Advice for friends and family of people with depression: 5 things to consider

It’s world mental health day!  So, let’s discuss depression.

Anywhere from 3 to 17% of the world’s population suffers from it, with US being one of the highest.  That is a lot of people!  It leads me to wonder a) why the difference in prevalence and b) why did we not hear about depression as much before?  Were the melancholic poets and anguishing writers from the days of yore actually just depressed?  Like, why did Van Gogh cut off his ear? And think of how many have committed suicide!  They must have been severely depressed!  Or is depression a function of the 20th century, 21st now?  It definitely has to be a function of life in America, especially currently!  Whatever the cause, it’s obviously a hugely prevalent condition, one that is sometimes fatal.

Let’s define depression first.   You might have depression if you have at least 5 of the following symptoms for at least 6 months or more:

• Depressed mood
• Loss of interest or pleasure in most or all activities
• Insomnia or hypersomnia
• Change in appetite or weight
• Psychomotor retardation or agitation
• Low energy
• Poor concentration
• Thoughts of worthlessness or guilt
• Recurrent thoughts about death or suicide

It can be tricky to diagnose for a doctor, because people don’t walk into the office and rattle off: “I have depressed mood, low energy, insomnia…” etc.  In fact, almost half of the patients come to the doctor with somatic complaints, ie complaints about their body, which are really depression manifesting itself.  You know that add, “Depression hurts…”  It does!

So, statistics say 3-17%. The thing is, trying to explain it to the other 97-83% is difficult. Normal people also have bad days, sad moods, some even recognize that life is nothing but a constant shit storm.  But for normal people, the shit storm doesn’t take over their existence.  And, for normal people, dealing with the bad days and sad moods isn’t an all consuming effort, not to mention that they’re able to deal with them at all, whereas depressed people can’t, not in an adequate manner.  So, when normal people ask: Can’t you just put this behind you? Or when they say: Don’t think about that now.  Do something active. Pull yourself up by your bootstraps.  Cheer yourself up.  You need to talk it out.  Just try to explain that no, you can’t and it won’t help, and also, why not!  It’s impossible because they just. don’t. get it.

But what does it feel like?  I can’t speak for everyone; I can only describe what it is for me.  For me, it’s like a quicksand trap. You feel that your foot has been caught, so you pull it out, but to get out of the quicksand, you need to step with the other foot, and as you do that, it sinks too; then you’re in with both feet, up to the knees, and as you kick your feet more, soon you’re up to the waist. Eventually, comes a moment when you realize it is inevitable; you’re about to get sucked down, so you just allow it. You relax for a second, and then it’s already enveloped you, and you’re in the dark.

Sometimes, it’s like a hole in my chest. It’s a hole that some vermin inside me has gnawed into existence laboriously and persistently. It comes on slowly, expanding and expanding until you start to feel it all the time. It itches, literally; there is a physical sensation, but it doesn’t go away even with the deepest breaths of fresh air.

It’s also been like a vise. Or a Chinese finger trap. The more you move, the tighter they crank it. You think, this will have to stop eventually, but you just don’t know when, and you have no choice but to stay still within the vise. Your life is bidirectional, but there’s a screw on either end, and you have no control of the tightness setting.

All of this sounds like melodramatic poppycock even to me when I put it on paper, so of course, it’s impossible to explain to people who have never experienced it.  Maybe simpler is better: this whole thing, it’s disgusting.

There is significant stigma still associated with depression, especially for men (because they’re supposed to be manly) or in certain cultures.  My own culture doesn’t recognize depression, for example.  It’s “made up” or “thought up.”  When I hear this, I have a mild seizure, because you know what, if I could help myself and “think it down,” make it go away, I would.  Trust me, I am not doing this for attention.  I had a great aunt who tried to commit suicide decades ago, and they called her “schizophrenic.”  She was depressed, but that’s not a thing.

Friends and family.  This is what you need to realize.

1. It’s an imbalance and people can’t help it

Depression, although it can be triggered by a specific event, in the end, is a deficiency of a neurotransmitter or hormone.  You’ll protest: “But it’s only because (insert stressor here)…” Look, it doesn’t make a difference how it got started.  If it’s short-lived, it might be situational or an adjustment reaction.  If you have had it for more than 6 months, however, regardless of what triggered it, it is an imbalance of serotonin and dopamine.  It is no different than, say, diabetes, when you’re deficient in insulin.  Or hypothyroidism, when you need synthetic thyroid hormone to keep your bodily functions going.  So, please please please, don’t tell people to “snap out of it.”  They can’t snap out of it any more than they can will their brains to get their neurotransmitter production back on track. 

2. Your friend is not depressed for lack of trying not to be

“You just need more positive energy!”   “You need to eat clean and exercise!”  “You lead an unhealthy lifestyle!”  “You need a vacation!”   All things I have heard suggested as to how I can cure myself.  And I am not knocking the benefits of healthy living, plenty of rest, or positive energy.  But for a person who might already be feeling hopeless or worthless, the suggestion that they’re not  thriving because of something they are or aren’t doing–that they’re a failure, basically–exacerbates the problem.  Along the same vein, please don’t try to cheer them up by reminding them that they “have no reason to be depressed.”  A reason would make it so much easier; you could deal with a reason!  But by pointing out that there is none, you would be invalidating the person’s struggle.  They’d feel worse, ashamed and ungrateful, knowing that they have no reason to be this way, and yet here they are.  I suggest a simple, “I know, this really sucks.”  It’s applicable in so many situations.

3. You can’t always fix it and that doesn’t reflect on you

Most people are generally kind to their friends and family, and honestly want to help. They truly believe that the person needs to “talk it out,” and that once the problem is identified, it can be fixed.  So, they try to provide help by encouraging talking or an active lifestyle, or trying to eliminate sources of stress as possible triggers, or whatever – they try, at least at first.  After a while, when it doesn’t work (and it won’t), they get annoyed at their lack of success, and possibly bored with trying, or worse, angry with the depressed person for their perceived not trying.  I think at least some of that is due to inability to accept that they can’t help.  Remember, you cannot fix depression with your bare hands and it doesn’t mean you failed.  It means this shit if for real.

4. Just be

If you really want to be supportive of your friend or family member, this is the best you can do.  Seriously.  Just be.  Sit there with the person and accept the fact that they are currently in a hole.  Hug them when indicated.  Get them tissues and tea, if they want it.  Don’t try to offer easy solutions.  Don’t get angry.  Don’t take it personally.  Don’t tell them to man up.

5. Get medical help

I cannot stress this enough.  Contrary to popular belief, doctors aren’t just going to plop you on an antidepressant and send you on your way, or at least they shouldn’t.  They should do a careful history, a physical to rule out any reversible organic causes, probe you for possible triggers.  They might recommend therapy first.  And yes, sometimes, your friend may not be able to do without a medication.   And please please please don’t tell people who are trying to get help and get on medication, “Do you really want to be numb to all emotion?” That is not what medication does. Medication helps that person to get to a normal place; they need the medication so they can feel like you feel every day.   Remember how I said it’s similar to diabetes?  You wouldn’t dream of telling a diabetic to “get a grip,” right?  This is no different, I promise.   I cannot stress this enough.  If it is determined that a person needs medication, they need it; they cannot do it on their own.  Get them the help: an impartial experienced professional who can recognize signs and will know what to do.  Remember what I said at the beginning: depression is a frequently fatal condition.

If you are concerned that a friend or family member may be succumbing to depression, please take them to the emergency room.  Send an ambulance to their house if they’re talking suicidal.  If it’s you, you are not alone.  If you feel yourself circling the drain…  Call the hotline:

• 1-800-273-8255