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Psych 101: When a Close Friend is Depressed

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It's depressing to be with a friend who is truly depressed. You may even get weepy yourself. The black cloud of depression spreads over you too, making you feel like you want to escape and be with anyone else but her. But read this first!

I've blogged here repeatedly about the importance of female friendships to women's emotional and physical well-being -- and about the perils of toxic ones as well. I've talked about friends who are too needy, too self-centered, too angry, too demanding, or too unreliable -- and have pointed out that some friendships reach a tipping point when it's time to call it quits.

I believe that relationships that are consistently draining should be ended or at least, placed on hold. Then I received a post from a reader entitled, Toxic Friends May Be Crying Out for Help, which reminded me that there are exceptions to every rule -- and that it is important to distinguish between a toxic friendship (which is pathological relationship) and depression (which is a mental disorder). This is a copy of the post:

Dear Irene:

Thanks for pointing out that there are bad friends out there, However I want to play devil's advocate here and say that in 2006 when all and I do mean all 5 of my close friends bailed on me like a chain of dominoes I nearly died from the depression it caused. In the wake of that nightmare I found out I had a mental problem and needed help. Your call to dump Toxic Friendships would be better served by advocating intervention for people who may possibly be in serious trouble rather than leaving them behind like trash on the street corner.

Signed,
Anonymous

Yes, there are some cases when close friends need to cut a little slack. Could it be that your friendship feels burdensome and painful because your friend is depressed?

Recognizing depression

Clinical depression is extremely common, affecting nearly one out of ten people in a given year, and it's is twice as prevalent in women as it is in men. It's more than a case of the blues or a bad mood that passes. Depression profoundly affects a person's ability to function. And as hard as someone tries to shake it, it recurs nearly every day, all day, for at least two weeks or longer.

According to the National Institute of Mental Health (NIMH), the symptoms of depression may include:

*Persistent sad, anxious or "empty" feelings
*Feelings of hopelessness and/or pessimism
*Irritability, restlessness, anxiety
*Feelings of guilt, worthlessness and/or helplessness
*Loss of interest in activities or hobbies once pleasurable, including sex
*Fatigue and decreased energy
*Difficulty concentrating, remembering details and making decisions
*Insomnia, waking up during the night, or excessive sleeping
*Overeating, or appetite loss
*Thoughts of suicide, suicide attempts
*Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

Does this list of signs and symptoms remind you of one of your friends? Listen to this: As much as you might like to, you can't talk a friend out of being depressed. Even a kick in the pants won't help. Depression is a biological illness.

What you can do

If you are a good friend, there are some ways in which you can help and possibly make a difference:

*You can listen carefully, provide support, and offer to spend some time doing things you enjoy together (taking a walk or bicycle ride, or going to a movie).

*You can offer to help her with concrete tasks she can't accomplish on her own because she feels so overwhelmed or has no energy.

*Try to be patient -- and never be pushy. Don't dismiss her feelings. Show that you understand them but encourage her to realize that these feelings are only temporary and will eventually pass.

*Don't pussyfoot around it. Remind her that depression is a treatable illness and encourage your friend to seek treatment.

*If she resists your initial suggestion, try again but don't nag. Don't make demands or set ultimatums. Many depressed people need time to find their way to treatment and some people just want to be left alone.

*If you worry that your friend may be harboring suicidal thoughts, you have certain ethical obligations. Be direct and ask her if she feels suicidal. If she does, remind her that she is important to you and that she needs immediate professional help. Don't let the burden of having a depressed friend be yours alone. Be sure to inform someone else (e.g. her partner or closest relative.) If you're her partner, tell her doctor.

Recognize that you can only be a friend, not a mental health professional. Remember that there is just so much that friends can do and so much that they can give. You may need to cut loose and be there for her when she begins to recover.

Note: This post isn't intended as medical advice.

Irene S. Levine, PhD is a freelance journalist and author who blogs about female friendships at HuffPo and www.fracturedfriendships.com. She is a professor of psychiatry at the New York University School of Medicine and is working on a book about female friendships, Best Friends Forever, which will be published by Overlook Press.

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