What To Do When a Loved One Is Severely Depressed

June 7, 2018

At a suicide prevention event at Walla Walla High School in Walla Walla, Wash., last month, participants choose necklaces of different colors representing how suicide had affected their lives.CreditGreg Lehman/Walla Walla Union-Bulletin, via Associated Press

Reports of Kate Spade’s suicide and struggle with depression instantly transformed her from symbol of polished prep to a blunt reminder that suffering affects all types. Three days later we woke to the news that another beloved figure, Anthony Bourdain, had taken his life.

These two tragedies have inspired hundreds to tweet some version of the same message: Mental illness is nothing to be ashamed of.

But deep in the comment threads, some have also been debating a more uncomfortable question: What do you do when a friend is depressed for such a long time that you’ve started to feel that that nothing you can do will make a difference, and your empathy reserves are tapped out? There are no easy answers. But here are some tips from experts:

Don't underestimate the power of showing up

You may not feel that your presence is wanted. But just being by the side of someone who is depressed, and reminding her that she is special to you, is important to ensuring that she does not feel alone, said Dr. Norman Rosenthal, a clinical professor of psychiatry at Georgetown University School of Medicine.

If she acknowledges she’s depressed, that’s a good sign, said Dr. Rosenthal. He recalled the story of a patient who stopped feeling suicidal after telling people he was close to how he was feeling.

“When you shine the light on the shame, it gets better,” Dr. Rosenthal said.

Don't try to cheer him up or offer advice

Your brother has an enviable job and two lovely children. He’s still ridiculously handsome even though he hasn’t gone to the gym for six months. It’s tempting to want to remind him of all these good things.

If you want to say something positive, focus on highlighting what he means to you, Dr. Rosenthal advised. And though offering suggestions for how to improve his life will be tempting, simply listening is better.

It's O.K. to ask if she is having suicidal thoughts

Lots of people struggle with depression without ever considering suicide. But depression is often a factor.

Although you may worry that asking, “Are you thinking about killing yourself?” will insult someone you’re trying to help — or worse, encourage her to go in that direction — experts say the opposite is true.

“It’s important to know you can’t trigger suicidal thinking just by asking about it,” said Allen Doederlein, the executive vice president of external affairs at the Depression and Bipolar Support Alliance.

If the answer is yes, it’s crucial that you calmly ask when and how; it’s much easier to help prevent a friend from hurting herself if you know the specifics.

Take any mention of death seriously

Even when a person with depression casually mentions death or suicide, it’s important to ask follow-up questions. If the answers don’t leave you feeling confident that a depressed person is safe, experts advised involving a professional as soon as possible. If this person is seeing a psychiatrist or therapist, get him or her on the phone.

If that’s not an option, have the person you’re worried about call a suicide prevention line, such as a 1-800-273-TALK, or take her to the hospital emergency room; say aloud that this is what one does when a loved one’s life is in danger.

In some cases, calling 911 may be the best option. If you do, ask for a crisis intervention team, Mr. Doederlein urged.

But remember that interactions with law enforcement can vary wildly, depending on race and socio-economic background. In cases where you’re concerned that calling police could put a person in danger, try to come up with an alternate plan in advance.

Make getting to that first appointment as easy as possible

You alone cannot fix this problem, no matter how patient and loving you are. A severely depressed friend needs professional assistance from a psychologist, psychiatrist, social worker or another medical professional.

Yeah, you know. You’ve told your boyfriend this, but it’s been months — or maybe even years — and he still has not set anything up.

“You can’t control someone else’s recovery,” said Kimberly Williams, president and chief executive of the Mental Health Association of New York City. But you can try to make getting to that first appointment as easy as possible.

That might mean sitting next to your friend as he calls to make the appointment, finding counseling that he can afford, or even going with him that first time, if you’re comfortable with it.

What if you’re not sure whether you should start with a therapist or a psychiatrist, or whether you’ve found the perfect person? Ask around for recommendations, and know that one practitioner may ultimately lead to another.

But don’t overthink it. The key initially is just getting a professional involved so you are not the only person managing this situation. (That said, if that first appointment seems really unhelpful, trust your instincts and find someone else.)

Take care of yourself and set boundaries

When the thoughtful and kind people we’ve loved for years are depressed, they may also become uncharacteristically mean and self-centered. It’s exhausting, painful and hard to know how to respond when they pick fights or send nasty texts.

“You don’t have to attend every argument you are invited to,” Ms. Devine said.

Still, just because someone is depressed is not a reason to let their abusive behavior slide. Set clear boundaries with straightforward language such as, “It sounds like you’re in a lot of pain right now. But you can’t call me names.”

Similarly you may find that your friend’s demands on your time are starting to sabotage other relationships or your job. You’re not going to be able to help if you’re not in a good place yourself.

It’s O.K. not to be available 24-7, but try to be explicit about when you can and cannot help. One way to do this, Ms. Devine advised, is to say: “I know you’ve been really struggling a lot, and I really want to be here for you. There are times that I physically can’t do that.”

Then come up with a contingency plan and kindly push her to stick with it. Coming up with a consistent schedule for when you’ll see each other every week can be helpful to you both.

Remember, people do recover from depression

It can be hard when you’re in the middle of the storm with a depressed friend to remember that there was a time before, and hopefully an after, this miserable state. But it’s essential to remind yourself — and the person you’re trying to help — that people do emerge from depression. Because they do.

I have seen it. Every single one of the experts quoted here has seen it, too. But it will take patience and time.