What to do when there’s nothing you can do
So your friend or loved one has chosen to share with you that they’re experiencing a serious episode of depression. A heavy responsibility has been bestowed on you — you’re worried for them, and you’re not sure how to be the supportive friend that you’d like to be.
If you’ve never experienced a deep depression, you might think you can imagine what they’re experiencing ― an unshakeable sadness, a dark cloud over their head, soft weeping in bed for days. If that’s what you’re thinking, be prepared for your friend to be suffering from something much worse. Depression is a vile, consuming, physiological, and life-eclipsing illness of both the body and the mind. It can fill your head with lies — spoken to you in your own voice — telling you that your life is not worth living, that your pain will not end, that you do not deserve to recover, that you can only end the suffering through self-harm.
Helping your friend or loved one during their depression might be a more subtle task than you’ve anticipated. I live with recurrent major depression, and the associated anxiety that typically comes with it. Here’s the kind of support that I want from my friends and family.
Disclaimer: I’m not a mental health professional, so my advice here should be taken as anecdotal advice only.
Assignment 1: Appreciate the weight of communication, and expect more
You may think that you’re up-to-date on your friend’s condition now that they’ve decided to tell you about their depression. However, depressed people face a maelstrom of feelings when sharing their condition with others. For a detailed snapshot of what I felt as recently I told my family, read over this earlier journal post of mine to understand the feelings of shame, guilt, unworthiness, and gravity that make depressed people so averse to opening up about depression.
As a result of these feelings, your friend likely gave you an incomplete picture of their condition at first. When sharing our thoughts, we test the waters one word at a time, we slowly shift our weight out onto the ice and see which friends can take the burden. It’s likely that your first conversation about depression won’t be the last, and your next conversation will probably be harder to hear than the first. I take a rather blunt approach to discussing my depression with others, but even I don’t start conversations by talking about the thoughts of suicide I had that morning.
You should make it clear that you are open and willing to talk with them about their depression, that you don’t want there to be any stigma around mental health in your relationship, and that you’re always available to talk when they’re ready. Be available, and if they don’t ping you for a few days, gently reach out to them to show that you really are ready to listen.
Assignment 2: Offer to help, carefully
Next you’re likely to feel the urge to ask your friend: “Is there anything I can do for you?” If your friend had a cold, you could prepare them a tea; if your friend had a headache you could get them aspirin; if your friend has depression, what could you possibly do for them?
When I get this question from friends and family, I try not to grimace as I gnash my teeth and my stomach churns, because usually the short answer is “No, there’s nothing they can do for me. Each time that I get asked that question, I’m reminded of my feelings of helplessness in fighting depression. I’m on three kinds of drugs, in their fifth permutation, and I have only seen tiny improvements in the last three months. You should expect that there is nothing that you can do to relieve your friend’s depression.
That said, there are often little things you can do to remove or lesson some stressors in your friend’s life while they work on recovery. Maybe they have a familial responsibility or a work task that could be made easier with your help. Make it clear to your friend that you would be glad to pitch in if there’s any way that you can help. Keep in mind that depressed people feel worthless, and feel like they don’t deserve your help, so they might need nudging to realize which small tasks you could do to support them.
Make offers to help in specific ways — “would it be helpful if I took care of _____ for you, while you’re working on recovering?” for example.
Assignment 3: Do your homework on suicide
If this depression is sufficiently serious, follow this link to learn the warning signs and risk factors for suicidal behavior. If your friend has a few of the risk factors and is exhibiting some of the behaviors of a suicidal person, you should give your friend the Lifeline phone number and ask them to use it if they have to.
Ask your friend: “If you’re ever in a crisis and need me to be here with you, you know you can call me and I’ll drop everything, right?” Saying these words out loud can be important, even if the sentiment seems obvious in the context of your relationship. When your friend is in a crisis they will not be thinking logically, and the option to call you may not be their first instinct, even if under other circumstances they know that you’d be available and helpful. So say it out loud.
There’s a reason I wrote the hotline number suggestion first, before offering your personal assistance, because it’s more important to have a hotline number nearby. When I’m at my lowest, I won’t reach out to friends because I don’t want to put the burden of my suicidal thoughts on them. It’s a terrible conversation to have with anyone, and it’s even harder to have with someone who is emotionally invested in keeping you alive. Rather than putting that deep pain on my wife or best friend, I spoke with my therapist first. Give your friend that option, too, by making sure they have a hotline number, in addition to their mental health professional’s phone number.
