How to be be friends with someone suffering from Depression

For the "What I want you to know" carnival:  I want you to know how to be friends with a person suffering from depression. 

Sometime ago, I read a couple of different posts—“how to be friends with an infertile.”  “How to be friends with a birthmother, etc”  I looked for but I have not been able to find one on how to be friends with someone dealing with depression.  I wrote this because this is what I would like my IRL and online friends to know about what I am going through.  I don’t pretend to speak for all people with depression, but I have tried to account for a wide range of experiences--not all of my examples are my own personal experience.  I would appreciate any linkage you could give this particular post because I would like to help as many people as possible.   

•    All depression is not the same.   When someone says “I’m depressed” or “My doctor says I have depression,” they might mean any one of a number of things.  They may have had a major change in their life—a birth, death, move, divorce—which is causing situational depression.  If the depression isn’t triggered by outside events, your friend may have clinical depression which is caused by an imbalance in brain chemicals.  This depression can be mild, and not requiring treatment, or can be disabling.  There is a wide range of depression and types.  Many types of depression come back over and over again.
•    Recurring depression is not a sign of failure.  Don’t assume that your friend went off their medication, stopped treatment, or did some thing wrong to make depression recur.  Recurring depression is not a sign of YOUR failure as a friend either.  You can offer the best suggestions in the world, the biggest shoulder, and the most support and still the pesky brain chemicals can beat both of you.  This doesn’t mean that you are lacking as a friend. 
•    Don’t assume that it is not depression.  If your friend has all the signs of depression, don’t wait for her to tell you.  Cut her some slack.  If she says she is struggling, encourage her to open up.  Try to create a safe space for your friend to share.  Assume that she wants to beat whatever it is that is plaguing her. 
•    Depression has a lot of effects.  Your friend may have gained or lost a lot of weight.  They may be suffering health problems.  They may be dealing with fatigue.  Anxiety frequently accompanies depression.  Your friend may not be taking good care of herself.  Depression takes a huge toll which isn’t always visible.  Try to understand this, and try not to leap to assumptions like “she’s a hypochondriac”  or “she’s always sick,”  or “she needs to do something about that.” 
•    Depression doesn’t resolve overnight.  This can be hard for you to deal with.  Your friend has been taken over by the depression monster and it doesn’t appear to be leaving anytime soon.  Even with medication, depression can take 3-4 months or more to lessen.  Your friend needs you to be committed to the long haul, and doesn’t need pressure to get better faster.   
•    Depression can’t be wished away.  Ordinary blues can often be resolved by doing something, by distraction, by positive thinking, and by simply deciding to have a good day.  Depression is different. Depression zaps your ability to think positive, and even when you make efforts, it can still creep in.  A depressed brain is not going to respond to sheer force of will.  Statements like “just don’t dwell on it,” “if you just decide to be happy . . .” “just calm down”  “just do X.”  If there was a “just” solution to depression, your friend would be doing it.  Better things to say would be, “I am so proud of you for hanging in there,”  “I know you are trying.”  “Can we think of anything to help you get through today?” 
•    It’s not about you.  Your friend may start crying in the middle of a conversation, abruptly change the subject, or get irritable or aggressive without provocation.  You can be a great friend, and depression can still win.  It is the depression talking, not your friend.  Your friend wants to be happy for you, or to be able to deal with your frustrations and problems, but the depression is not letting them right now.  Your friend wants to be able to say “please, don’t give up on me.”  Don’t assume that just because you had one bad phone call, or one bad experience that the friendship is over or that your friend is no longer able to deal with certain things.  Try again.  Be patient.   
•    Your friend may not want to talk about depression.  Or she may want to talk about nothing else.  You need to respect both, but either way, try not to dwell too much on the depression.  Statements like “wow, your medication really seems to be working,”  or “you seem so much better today!” or “how is counseling going?” are well intentioned, but may not be received well by your friend.  She may be experiencing side effects, putting on a good face, or not want to talk about how things are going.  She may be doing really important work in counseling, but not be able to share that with you. 
•    Respect confidentiality.  Don’t ask “do you talk about me in counseling?” Your friend needs a safe space to talk about everything, including you.  You are not causing the depression.  You are most likely not a roadblock to recovery.  This is not about you.  Your friend may need to explore emotions that she can’t share with you right now.  If your friend shares with you, respect that too.  Don’t tell other acquaintances that your friend is suffering from depression, on medication, in counseling, on leave of absence or in treatment if your friend has not told you it is okay to share.  You can encourage friends to support your friend without telling them confidential information. “X is going through a rough time right now.  Why don’t we do something for her?”  “X isn’t here today, because she dealing with some personal issues.  I know she would appreciate your good wishes.” 
