How to help someone with depression

Did you know that depressive symptoms are contagious? That’s why it can be particularly difficult to help someone with depression, as opposed to other diseases. The hopelessness and irritability of a depressed person can easily affect the person trying to help. This article aims to present several useful strategies that will protect both you and your depressed loved one in the process of recovering from depression.

If you need more information about depression, check out the NHS website, or read the article from Flow Neuroscience: Am I depressed?

The difficulties of helping someone with depression

– The downward spiral

To be able to help someone with depression, we need to further understand how depressive symptoms affect the relationship between the helper and the person in need of help.

According to psychologists Dr Laura Epstein Rosen and Dr Xavier Francisco Amador who wrote the book When someone you love is depressed, the people who live with a depressed person are at higher risk of becoming depressed themselves or to suffer from other mental problems, such as anxiety.

Why is this?

Well, losing interest in activities and other people, expressing hopelessness and irritability and rejecting help from others are all common behaviours when going through depression. It’s easy to understand why the people closest to a depressed person can experience similar feelings, such as anger, fatigue, discouragement and strain when trying to help.

You could say that depression is contagious. Part of the explanation is that depression makes it very difficult to communicate with one another. Here’s an example:

Peter and Mike
Peter is living with his partner, Mike, who is currently going through depression. He notices that Mike is feeling blue all the time and has lost interest in most activities (common symptoms of depression). This is difficult to deal with, both for Peter and for his depressed partner. Peter tries to do what he can to cheer up Mike, but nothing seems to help, which makes him feel lonely.

After several weeks, Peter feels more and more resentful because Mike doesn’t show interest in him, rejects his support and doesn’t want to do anything. When Mike asks Peter to perform yet another household chore because he himself is too tired to do it, Peter responds with a deep sigh and an expression of annoyance. Mike, who was secretly asking for support, senses this negative reaction, feels unsupported and more helpless. In turn, Mike’s reactions make Peter feel even more lonely and resentful.

The example above can be thought of as a downward spiral in communication and it’s especially common when trying to help someone with depression.

Remember, no one is to blame here! The downward spiral is not a symptom of a bad relationship or a faulty personality, it’s depression.

So, why does communication so easily break down when we’re trying to help someone with depression? A common reason for a communication breakdown is that the non-depressed person feels guilty about being resentful or angry towards someone who is suffering.

Peter felt guilty about his negative feelings towards Mike. Instead of telling Mike how he felt, he tried to hide it because he didn’t want his depressed partner to feel worse about himself. It didn’t work. Peter’s resentment grew stronger as the weeks passed and Mike sensed that Peter was angry with him. Mike also noticed that Peter was not telling the truth about his reactions, making Mike feel more alone and depressed than before.

Again, it’s easy to see why this happens and it’s no one’s fault. Depression can have a frustrating impact on an otherwise good relationship. Later on, you will be introduced to some strategies that could stop the downward spiral and help you help someone with depression. First, a quick insight into how the depressed mind works.

To keep in mind when helping a depressed person

– Cognitive distortions

When helping someone with depression, it can be useful to understand how depression changes thought processes.

Depressed people usually suffer from what psychologists call “cognitive distortions”. It means that depressed people see things in a negative light. For example, if a work project is put on hold because of budget cuts, a depressed employee may assume it’s because she wasn’t good enough at her job. If you need to cancel dinner plans with a depressed person, he may immediately assume it’s because you don’t enjoy spending time with him. So, the depressed person may instinctively distort what you are saying, making communication more difficult.

When talking to a depressed person, you need to be extra careful to make sure there are no misunderstandings. Don’t make room for fantasies or interpretations. Keep this in mind as you read the rest of the article.

The next section will give you general advice on how to help someone with depression. Later on, you’ll be presented with practical tips on how to behave in a conversation with a depressed friend, partner or relative and what to do when your help is rejected.

General advice when helping someone with depression

• When helping someone with depression, make time for yourself so that you are rested and well-equipped to support your depressed friend or family member. The best thing to do to stop depressive symptoms from becoming contagious is to maintain as many of your regular routines as possible. Try to keep in touch with your friends and tell them what you’re going through. 

