Erik Wing, Ph.D.
Psychiatry & Psychology
When a loved one is affected by depression, it can be difficult to understand what is happening or what you can do to help. It's OK to be confused.
Clinical depression is an incredibly complex and individualized process. Understanding depression spans multiple levels of knowledge, from genetics and brain biology to culture and situational stress. Universal truths or simple solutions don't exist.
Understand the downward spiral of depression
Gaining perspective on what your loved one is experiencing can be critical to the support process. Visualizing depression as a downward spiral is one way to simplify and understand clinical depression.
The downward spiral may begin with the person feeling worse than usual from physical, social or psychological stressors. A worsened mood may lead to taking part in fewer meaningful day-to-day activities. Self-criticism and stress increase due to mounting responsibilities or missed opportunities. Depressive thinking may encompass guilty thoughts, pessimism and irritable behavior.
As the spiral develops, a complex dynamic emerges. Your loved one becomes increasingly stressed while simultaneously less capable of coping with this stress. The response of the brain to this dynamic is to slow, stop and depress. A person can get stuck at the bottom of the spiral for weeks, months or years.
The silver lining is that if people can spiral down, they can spiral back up. However, depression affects the motivation, energy and curiosity needed to spiral up.
It's disheartening that you can't fix a loved one's depression or spiral up for them. But you can help them get started and continue moving on an upward path.
Here's how to offer support and understanding:
Learn the symptoms of depression.
Depression signs and symptoms vary from person to person. They can include:
- Feelings of sadness, tearfulness, emptiness or hopelessness.
- Angry outbursts, irritability or frustration, even over small matters.
- Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports.
- Insomnia or sleeping too much.
- Tiredness and lack of energy, so even small tasks take extra effort.
- Changes in appetite — reduced appetite and weight loss or increased cravings for food and weight gain.
- Anxiety, agitation or restlessness.
- Slowed thinking, speaking or body movements.
- Feelings of worthlessness or guilt, fixating on past failures or taking unnecessary blame for things.
- Trouble thinking, concentrating, making decisions and remembering things.
- Frequent or recurrent mention of death, suicidal thoughts, suicide attempts or suicide.
For many with depression, symptoms can be severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Others may generally feel miserable or unhappy without knowing why.
Children and teens may show depression by being irritable or cranky rather than sad. Clinical depression doesn't require profound sadness. Rather it can be lack of positive emotion instead of intensely negative feelings.
Encourage treatment for symptoms.
People with depression may not recognize or acknowledge their symptoms. They may have difficulty seeing the point of getting treatment.
Here's what you can do to help:
- Talk to the person about what you've noticed and why you're concerned.
- Explain that depression is a complex condition, not a personal flaw or weakness — and that effective treatment exists.
- Suggest seeking help from a health care or a mental health professional, such as a licensed counselor, psychologist or psychiatrist. Often, the best place to start for a referral is your primary care provider, especially if a trusting relationship has been established.
- Offer to help prepare a list of questions and notable changes to discuss at an initial consultation.
- Express your willingness to help by setting up appointments, going along to them and attending family therapy sessions.
Your support and understanding can kick-start or reinforce the healing process.
Here are some ideas for helping your loved one:
- Encourage sticking with treatment.
Help your friend or relative remember to take prescribed medications and keep appointments.
- Be willing to listen — when desired.
When your loved one wants to talk, listen carefully and intently. Avoid giving too much practical advice or opinions, or making judgments. Just listening and being understanding can be a powerful healing tool.
- Give positive reinforcement.
Remind your loved one about his or her positive qualities and how much the person means to you and others.
- Offer assistance.
Certain tasks for your friend or relative may be hard to do. Suggest specific tasks you'd be willing to take on.
- Help establish a routine.
Someone who's depressed can benefit from having a routine or increased structure. This is because it can be difficult for a person with depression to make spontaneous healthy choices, so advance plans or everyday habits become crucial. Offer to make a schedule for meals, medication, physical activity and sleep, outside time or time in nature, and help organize household chores.
- Locate helpful local organizations.
Access and affordability for mental health treatment can be burdensome. You may be able to use help from other resources, such as the National Alliance on Mental Illness, employee assistance programs, or other community-based groups or programs.
- Make plans together.
Ask your loved one to join you on a walk, see a movie or work together on a hobby or other activity. But don't try to force the person into doing something.
- Be patient.
For some people, symptoms can quickly improve after starting treatment. For others, it will take much longer.
Be aware of suicide risk.
People with depression are at an increased risk of suicide.
If you believe a loved one's illness is severe or in a potentially life-threatening emergency, you may need to:
- Contact a health care professional or hospital.
- Call 911.
- Call the National Suicide Prevention Lifeline at 988. To reach the Veterans Crisis Line, use the same number and press "1."
What you can do for yourself
Supporting someone with depression is challenging. Part of the challenge is witnessing a loved one's struggle and knowing you cannot complete the path for that person. Understand that emotions such as frustration, helplessness or anger may be natural responses to a loved one having depression.
Practice acceptance and coping with difficult emotions by permitting yourself to prioritize your mental health. Devote time for hobbies, meaningful experiences, physical activity and other valued relationships.