10 ways you can help someone with depression

Do you actively want to make a difference by 'being there', as a friend; a family member; someone who cares? If you know somebody who suffers from chronic illness of any kind, I believe this post will help you identify ways that you can show care and support.

This is a subject that is very close to my heart at the moment. My partner has been suffering with painful, debilitating symptoms for over eleven years and has become increasingly isolated. Very recently, we learnt that the normal functions of a persons nervous system can become disrupted as a result of chronic pain or depression and he has embarked on a relatively new course of treatment. The treatment works directly with the physical symptoms in his body in an effort to restore the normal operation of the nervous system. The process is emotional, nerve-wracking, uncomfortable, and unfamiliar. At times my partner feels even worse, not better. It is taking a lot of effort in his part. And what keeps coming up now, every day, is the grief and self-doubt that is a result of social isolation. All long term health problems can cause isolation and I will probably write about this another time, it is not unique. But what breaks my heart is that one person (me) is not enough to convince him that people want him to get better. His family, friends, busy with their own lives, don't know that anything is changing; don't know how bad things got, and that he needs them now because he is trying to piece his life back together - and he needs other people to think that it's worth it; that he's worth it.

My partner does suffer from depression but I feel very strongly that many of these tips below also apply to chronic illness of any sort, even if it doesn't involve depression. People who suffer chronic conditions are often made to feel bad for not getting better; they are less available to go out with their friends; and although their symptoms are a daily hinderance, they don't want to bore their friends with being honest about how they're feeling: not very well, as usual. I remember a friend saying that when a close loved one dies, people stop asking and showing they care after a while, even though it hurts forever. It is the same with chronic illness, in the first couple of weeks people will acknowledge that you're in a bad way with thoughtful acts of kindness - after a while they can start behaving like they're bored of you! Are you bored of your friend or loved one? I don't think so. Show them you care about their wellbeing by practicing your favourite tip from the list below.

Advice for Friends and Family.

1. Remember that they cannot help being affected by a depression.

• A person with depression cannot 'snap out of it' and you cannot cure it for them. It is not just sadness which can be waved off with a few kind words. It goes far deeper than that. If you are going into this with the heroic notion that you can somehow "fix" it for your friend, spouse or relative, then you need to disavow it immediately. Operating on this assumption will only frustrate you and does no one any good. Read more on my blog post: the dangers of trying to fix it...

2. Encourage him or her to talk and listen to what they are saying.

• Don't ask very general questions; you won't get a meaningful answer. As an example: Rather than asking "How are you?" ask "How are you today compared to yesterday?" or something of this kind. Make the question open-ended, so the person can say what he or she wants, but provide something specific for them to talk about.
• Don't be afraid to let them talk about whatever they want to. Even if they mention self-injury, or they are suicidal, you are not endangering them by listening. Actually, you are helping to protect them from those things; talking helps them deal with these feelings.

3. Let them know that you care about them.

• Little things go a long way for someone with clinical depression. Small gifts and favors seem much bigger to them than to you. Don't be afraid to (for example) leave the person a short note with a smiley face on it. Even if it seems silly or hokey, small considerations will help.
• Being prepared to listen and hear what they are saying, even if the persons emotions are uncomfortable for you both shows that you care.
• Some people find it very difficult to listen to people who are in so much pain, and their own emotions can get in the way of fully being able to 'be there' for the person who is depressed or in pain. If this is you, do encourage your depressed friend or relative to find someone they can talk to about their feelings, and most importantly, remember that staying away and loosing contact for weeks on end will give the impression that you don't care.

4. Help the person to feel less isolated. Depression (and long-term illness of any kind) can be a very isolating experience.

• Stay in contact with them: send a card, give them a ring, visit them in their home, send regular text messages so the person knows you are thinking of them.
• Try to get the person out. He or she will want to isolate themselves —hibernate, even— but this is exactly what should not happen. Take walks, go shopping, go to a movie, whatever you have to, to get the person out of the environment they are trying to take shelter in. You may get some resistance, and even complaints; be persistent but not unreasonable.
• At times, it may seem that the person is actually pushing you away. This is very likely true. Most depression patients believe that they unduly affect those around them and will do anything to prevent that from happening. Thus, they isolate themselves from others. This kind of self-sabotage is actually a symptom of the illness itself. Don't let it overcome your relationship. Try to understand that this is often involuntary and irrational, and act accordingly.

5. Help them to feel good about themselves by praising daily achievements.

6. Encourage the person to look after themself. People who are depressed are very harsh and critical with themselves so this is a big ask - asking them to be kind to themselves. Don't say "try not to be depressed" or imply that they can easily feel better "if they just do...". Trust the persons ability to know what is right for them and instead of prescribing what you think they should do, listen to what they are finding difficult and encourage them to think about how they can support their own wellbeing. The result may simply be that your friend or relative becomes able to avoid some of the activities that make him or her feel worse, or identify his or her 'coping strategies'.