•    Your friend feels judged.  Regardless of what you do and say, your friend is going to feel some amount of external judgment and pressure. This is part of the nature of the beast.  You may mean “have you thought about acupuncture?” as a nice suggestion, but your friend may hear “You are still a real drag to be around.  You need to do more to fix your problem.  I would be happy if you tried acupuncture.” Thinking distortions like this are really common in all types of depression. Understanding this can help you to cope when your friend reacts badly or misinterprets something you said.  Your friend may need more explicit reassurances. Reassure your friend that your love is unconditional, and that others are not judging her.  Repeat this often.
•    You have to do more of the work.  No one enjoys being in an unbalanced relationship where one party has to do more of the “work” of the relationship.  However, when your friend is depressed, she is going to need you to carry the burden of the relationship for a little while.  You may find yourself being the one who makes all the phone calls and emails for a little while.  This sucks.  But, right now, the depression beast is telling your friend that she is not worthy of your friendship, and the depression beast is zapping her energy.  As the brain chemicals get ironed out, you can expect your friend to do more to maintain the friendship.  Right now though, your friend needs you more than ever, but may not be able to reach out to you, so you have do the reaching.   
•    Forgive your friend.  Part of doing more of the work of the relationship means dealing with unreturned phone calls, unanswered emails, and repeated “no, thanks” or no-shows at events.  This is a sign that the depression is fairly severe, but it is not a sign that your friend no longer needs or wants you in their life.  Ordinarily, this would be pretty rude behavior, but right now, this is not your friend talking.  This is the depression.  Try to understand that your friend wants to be able to do everything she used to and to be able to communicate, but the depression just isn’t letting her.  Your friend needs you to continue to reach out.  You never know what effort is going to be one that she is able to respond to. 
•    Don’t make excuses for your friend.  While you need to understand that some bad behavior, lack of communication, and one-sided giving is to be expected, you should not put up with hurtful statements, attacks, and dangerous actions.  You need to tell your friend when they do or say something that is not acceptable.  “I know this is the depression talking, not you, but that really hurts me.  Could you please not verbally attack me like that?”  You may need ask more than once.  You can ask your friend to go cool off or to come back once they are able to talk with without hurting you.  Acknowledge when your friend drops the ball—“Yes, it sucked that you didn’t come to the party.  I missed you.  I forgive you, but it still hurt.”  You should never feel threatened by your friend.  Encourage your friend to call a crisis line or do so yourself if this is the case. 
•    Make compromises.  Rather than put up with behavior that bothers you, try to give your friend manageable goals.  “Could you come for thirty minutes?”  “If you can’t come, could you please call?”  “Could you tell me how you feel without making degrading comments?” “Could we watch a movie and then talk later?”  Your friend is probably feeling pretty overwhelmed.  While you have a right to expect certain things, you are going to get more positive results if you break things into manageable, concrete steps for them.  You may need to break down even simple tasks for them.  Offer to help them.  Your friend may be more likely to go somewhere if you pick them up, or to help if you bring the project to them.  Going for a coffee may seem simple to you, but to your friend it seems like a mountain right now. 
•    Do strive for a happy medium.  You can’t “cheer up” depression, but you can still make your friend laugh, distract her, do silly things, and do things you enjoy together without talking about the depression.  She may not be as animated as usual, may not respond as much, but she will appreciate the effort.  Don’t avoid all hot button issues though.  Your friend does not need you to be the comedic relief.  Most depression is not triggered by a specific event, so don’t feel that you can’t discuss something sad or serious.  You can still discuss problems in your own life.  In fact, your friend will probably welcome the chance to talk about you and to focus on someone else’s problems for a bit.  Understand if she is not at this point yet, or if she can’t focus right then, but don’t give up on trying to have balanced conversations.  Still call your friend when something big happens in your life.  Share your good news.  Share your problems. She may not be able to have the reaction you want right now, but your friend will appreciate still being “in the loop” and this will make it easier for your friend to reconnect when the depression loosens its grip. 
•    Your friend may not look like your friend.  Trust me, your friend is probably well aware that she has gained or lost weight or is no longer taking good care of herself.  You can encourage her to do nice things for herself, but don’t assume that she needs you to point out the obvious.  Try to reward your friend for little strides she makes in this area—if she has been wearing yoga pants and pj’s out, compliment her when she wears anything else.  Try to find genuine things to compliment, even if your friend is not meeting your personal standards of grooming and self-care at the moment.  This can make a huge difference for your friend.   Remember your friend probably feels like everyone is judging her new appearance in a negative light—she may need repeated assurances that she is still beautiful no matter what.  Even if your friend has a big weight change, this may not be the time to suggest a joint diet and fitness plan.  Your friend may not be in a place right now where she can focus on that. Please don’t give up though—invite your friend on walks and give her opportunities to be active.