Assignment 4: (Re-)Learn to communicate with your friend
As a worried companion, you’ll want to send messages to your friend frequently to check in — “how are you doing today?”, “how are you feeling?”, “How are the drugs treating you today?” Depending on how many people your friend has opened up to, and on their condition, they may or may not appreciate these benign daily check-ups. Since the timescales for recovery in depression are measured in months, it can feel very discouraging to be asked how you feel every day because it’s likely that you’re not feeling any better than the last time your friend asked. Broadcasting a continuous disappointment reinforces hopelessness for a depressed person. There are some days when I get asked these questions from five different friends, and I’ll get worn down by trying to find new ways to express the response: “I’m OK right now, but things are really bad and this sucks”.
Be direct with your friend about how they want to be spoken to. Ask how frequently they would like to be checked up on. Ask if they’d prefer that you start conversations, or if you should wait until they reach out to you to start a conversation. Ask if they’d like your conversations to be distractions from the depression – perhaps about some common interest of yours, or if they’d like you to be a confidant that they can talk to about the depression specifically. Ask these questions frequently, because your friend’s preference might change from week to week.
Assignment 5: Get to know what depression is
It’s difficult to appreciate what a serious episode of depression feels like until you’ve experienced one. Reading the writings of depressed people might give you a window into your friend’s experiences, and help you understand what they’re going through. An important step in supporting a depressed person is articulating that you don’t know what they’re going through, but you’re willing to listen to whatever they might have to say about it.
I’ve written at length about how it has affected my life, which could give you one place to start. You can visit my Medium profile for a creative journal through my current episode of depression to get a view into the brain of a depressed person.
Your friend will feel profoundly alone in ways you may not have experienced. Their sleep cycle might be dramatically disturbed, wreaking havoc on their psyche to a degree that’s difficult to overstate. They’ll be experiencing strains in their romantic relationships, as their significant others learn to support them. They’ll be figuring out how their depression fits into their tangle of familial relationships. They’ll be adjusting to new medications, sometimes with catastrophic results, other times with numb catatonia. They’ll be debating who to tell and how to tell them about their darkest thoughts of suicide and self-harm. They’ll be finding ways to articulate their crisis with their superiors at work. They’ll be entrenched in an all-encompassing internal battle, and as a result, sometimes you’ll need to suffer through their lamentations as they pontificate on the meaning of it all. Or at least, that’s how my depression works.
Assignment 6: Be there, or don’t, but ask
Similar to Assignment 4, your friend may really want you to be in the room with them, or may really want to be alone. Sometimes just having another person in the room makes me feel less profoundly lonely. In worse times, I have no control over my emotions and I wouldn’t want a friend to be around while I cry for an hour. The only way to know what’s best for your friend is to offer frequently. Be direct — “would you like me to be around today, or would you prefer to be alone right now?” Your offer will be appreciated even if it’s not accepted.
Assignment 7: Be patient
One of the most difficult parts of recovering from depression is how excruciatingly slow it can be. It’s helpful if you’re careful with your language as you talk with your friend about their treatment and recovery. A lot of us tend to identify and reassert positives in conversations with ill people, saying things like “well once this new prescription kicks in you’ll…” or “maybe this time the psychiatrist will…” This kind of short-sighted positivity, though well-meaning, is often counter-productive because the most likely scenario is that tweaks to treatment will not make a significant difference between one day and the next. Again, the timescales for recovery from depression are measured in months, not days. So if you feel the urge to say something positive, choose reassuring phrases like: “I’m glad you’ve been getting treatment, and even though it’s taking a lot of time, you’re putting in the work to heal and it will pay off eventually” or “this really sucks, but you’re going to fight this day by day, and I’m going to be here for you whenever you need me.”
Assignment 8: Take care of yourself
This is may be the hardest assignment for significant others of depressed people, so let me be clear – if you become unwell as a result of caring for your depressed friend, you will create more problems than you solve. It’s important to put yourself first over your friend, difficult as that may be. Make sure that you’re eating, drinking, and sleeping enough. Make sure that you’re not withdrawing from the parts of your life that you love to take care of your friend — there must be a balance between caring for yourself and caring for your friend. Surround yourself with the support you need to get through the secondary trauma that you may experience as you support your friend.
In short, take care of yourself because your depressed friend shouldn’t have to take care of you.
Good luck to you, and I hope your friend recovers soon.
You can keep up with me by following my journal on Medium.