• When trying to help someone with depression, try to separate the person from the depressive symptoms. Suggest to your depressed loved one that the two of you can work as a team to conquer the depression. Make sure to tell your friend or family member that you don’t blame them for the depression AND that you don’t blame yourself either.
  
  A depressed person can become more distant, stop answering calls or initiating meetings. It’s important that both of you realise that this behaviour is a common side effect of depression, not a result of a bad relationship. It’s not you, it’s depression.
  
  Depressive symptoms can easily be mistaken for personality traits. Concentration difficulties and a lack of joy or interest in activities can be misinterpreted as a lack of caring about the relationship. To overcome this obstacle, suggest to your depressed loved one that you see the depression as the trouble in your relationship, not the relationship as troublesome.

• Have realistic expectations about how much you can help. You can’t treat someone else’s depression by yourself. It may take longer than you think for your friend or family member to recover and they will probably need help from a professional.

• Ask for help. Seek help from a professional, but also from friends and other family members. Recovering from depression can take time and, as a helper, you’ll need all the support that you can get. Confide in people whom you trust.

• Offer love and support. Tell your friend or family member that you will be there during this period. Love and support is probably what a depressed person needs more than anything, even if she/he doesn’t show it or turns down your invitations to spend time together. (The last section of this article will give you advice on what to do when your help is rejected.)

• Don’t take it personally! When helping someone with depression, try not to take their rejections personally. If the depressed person is too tired to talk to you or seems uninterested in your advice, keep in mind that the rejection is not a reflection of the depressed person’s feelings for you. It’s depression talking, not your friend or family member giving you a negative evaluation.

The next section will give you practical guidelines on how to behave in a conversation with a depressed loved one.

Talking strategies for helping someone with depression

1. REFLECT ON YOUR FEELINGS

Before rushing off to give your depressed friend or family member emotional support, take a few minutes to reflect on your own thoughts and feelings.

Yes, that’s right.

Your own feelings in this situation are just as important. Sometimes, we’re too preoccupied with helping a depressed loved one and paying so much attention to her/his feelings that we forget our own. It’s common to feel worried, sad, irritated, exhausted and even resentful when living with a depressed person or helping someone with depression. Of course, this is no one’s fault, but it is certainly unhelpful to ignore or repress such feelings. Instead, try to understand your inner world.

You may benefit from taking some time to notice your own reactions to the situation. Ask yourself these questions:

• In what way has this depression affected my everyday life?
• How do I feel about that?

Just so you know, it’s okay that you feel this way. The next section will show you how to talk about your feelings without blaming your depressed friend or family member.

2. TALKING WITHOUT BLAMING

Do you remember Peter and Mike? Peter felt guilty about his negative feelings towards Mike, who was going through depression. Instead of telling Mike how he felt, Peter tried to hide his feelings because he didn’t want to add to Mike’s problems. This behaviour started a downward spiral in communication where Peter and Mike stopped sharing their experiences with one another. 

Hiding your negative feelings from a depressed person is nearly impossible. Depression distorts a person’s thoughts and she/he becomes unusually attentive to negative signals from other people. That’s why it’s better to talk to your friend or family member about the negative feelings you are experiencing in the relationship. Otherwise, you risk the person picking up on them anyway and interpreting them in the wrong way, for example thinking that your negative feelings is another proof that she/he is worthless.

So, how exactly do you express negative feelings without blaming the other person?

This list contains some valuable talking strategies that you can use when helping someone with depression:

• When talking to a depressed person, it’s important to pay attention to what you are communicating with your body language. Is your tone accusatory, even though you’re trying to sound supportive? Give yourself time to calm down before talking to your depressed friend or family member.
  
  
• Tell your depressed friend or family member that the reason why you want to express your feelings is because you value the relationship. Tell them that you think your friendship is worth the trouble. Here’s one way to start:
  
  “I want to talk to you about something that’s been on my mind. I’m only bringing it up because I love you and I want to improve our relationship.”
  
