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How to Really Help Someone Who Is Depressed

Date: December 1, 2016      Publication: Bottom Line Health      Source:  Susan J. Noonan, MD, MPH      Print:

Here’s a 5-step action plan…

It’s gratifying (if a little tiring) to care for a loved one who’s recovering from surgery or suffering from a physical illness like the flu. Whether you cook up a pot of chicken soup or help out around the house, your efforts are bound to be appreciated.

But that’s rarely the case when a loved one is depressed. Your efforts to help are more likely to be met with silence or withdrawal.

Most people who are depressed don’t like to talk about it—assuming they even realize that they are depressed. And it’s easy to get frustrated when they won’t take the smallest steps to help themselves, especially if they’ve also stopped pulling their weight with household and family obligations. So what’s your best course of action?

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YOU CAN HELP

Depression—as well as other mood disorders (such as bipolar disorder)—can literally change the way the mind works. That’s why the sufferer may find it nearly impossible to even imagine feeling better. So the nudge to get help often has to come from outside.

It’s crucial to do your part because about 80% of those with depression will improve substantially when treated with therapy and/or medication. What you can do…

STEP 1: Talk about any changes that you’ve observed. You’re likely aware of many classic signs of depression such as a loss of interest in things that used to be enjoyable…changes in appearance or hygiene…sleeping more or less (or in fragments)…eating more or less than usual…and feelings of hopelessness and/or withdrawal from friends and family. But signs of depression can also be less obvious to you (or the person who’s suffering). Examples: Having more bad days at work…and/or drinking more than usual.

If you observe any such changes, you might say something like, “I’ve noticed that things are different with you lately. You seem to be sleeping a lot more and have not been getting cleaned up in the morning. Do you think it might be depression?”

Your comments might be well received, but don’t count on it. Even people who know they are depressed don’t like to admit it. Denial is part of the process. You don’t have to push the issue right away…but do bring it up again (every four days or so) if the person doesn’t start to show more interest in his/her physical and mental well-being.

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The gender difference: Women are more likely to see signs of depression in themselves. A man’s depression might be marked by less recognizable red flags such as anger, irritability and/or the use of drugs or alcohol. He’ll probably be less likely than a woman to seek professional help, so don’t hesitate to reach out if you notice behavior or personality changes. Let him know that you’re concerned.

STEP 2: Encourage treatment…but don’t push. The first time you suggest to a loved one that he might want to see a mental health professional, you’re likely to get a response such as “I’m fine”…or “Just leave me alone.”

At first, just raise the possibility of treatment and give your full—and nonjudgmental—support. You may even offer to help find someone to talk to. When a person is depressed, just picking up the phone to call a doctor or other health-care professional can feel overwhelming. Your loved one’s efforts to get help should include a visit to his primary care physician, who can rule out any medical conditions and make a referral to a therapist, if necessary.

Important: People who begin treatment for depression need a lot of encouragement. Treatment can be effective, but it typically takes at least a few months to notice improvement with therapy and/or medication.

STEP 3: Keep the conversation going. Most people with depression know (or eventually learn) that they’re “off” but need to feel safe before opening up about it.

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To encourage the free expression of feelings, I recommend what’s known as active listening. When your loved one does open up, remind yourself to be fully present…let him speak without interruption …and ask “open” questions (such as, “How do you feel about that?”) to keep the person talking.

Another good technique is reflection. When talking with your loved one, you identify the emotions that you’re hearing the person express. If someone says, “Life is no good,” you can “reflect” the emotions by saying something like, “I hear that life feels no good to you right now and everything seems hopeless.” With this approach, you acknowledge the person’s feelings and show that you’re listening closely.

Caution: It’s tempting to give assurances by saying something like, “Everything will be fine.” To someone who’s depressed, this type of response can feel like a brush-off.

STEP 4: Challenge your loved one’s thinking. Depression causes people to view the world through a negative—and distorted—lens. They may truly believe that “I have no friends.” When you hear something like this, offer a more realistic (and fact-based) substitute. You could say: “What do you mean you have no friends? Didn’t you tell me you’re getting along with people in your book group?” The idea isn’t to argue but to point out the inaccuracy of what’s being said.

Also helpful: Encourage your loved one to write two columns on a piece of paper. One column will say “Evidence For”…the other will say “Evidence Against.” Seeing evidence that refutes reflexively negative thoughts in writing can help people shift their thinking.

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STEP 5: Recognize that action precedes motivation. If you don’t have depression, you probably do things when you want to do them. But someone who’s depressed never feels motivated and might need to commit to an activity—joining a social group, going out to dinner, etc.—despite a lack of enthusiasm.

Example: If a loved one is too depressed to take the long walks you know he used to enjoy, you might say something like, “It’s a nice day and I’m going for a short walk. Would you like to come with me?”

Once outside, your loved one may realize how good it feels to get some exercise. Your goal is not to apply pressure…but to encourage an activity until the person feels motivated to do it again.

For more on supporting a loved one with depression, contact the National Alliance on Mental Illness (NAMI.org). If you’re concerned that your loved one could be suicidal, call the National Suicide Prevention Lifeline at 800-273-8255.

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Source: Susan J. Noonan, MD, MPH, a physician who has personally suffered from depression and currently counsels patients at McLean Hospital in Belmont, Massachusetts, about depression and recovery. She is also a volunteer consultant at Massachusetts General Hospital in Boston and the author of When Someone You Know Has Depression. SusanNoonanMD.com