How to help your friend, family member, etc person who is depressed- a comprehensive guide. I wrote it to be informative and to the point, addressing all stages, outward symptoms, and outcomes- including suicide. I wrote it to help you, the non-depressed person, to better understand how to help.
Disclaimer- I'm [still] not a doctor. The advice I give in this post is based on my own experience and research. If a medical doctor, crisis expert, or other trusted source disagrees with me- listen to them. That being said, I've experienced all of the below stages and I understand depression really well.
According to the World Health Organization:
Globally, an estimated 350 million people of all ages suffer from depression. Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.
This means around 1 out of the 20 people you know has it. Globally.
It's 3rd on the list of top causes of disability worldwide. (W.H.O. Report: The Global Burden of Disease: Part 3).
Long story short? You know someone close to you with depression (you probably know more than one person). Over the course of your life, there is a good chance that you could go through it too. Like knowing basic first aid, CPR, or other life-saving measures- it's important to understand the stages of depression and how to help someone in each stage.
First- let's define each stage:
Early:
The person seems "off." They could have had something interrupt their life recently (like a death of someone close, tough breakup with significant other, or other emotional event), or it could be set off by something physical (pregnancy/birth, injury, environment change, etc). It can even be caused by nothing at all. Since depression is simply a lack of the right chemicals in the right amount in the brain- a lot of different things can set it off, and its severity can vary. Sometimes the brain can right itself- similar to the way you can feel better after a cathartic emotional release (a "good cry"). Other times it cannot, and depression can set in. What happens at the outset governs how severe it is in the remainder.
In the beginning the person might be standoffish, not wanting help for what is perceived to be a non-issue. It might be "all in their head" (brain chemistry usually is) or they might say things like "I'll get over it." Which is true. They might. Or they might not. In the early stage, it could still go either way. You might believe they "just need some time" or to "relax."
Middle:
This is when things begin to get questionable. There are public or private outbursts of emotion (ie- calling in the middle of the night crying, outbursts of anger over seemingly trivial things, etc). The depressed person begins to shut themselves off from the world, then the important parts of their life, and finally the important people. They might begin to miss work more often with mysterious illnesses. Their grades in school may slip. They might dress or act differently/more abrasive. Usually at this time they might (knowingly or unknowingly) try to cling to someone or something that isn't really equipped to handle their emotional baggage, rather than looking to the core relationships in their life for support (this is for fear of ruining the core relationships). The spiral downwards can be slow and methodical, or immediate and all-encompassing. At the bottom, the person will usually seek help of some kind- therapy, trusted friendships, crisis line, etc. This stage can drag on and on for years, or last only a few weeks.
Endgame:
Endgame is not a stage you should let anyone reach if at all possible. At this stage, a person contemplates taking their own life. There are only two possible outcomes- suicide or back to the middle. This can happen over and over, or just once (or never, hopefully). The thought of suicide is a learned thought pattern- meaning the more it's thought of, the easier it is to think of it. The danger here is obvious- thinking is only one step from acting.
This probably seems pretty intimidating, and since the consequences can be pretty serious- it's perfectly reasonable to feel that way. My goal with this post is to help you know how to respond in a way that will help, rather in ways that do more harm than good.
Early:
Like many diseases, the best time to help someone fend off a long-term depressed state is in the early stage. If you recognize someone struggling- the best thing to do in this stage is to build the relationship. In this stage, the brain likely hasn't solidified some of the learned paths toward negativity. Helping a person break out of a spiral could be as easy as listening, or might require more consistent effort. Sometimes depression is caused by negative events (like a death of a loved one)- which cannot be resolved. Avoid the temptation to leave someone alone or give them their space when you suspect depression might be setting in. Better to be a little annoying than to abandon a friend or family member to the less pleasant portions of this disease.
Here are a few examples of things you can do to help a friend in early stage depression:
- Help them talk through feelings and the chemistry of their emotions- positive action results in positive chemistry.
- Offer encouragement, respite, or consolation.
- Spend time with them, publicly or privately- whichever they prefer. Let them know by your actions that you will not give up on their happiness.
Middle:
This is when things get more difficult. In the middle, depression can really take a toll. The strategies that I just described become increasingly less effective- the more the brain loses balance of chemistry, the harder it is to fix. By this stage, learned negativity is likely more ingrained as thinking patterns in the brain that lead to negative thoughts are used more and more. Coming in and telling someone to think positive won't help anymore- they physically can't. Your goal as someone who wants to help must change to accommodate the new symptoms. You must become more adaptable forgiving, and 100% trustworthy.
Also worth noting that doing things that were effective in the early stages is an exercise in futility in the middle stages.
Here are a few effective strategies for helping someone in the middle stages:
- Right out of the gate- you have to lose your stigma, prejudice, or judgments. They may be as real and valid as the sun in the sky- but they have absolutely no place in the middle stages of depression.
- Help them admit they have a disease and should seek treatment. Say the words- "Depression is a physical condition with mental and emotional symptoms. Better to find out if you're sick than risk facing the symptoms alone. Go to the Doctor."
- Don't discount the difficulty of their situation, no matter how easy the hurdle may seem from your perspective. Remember- their brain is fighting them on every front, with waves of sadness and negativity caused by chemicals they can't change by "trying harder."
- There is a fine line between letting someone be alone to recharge and letting them be alone to wallow in depression. Find the line.
- Take away some of the stress-causers in their life to help promote some positivity. Helping with the basics can mean the world for someone with depression. Think- what would I do for my friend if I found out they had Cancer? Once you decide on something, do it.
- Find a way to forgive. Your friend is sick. They might suck to be around until they can get better.
Endgame:
If you find out someone has been/is actively thinking of suicide- there is only one goal. Delay, delay, delay. Crossing over into endgame depression is always temporary. Someone is suicidal for a time, and they either end it or cross back into the middle. Get them to the middle. There is no wrong way to getting someone back from the brink. Your singular focus should be to save their life by not letting them go through with it. I've been there and back by myself- and it's very dangerous. It was the vivid memory of pleading words by a grieving grandmother who had just lost a son (my uncle) to suicide that brought me back. I was lucky. She probably has no idea.
Here are some examples of strategies that have either worked for me or for people I know well in getting their loved one back from the edge- again, the point here is to do whatever it takes.
- First and foremost- if a person is 'on the edge' (literally or figuratively), immediate, professional help is no longer optional. Call for help, call the police/paramedics, do whatever it takes, but don't do it by yourself.
If a person is not on the edge, but considering suicide as an option- here are ways to help:
- Professional help is no longer an option. You may not need to call the police, but a medical doctor is needed right away.
- Make no promise you cannot or don't intend to keep. If a person's brain is fighting against them, a false promise will only stave off suicide short-term. It will also do nothing to help the person get back to the middle, and eventually out altogether.
- Explain that help is available, right now. A single positive action can release the right chemicals into the brain to stave off suicide.
- I once stayed with a friend for several days while their suicidal thoughts subsided. He already had professional help, but it was not enough. It wasn't hard to convince him- "I'm here because you shouldn't have to go through this alone- and you WILL get through it."
- Someone close to me once called the police and the parents of a best friend who had confided in her about being suicidal. Ruined their friendship, probably saved a life.
I hope this post has been helpful/informative. Let me know what questions/comments you have and I'll do my best to answer/address them.
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