. Often times, though, otherwise well meaning people will advise them to “just get over it” or perhaps “look on the bright side.” Going back to the insulin analogy, would anyone ever dare to say this to a diabetic? Of course not, yet this is a common complaint that depressed persons share with their therapist. People who have never experienced depression often think it’s a matter of attitude adjustment and their well meaning pep talks unfortunately do far more harm than good.
This is not to say that depressed people can’t benefit from words of encouragement. However, sometimes there is a thin line between encouragement and patronization. If depression was really a choice, you can rest assured that depressed people would choose not to be.
DO: let them know you are there for them.
Depressed people tend to isolate, but this is not necessarily what they prefer. One cannot be judged or pities when in isolation, which is one of the reasons depressed people tend to keep to themselves. The best thing you can do is to let them know that you are there for them, however they might need. As has been established, depression is not a one size fits all condition, nor are the ways depressed peoples cope with their condition. Offer to sit with them. Offer to drive them to a therapy appointment. Offer to cook them a meal. Offer to listen to them. Offer to talk if that’s what they want instead.
One thing you can do with a depressed person is to gently challenge any statements they make about their low self-worth. If a depressed person says something like “Everybody just wants me to die,” you can gently say something like “Well, I think we both know that’s not true. I know I don’t want you to die. I do want you to feel better because I’m sure you’re in a lot of pain. You are suffering from depression right now and when you start to feel better, you’ll realize that there are many people who love and care about you.” In counseling, this is called confrontation. It’s okay to dispute an irrational belief like the aforementioned example, just make sure you are doing it with love and compassion. And speaking of compassion...
DON’T: be afraid to talk about suicide.
Suicidal ideation is a common symptom of depression. If you have never experienced it, imagine you have a fear of flying and you are trapped on a plane. You don’t want the plane to crash but you can’t stop thinking about it happening. That’s suicidal ideation. They have the thoughts, but that doesn’t necessarily mean they want to die.
There are many myths associated with suicide and one of them is that talking about suicide encouraged suicidal behavior.
Actually, the reverse is true. If a loved one expresses their suicidal ideations to you, by all means have an open and frank conversation about it. The depressed mind is often muddied and confused – it is the ideal place for something like suicidal ideation to fester. Talking about it, though, often provides relief for the depressed individual, as well as the understanding that they don’t actually want to kill themselves. Keep in mind that when a person says they want to kill themselves, what they usually mean is that they want the pain they are feeling to go away.
Suicide, of course, is an irrational and extreme way to handle the pain, as all it does it transfer that pain to all the people who love and care for that individual. Don’t be afraid to tell them that.
As long as you are not actively encouraging them to hurt themselves, talking about suicide helps more than it hurts. You can even appeal to their sense of honor and have them promise you that they will not hurt themselves. Or have them promise you that they have to call you or someone else if they start experiencing those feelings again. You’d be surprised how effective this is.
It’s okay to ask questions. It’s okay that you don’t know the right thing to say or the right thing to do. It’s okay to just be physically present. Silence is fine, too. Depressed people are wired to feel like they are all alone. Show them this is not true. Just remember, depression is not a choice, nor is it something that a person can turn off. Like any disease, it runs its course and just like any disease, if not treated effectively it can turn deadly. As a friend or a family member, you primarily need to respect the severity of the condition. Do this by educating yourself about clinical depression and the various ways it is treated.
You also need to respect your loved one, too, as they did not ask for this affliction and many times they are as in the dark as you are about what to do. That’s okay. The important thing is that you care about them. The depressed mind tells its victim that nobody cares. Show them that just isn’t true.
What are your thoughts? Do you have any other suggestions? Leave them in the comments section below.