•    Your friend may need more help than you can give.  Your friend may need a support group, counseling, doctor, or any number of other interventions.  This isn’t a failure on your part, but a sign that your friend is getting the help they need.  Offer to go with your friend if they are having trouble getting help.  The first step is the hardest for your friend, your support may make a huge difference.  If your friend is demanding more from you than you can give, DON’T give up on the friendship! Don’t withdraw, but do set reasonable limits on your assistance.  Don’t wait until you are completely burnt out to address your limits.  Do encourage your friend to get additional help.  Do tell your friend when you need a break.  Even a one line response to a lengthy voice mail or email can make your friend feel listened to and validated.
•    Do encourage your friend to help themselves as much as possible. Resist the temptation to just do things for your friend.  Say “I will go with you this time, but next time, you can go and then call me, okay?”  “How about we do this together?” “Have you written in your journals (drawn, knit, walked, done yoga, etc) today”  “If you write it down, I will make the call for you, but you have to tell me what to say.”  Ask your friend what works for her, what she would like to be reminded to do. 
•    Not all medication is created equal.  Your friend may or may not be open to discussing how she is treating her depression, but if she is, don’t assume that just because a medication worked for someone else that it will work for your friend.  Conversely, if someone else had a side effect on a medication, it does not mean that your friend will experience the same set of side effects.  Everyone is different. Those pesky brain chemicals respond differently for everyone.  Many doctors will use a combination of drugs, varying doses, and off-label uses to help treat depression.  A combination of drugs does not mean your friend is more ill or “addicted” to antidepressants.  Many doctors now use low doses of anti-psychotic, sleeping medications, seizure meds, and other medications that may sound really scary to you.  This does not mean that your friend cannot be trusted, is schizophrenic, needs hospitalization, or is crazy. 
•    Not everyone responds to medication.   If your friend stops a medication, or does not take medication, it does not mean that she is ignoring the problem.  Medication does not work for all people.  Your friend may try a lot of alternative therapies.  She may try none.  She may take supplements instead.  Some supplements work for some people but not others.  Not everyone can take supplements because of drug interactions. 
•    It is really hard when a treatment does not work.  It can be hard for both you and your friend when a treatment fails to bring about results. If your friend seems to be trying every alternative cure that comes along, or switching medications frequently, she probably feels pretty desperate, and is really wanting something to work.  It can be difficult to gear up for yet another treatment option, and it can be hard to stick with a treatment that is not working.  Sometimes a medication works for a while and then stops working.  It is really important to support your friend without judgment when treatment isn’t working.  Don’t bombard your friend with new options, but don’t be afraid to bring up options in a non-coercive way. 
•    Your friend still needs you.  It can be really hard when your friend continually breaks down, when you offer help, and nothing seems to “snap” them out of the depression.  Don’t get discouraged.  It may seem like your presence isn’t needed or like it makes no difference. You have no idea the difference that you make.  Just holding hands, listening, be physically there can make a huge difference.  She may not acknowledge it at the time, but she needs you.  Your presence is needed more than you can ever really know. 

Comments

[baggage]

Wow, what a great post. I'm going to forward this to a few people. Thank you.

[TSC Girl]

This was an amazing post. I posted a link on my blog.

[Jenny Ryan]

Thank you for this post. I wish I'd had it years ago when I was first diagnosed with depression.

I hope you are getting all the help and support you need right now.

[Margaret]

This is really helpful to me right now. I won't get in to why it's so timely. But trust me when I say thank you.

[Poor_Statue]

This is absolutely wonderful. I think everyone should read it. Thank you.

[Stephanie]

Thanks for giving us a different perspective and for helping others to see how we may be helpful to those suffering from depression.

[jeannette]

I've just been diagnosed. This post was really timely for me. I wish I could see the resolution to my depression, but in the meantime, this helped me see how the world might (and should) view me during this rather crappy time.

[Beth]

Wow - all really great points. Thanks for putting it out there.

[Jo]

Thanks for that, my best friend has had severe depression for about 2 years now and I was starting to get exasperated as nothing was helping but that post has helped me a lot and I will definately try to adhere to the tips!! You should write a book :)

[Diesel]

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[Diesel]

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