Depression can be devastating to those afflicted with the disease, but the toll it takes doesn't end there. Friends and loves ones are affected, too. They can see the damage the disease is causing, but may feel helpless or confused about what to do to assist.
Yet there are many ways that friends and family can help. Indeed, the first but sometimes hardest step is simply letting the person know of your concern and your willingness to provide support. "Let the individual know you are there to be helpful, and that you are bringing it up out of genuine concern for them," says psychiatrist Dr. Jeffrey Borenstein, president and CEO of the Brain & Behavior Research Foundation, and a member of the American Psychiatric Association's Council on Communication. "It is important to also let them know that depression is fully treatable, that people shouldn't suffer in silence and they should get help."
[See: 9 Things to Do or Say When a Loved One Talks About Taking Their Life.]
Know the Symptoms and Be Sympathetic
The first step to helping a loved one is recognizing that he or she may be depressed. That means learning the symptoms of depression. Also, it means realizing that the individual may not recognize the signs him or herself. Depression can be so severe it interferes with daily life, but often it may appear as persistent unhappiness, irritability, anger, lethargy or other feelings and emotions that the individual may ascribe to something other than depression.
The most important thing is to be sympathetic. "Do not say things like 'snap out of it' or 'get a grip' or suggest in any way a sense of surprise or disappointment that this person is depressed," says Alison Ross, a psychologist and adjunct associate professor at City College of New York. "Listen with patience and acceptance. Let the person talk about how they're feeling no matter how sad or negative or hopeless their comments are. Allow the person to express themselves and the thoughts and feelings they're wrestling with as openly as they can. Do not argue their points or try to convince them to see things in a more positive light, because someone wrestling with depression does not have the ability to do so."
Depression still carries a stigma with it, and many people are ashamed and deny the possibility that they are depressed. In those cases, it may be helpful to focus on the symptoms, rather than the possibility of depression, Borenstein says. "Say something like, 'I am concerned about you; I see you are anxious, you're not sleeping well,' whatever the symptoms are, and you want to be helpful. By bringing it up that way, that often opens the door for them to seek help. Sometimes the person may not have full insight into what's going on, but they know something is bothering them, like sleep disturbance. If the person is more comfortable talking about that, that may be the entrée, so encourage them to talk to a family doctor about it."
Support Them Through Treatment
It can also help to point out that depression is not a personal flaw or weakness of character; it is a medical condition that responds to treatment, just like most other medical problems. "Point out that for most people who suffer with depression, there is a biological component that contributes to its severity," Ross says. "That means there is a family inheritance equal to other kinds of medical conditions that can run in families like breast cancer, for example." She says that people who have a biological predisposition to depression are more prone to experiencing it when life events occur that involve significant loss or trauma, such as the death of a loved one, divorce or losing a job. "Pointing this out may help normalize their depression for them, to see it as a human response to painful, difficult situations and that the mind and body go hand-in-hand, they are two sides of the same coin," she says.
If the friend or loved one still balks, offer to go with him or her to the doctor and share your observations, Borenstein says. Help set up appointments and create a list of the symptoms he or she is feeling, along with any questions for the doctor. If it is a family member, be willing to attend family psychotherapy sessions if the doctor recommends that course of treatment. Also help with any other care recommendations, whether it's offering to exercise with the individual, help create healthier meals, socialize more or assist with medication management. And help your loved one stick with treatment, which may take several weeks before the patient sees signs of improvement.
[See: Am I Just -- Sad or Actually Depressed?]
Watch for Worsening Symptoms
Those with depression are at increased risk of harming themselves or others. Do not take this lightly. "This is a very important issue," Borenstein says. "Sometimes people are concerned that just by asking about [suicide] they may give them the idea, but the reality is that is not the case. It is good to ask about it. If someone verbalizes that, that is an emergency, similar to someone clutching their chest and saying they have chest pain. You want to know about it and make it urgent for them to seek professional help."
For immediate help, you or your loved one can call the toll-free, 24-hour National Suicide Prevention Lifeline, at 800-273-TALK (800-273-8255) to talk to a trained counselor. And ensure that the person is in a safe environment away from weapons, medications or things that could be used to attempt suicide. If there is immediate danger, call 911 and stay with the person until help arrives.
Seek Your Own Support
Caregivers need to care for themselves as well, Borenstein says. "Family members need support, too, and organizations like the National Alliance on Mental Illness can be helpful," he says.
NAMI has chapters throughout the country that offer resources and support groups both for those with depression and those caring for and about them. If there is no such chapter in your region, Borenstein suggests talking to your own physician. "Share what's going on and ask what they suggest. It won't be the first time they have heard this, and they have resources that will be helpful," he says.
[See: 14 Ways Caregivers Can Care for Themselves.]
For the friend or loved one, the best thing to offer is your understanding and a sense of hope, Ross says. Let them know that, "as painful and real and immutable as their hopelessness and sadness feels in the present, they will start to feel better and see things differently once they seek help and undergo treatment; that you are hopeful for them -- even if at present they are not hopeful for themselves -- and that in time the depression will lift and they will feel better again."
David Levine is a freelance Health reporter at U.S. News. He is a contributing writer for athenaInsight.com and Wainscot Health Media, a former health care columnist for Governing magazine and a regular contributor to many other health and wellness publications. He also writes about lifestyle and general interest topics, from history and business to beer and baseball, as a contributing writer for Westchester, Hudson Valley and 914INC magazines. His work has appeared in The New York Times, Sports Illustrated, American Heritage and dozens of other national publications, and he is the author or co-author of six books on sports. You can connect him on LinkedIn.