  
• When helping someone with depression, make sure to clearly explain how you felt in a particular situation. Don’t talk about your depressed friend’s behaviour in general. Try to give the depressed person concrete examples of real situations, e.g when you hung up the phone yesterday or when you discussed the laundry this morning.
  
  
• Start your sentences with “I” and avoid starting them with “you”. This is good advice for any conversation, but especially important when helping someone with depression. For example,
  
  say: “I felt angry” and avoid “you made me angry”.
  
  Say: “I felt hurt” and avoid “you were rude”.
  
  
• When talking to someone with depression, avoid “always” and “never”.
  
  “I’m upset because you didn’t clean the house yesterday as we agreed” is better than “you never clean the house!”
  
  “I’m hurt because you didn’t call today as you promised” is better than “You never call me!”
  
  
• Don’t ‘kitchen sink’! Kitchen sink is the name of a tactic often used by fighting couples. It’s when they throw everything into the argument. It may have started as a discussion about saving money, but soon they argue about other things as well, such as vacation plans, sex, when to visit whose relatives and who should clean the kitchen sink. When you have an argument with a depressed person, don’t bring up other conflicts. Keep the discussion on a particular topic and stay there.
  
  
• How do you help people with depression who seem unaware of their own condition? Sometimes a friend or family member withdraws socially, stops answering calls and suddenly seems uninterested in spending time with you. These are common behaviours when going through depression, but the depressed person may have too little information about the condition to realise what’s going on. Start by giving your friend or family member a concrete example of a situation where you think she/he expressed depressive symptoms.
  
  Here’s one way to start the conversation:
  
  “I felt hurt when we hung up the phone yesterday. I was left with the feeling that you had no interest in talking to me. It made me angry, but it also made me worry about you. Usually, I feel that you care a lot about me. Are you alright?”
  
  
  Before forcing your own theory on your friend or family member, try to really listen to their side of the story and their experience of the situation. After that, gently suggest that they could be experiencing depressive symptoms and ask them what you can do to help. In this process, you will benefit from active listening. Luckily, the next section will tell you all about it.
  

3. ACTIVE LISTENING

As mentioned earlier, communication can be difficult when depression plays a part in the relationship. Active listening helps you overcome some of the problems and it can make your depressed loved one open up and feel valuable.

The following steps will most likely help you help someone with depression:

• The first step in the process of active listening is to make time for communication. Don’t talk to each other in a rush. Suggest to your depressed friend or family member that you sit down on the couch to talk or take a walk together.
  
  If you’re not living in the same house, agree to talk to your depressed friend on a specific time and day of the week. This helps to make communication a priority in the relationship and also less arguing about who should call whom more often.
  
  
• Let depressed people know that you’re trying to walk in their shoes. The most effective ingredients in active listening are
  
  1) reflecting back what was said and
  2) making a guess at the feeling underneath the words.
  
  Here are a few examples of active listening:
  
  
  “It sure sounds as if you’re having a tough time. I know I would be exhausted if I was going through the same thing.”
  
  “It sounds as if you feel angry about the thing that your mother said. Is it because you wanted her to react in a different way?”
  
  “That must make you angry. I know that I would be angry if that happened to me.”
  
  
  
• Be sure to listen closely when helping a depressed friend or family member. The impulse to give advice and say something helpful can make us poor listeners.
  
  When talking to a depressed person, there may be more silences than usual because the person is reluctant to open up. Try not to fill all of these silences with chit-chat. Instead, try to tolerate the silence and give the depressed person extra time to open up. Give your depressed friend or family member space and an interested listener.

• Don’t be too quick to give advice. When someone you care about is going through depression, it’s tempting to give them frequent advice about what they should do to feel better. Try to take a step back and don’t come on too strong.
  
  A common symptom of depression is feeling hopelessness. If you bombard depressed people with a thousand pieces of advice, they may interpret this as if you don’t understand their situation and are pressuring them to be 100% better at once.
  