7. Find out about support services available to them and to you (self-help groups, out of hours emergency support, helplines, etc).

8. Encourage them to visit their doctor, and ensure that they take any prescribed medication as directed. 

9. Remember that no one wants to make your life miserable by being depressed. Try not to view someone else's depression as your own affliction. Rather, be grateful that you don't have clinical depression and try to realize what the other person is going through. Don't take the things your friend, spouse or relative says/does, personally. They aren't meant that way.

10. Remember there are ups and downs in depression recovery. It is neither swift, nor steady. Your friend or relative is going to go on the decline, now and then. Don't think it's because you are failing them or they are not trying hard enough. The "roller-coaster" effect is just a part and parcel of depression.

This blog post takes excerpts from The Depression Alliance: Advice for Friends and Family section, and the article "If you know someone who is depressed" at the 'Healthy Place' website. You can click the links for the original articles.


Talking to Someone Who is Depressed 
Advice from the Depression Alliance: Original Article

DO SAY
1. You're not alone in this.
2. You are important to me.
3. Do you want a hug?
4. You are not going mad.
5. We are not on this earth to see through one another, but to see one another through.
6. When all this is over, I'll still be here, and so will you.
7. I can't really understand what you are feeling, but I can offer my compassion.
8. I'm not going to leave you or abandon you.
9. I love you (if you mean it).
10. I'm sorry that you're in so much pain. I am not going to leave you. I am going to take care of myself, so you don't need to worry that your pain might hurt me.

DON'T SAY
1. There's always someone worse off than you are.
2. No one ever said that life was fair.
3. Stop feeling sorry for yourself.
4. So, you're depressed. Aren't you always?
5. Try not to be so depressed. Snap Out of It. Man Up.
6. It's your own fault.
7. I think your depression is a way of punishing us.
8. Haven't you grown tired of all this me, me, me stuff yet?
9. Believe me, I know how you feel. I was depressed once for several days.
10. Have you tried chamomile tea?
11. Please don't tell a depression patient that "you understand."

Excerpt from the Healthy Place:
"Please don't tell a depression patient that 'you understand.' Unless you, yourself, have experienced clinical depression, you don't. And your friend, spouse or relative knows it. It's not a bad thing; since understanding depression means having it. I'd rather that no one, anywhere, understood it. The point here is to be honest with your friend or relative and don't profess things that aren't so. Sincerity will help him or her a great deal; it will engender trust, which every depression patient has a problem with, at one time or another.


Relevant Links

Depression caused by Chronic Illness

Depression is one of the most common complications of chronic illness. It is estimated that up to one-third of individuals with a serious medical condition experience symptoms of depression. Depression and illness may occur together because the physical changes associated with the illness trigger the depression or the individual has a psychological reaction to the hardships posed by the illness. The illness may affect a person's mobility and independence, and change the way a person lives, sees him or herself, and/or relates to others. For these reasons, a certain amount of despair and sadness is normal. In some cases, a chronic illness may actually cause depression . Read more in original article at Medicine.Net...


Depression and Chronic Pain

Depressed patients have three times the average risk of developing chronic pain (and visa versa). This is because depression and pain share the same brain pathways, as explained by the Harvard Health Publications website:

"The convergence of depression and pain is reflected in the circuitry of the nervous system. In the experience of pain, communication between body and brain goes both ways. Normally, the brain diverts signals of physical discomfort so that we can concentrate on the external world. When this shutoff mechanism is impaired, physical sensations, including pain, are more likely to become the center of attention. Brain pathways that handle the reception of pain signals, including the seat of emotions in the limbic region, use some of the same neurotransmitters involved in the regulation of mood, especially serotonin and norepinephrine. When regulation fails, pain is intensified along with sadness, hopelessness, and anxiety. And chronic pain, like chronic depression, can alter the functioning of the nervous system and perpetuate itself."

 4 Tips to help with Chronic Pain and Depression from the Spine Health website


Depression in people with Medically Unexplained Physical Symptoms

"Patients with medically unexplained physical symptoms have been shown repeatedly to have increased rates of depression and anxiety" (click for source)

I would argue that regardless of the nature of the patients symptoms, their experience of 'medically unexplained physical symptoms' lends itself towards depression. Add to the experience of not having a 'named condition' that sounds or feels legitimate, the difficulty these patients have in accessing the information, support, and treatment they need. I believe it is important to recognise that this is the context of the persons illness experience and that alone can toll on a persons physical and emotional health. Read more on my blog post: The Experience of Unexplained Illness here...


Other Posts in this Series:

• Being Supportive (the secret of)
• The dangers of wanting to fix it
• Don't jump to the rescue, practice being self aware