How to Help a Depressed Friend What to Say to a Loved One With Clinical Depression

Is one of your close confidantes suddenly and inexplicably irritated all the time? Is she canceling plans, getting quiet in conversations and generally not her cheery self? It could be clinical depression – which means that even though she’s grumpier than usual, you need to stay closer than ever. Here are 7 tips for helping a depressed friend... Roughly 25% of adults suffer from depression at some point in their lives. That means there’s a good chance either you – or a friend – has or will suffer from clinical depression. But first get this straight: Clinical depression is different from simply getting “blue” about something bad that happened to you. (For example, your car is stolen, you lose a boyfriend or a job promotion doesn’t come through.) Often, after a night out or a good cry, you move on and put the event behind you. “The word ‘depression’ is widely and tragically misunderstood,” says Stephen S. Ilardi, Ph.D., associate professor of clinical psychology at the University of Kansas in Lawrence. “One of the best things you can do as a friend is educate yourself about what it is.” Depression – called clinical depression or major depressive disorder by mental health professionals – isn’t primarily about being sad, Ilardi explains. “What grabs [a doctor’s] attention is losing the ability to love, work, play and focus,” he says. Tragically, depression leads to nearly 35,000 suicides a year. While most people suffering from depression don’t take their own lives, not getting treatment for it is risky. Untreated over time, depression can even cause brain damage. “In clinical depression, we see very high levels of the stress hormone cortisol,” Ilardi says. “If it persists, we see shrinkage in the hippocampus and frontal cortex, the memory centers and areas of the brain associated with higher-order reasoning and function.” This shrinkage may reverse as depression subsides, often through treatment. That’s where you come in: Friends can have a big impact on whether a depressed patient seeks help and eventually recovers, experts say. “I’ve had patients come [in] only because a friend made the contact and drove them to my office,” says clinical psychologist Andrea Bonior, Ph.D., an adjunct professor of psychology at Georgetown University in Washington, D.C. That doesn’t mean a friend can do all the work. Someone who's depressed will have to get help and follow through with treatment. Read on for the best ways you can help a depressed friend. Help a Depressed Friend: Pay Attention to Jerky Behavior If your friend is usually kind, considerate, pleasant and enthusiastic, but abruptly changes without behavior – pay attention. Bad behavior – for example, bailing on plans or being irritable or inconsiderate – is often the first stage of depression, Bonior says. “If your friend is depressed, you’ll probably have to tolerate a less-than-ideal friendship for some time,” says Bonior, author of The Friendship Fix: The Complete Guide to Choosing, Losing and Keeping Up With Your Friends (St. Martin’s Press). Nonetheless, stick by your friend’s side until you’ve exhausted your resources. You’re a crucial support during depression, she advises. How to Help a Depressed Friend: Have an Open Talk “Very often, friends and family recognize that the person is depressed,” Bonior says. “The depressed friend may not even realize how different she seems,” she adds. “Or maybe she knows she’s down but doesn’t think it’s a big deal. ” But take action in a one-on-one conversation. Unlike drug abuse, group interventions don’t work with a depressed person, according to Bonior. “They can feel intimidating and off-putting because someone who’s depressed may already feel self-conscious,” she warns. Say to your depressed friend something as simple as, “You don’t seem like yourself lately.” That can be enough for her to open up to you and then seek help from a mental health professional. Sometimes it helps to share a firsthand experience. “A friend who says, ‘I’m on [an antidepressant]’ or ‘My sister battles depression. Let me tell you what I know’ can really [alleviate] the stigma that’s still there for depression,” Bonior says. “You might not get the immediate reaction you want,” she adds. “More often it will take a couple times before you convince your friend to take action.” Help a Depressed Friend: Don’t Underplay or Overplay the Problem Not taking your depressed friend’s problem seriously – for example, telling her to just snap out of her blue mood or suggesting she has nothing to complain about – often will only distance her from you, Bonior warns. “Someone who is depressed wants to be able to count their blessings, but they just can’t at this time,” she says. It’s equally unhelpful to overdramatize their depression. “Don’t turn it into something that makes it seem like they’re going crazy,” Bonior warns. “Instead, show empathy, but try to treat her as you would any friend.” Help a Depressed Friend: Offer Practical Help Sometimes people with clinical depression can barely get out of bed in the morning – let alone find a psychologist on their insurance plan with time for an appointment. So offer to help them track down a therapist and schedule an office visit. Then offer to drive them there and sit in the waiting room. Handling the details will help them overcome perceived obstacles, says Bonior. “If someone is wondering, ‘Where am I going to park?’ or ‘How am I going to get there?’ that’s one more hurdle [to seeking treatment],” she adds. “Don’t let these keep them from getting the help they need.” Help a Depressed Friend: Don’t Allow Brooding Someone who’s depressed will have a tendency to ruminate out loud – especially to a friend who will listen. “Aside from spending a brief period to validate your friend’s feelings, this quickly becomes counterproductive,” Ilardi says. Listen to your friend a bit, but make the primary focus of your time together a pleasurable activity and avoid ruminating over negative thoughts. If she’s asking for advice, don’t shut her down, but also encourage your friend to shift focus, Ilardi advises. He advises friends to say: “I’m not sure talking about it more will be helpful. Let’s go on a walk, play cards or paint the patio furniture.” Physical activity is best. Walking briskly for 30 minutes three times a week helps alleviate depression, according to landmark 1999 research by Duke University. Researchers at the University of Georgia also found that exercise increases brain chemicals that lower stress. “Physical activity has an anti-depressive effect,” Ilardi says. “Aerobic exercise changes our brain chemicals – serotonin and dopamine – in beneficial ways." Help a Depressed Friend: Give Her Reading Material Sometimes buying books about depression and just leaving them on a table will spur your depressed friend to look at them and perhaps seek treatment. Bonior recommends two books about cognitive behavior: Learned Optimism by Martin Seligman (Vintage) and The Feeling Good Handbook by David Burns (Plume). “Both talk about how you can retrain yourself by challenging negative ways of thinking,” Bonior says. Ilardi’s book, The Depression Cure: The 6-Step Program to Beat Depression Without Drugs (Da Capo Lifelong Books), also offers proven mood-boosting lifestyle changes, such as adding omega-3 fatty acids to your diet or increasing exercise. Help a Depressed Friend: Know When to Fold ’Em Stick by your friend as long as you can, but if the person refuses to get help, you may have to walk away temporarily. “Untreated depression can bring a lot of toxicity to a relationship,” Bonior warns. That’s because the stress of coping with your depressed friend’s feelings can negatively influence your life. But if you plan to cut back on your availability to your friend, do it responsibly. “Be honest and tell her, ‘It tears my heart out, but you’re not being good to yourself and there isn’t much more I can do. I need some space now, but I trust this won’t be forever,’” Bonior says. Of course, be available if and when your friend wants to get help, she says. For more information, visit our Depression Health Center. Could You Be Depressed? Like Picasso, everyone goes through a “blue period” from time to time. But if you’re depressed, you are experiencing more than just the occasional bad mood or terrible day. Depression affects 20 million people in any given year and is a serious enough disorder to compromise one’s ability to function normally day to day.