  Explain that you understand how hopeless they feel and that depression makes most things seem meaningless. After that, you can offer advice, but limit it to one suggestion at a time. When helping someone with depression, conveying respect and understanding matters more than the advice itself.

How to help depressed people accept support

– What to do when your help is rejected

Social support is essential for depressed people and offering social support is important when helping someone with depression. Ironically, depressed people often turn away social support, thereby denying themselves the support they so desperately need.

This section will give you some valuable tools for giving support, but first we need to understand the reasons behind this paradox.

Why do depressed people turn away support when they obviously need it? 

According to psychologists Dr Laura Epstein Rosen and Dr. Xavier Francisco Amador, there could be many reasons. Sometimes cognitive distortions are the biggest villains when it comes to accepting social support. Cognitive distortion is a depressive tendency to interpret things in a negative way. Depressed people sometimes experience other’s attempts to help as useless or intrusive because their pessimistic mindset tells them that there’s no way out of depression and that their problems are too big to be helped by anyone. They think that there is no use listening to advice. 

Sometimes, accepting help from others makes people with depression feel like failures. It can be especially difficult for highly self-sufficient people to accept help, because they are used to handling things on their own. Their critical thoughts tell them that they should be able to deal with problems themselves and that accepting help makes them weak. 

At other times, depressed people are afraid that accepting help will disturb the dynamic in the relationship. For example, a person that has always been the ‘main caregiver’, ‘the responsible one’ or ‘the organiser’ may find it difficult to ask for help, fearing it would threaten their role in the family or in the relationship. 

So, what can you do to help a depressed person who is rejecting your help? Here’s some advice:

• Acknowledge that your depressed loved one turns away your offers of support. Admitting that this is happening and that it is a problem in the relationship is an important step forward. Remind yourself that depressed people have a natural tendency to turn away support and that it’s no one’s fault.
  
  It’s not a rejection of you, it’s depression.
  
• When your offers to help someone with depression are repeatedly rejected, it usually creates feelings of sadness, helplessness, anger and resentment. Make sure to take care of yourself and keep to your daily routines, to avoid becoming depressed yourself. Seek support from your friends and spend time with non-depressed people regularly.
  
• Start paying close attention to the situations in which your help is turned away. Notice how those situations make you feel. Frustrated? Angry? Guilty? Sad? Knowing how you feel is essential for coping with those feelings.
  
  Share your feelings in a calm and non-accusatory tone. It could prevent built-up resentment and frustration in the relationship.
  
  When your help or support is rejected, tell your depressed friend or family member how you feel about it (using the techniques presented in the section Talking without blaming). The depressed person may not realise what it feels like for you. Even though it’s tough for them to hear, it may create more intimacy between you in the long run.

• When helping depressed people, you’re allowed to ask them what kind of support they would like to get. Would they prefer a quiet listener or to receive specific suggestions on how to solve a problem?
  
  
• Try reversing the roles and ask your depressed friend or family member for help. Instead of becoming stuck in the role of ‘the helper’, give your friend an opportunity to help you out every once in a while. To “be useful” or “feel needed” is definitely something that can help a depressed person feel better. You could say something like:
  
  “I have a real problem that I was wondering if you could help me with. Would you be willing to talk to me about it?” 
  
  Ask for help from a professional. If your depressed loved one refuses to seek professional support, maybe you should consider going to therapy alone. 
  
  
• Let your loved one know that there are many things people can do at home to reduce depressive symptoms. The Flow depression app is free to download and contains a complete, at-home treatment programme for depression.
  
  Or, read more about 5 treatments for depression without medication.

In conclusion

Depression affects not only the person suffering from the condition, but also the friends and family members who are trying to help.

Sharing your feelings without blaming, offering social support, separating the person from the depression and asking for help are all useful tools for protecting your relationship from the negative impact of depression.

Hopefully, you found this article helpful. If you want to read more on the subject, check out the book When someone you love is depressed by psychologists Dr Laura Epstein Rosen and Dr Xavier Francisco Amador. 

Thank you for your attention!