Chances are, you know someone who is suffering or has suffered from depression, even if you don’t know it. In 2020 alone, approximately 21 million adults in America experienced at least one major depressive episode, according to the National Alliance of Mental Illness (NAMI)—that’s 8.4% of the country’s population. In 2019, 18.5% of adults had depression symptoms that ranged from mild to severe, according to the CDC.
When you learn that someone in your life is suffering from depression, you might struggle to know what to say or how to respond and worry about saying the wrong thing, especially if you don’t understand much about the illness or get how truly serious it is. Read on for expert information about the illness, as well as advice on what you can say to a person experiencing it that would be truly helpful to them, not hurtful.
What is depression?
As NAMI explains, when someone has depressive disorder (which is generally referred to as “depression”), this doesn’t mean that they’re simply feeling blue or having a rough time in their life. Depression is a serious mental health condition that affects people of all ages, races and socioeconomic backgrounds. “It’s important to differentiate between a depressed mood and major depressive episode,” says Christine Crawford, MD, MPH, the associate medical director at NAMI. ”The more we can do that, the better people will be able to recognize it and get help.” In depressive disorder, Dr. Crawford continues, “the symptoms get in the way of functioning—at work, at home, in your relationships. And when the symptoms get in the way for two weeks, it’s a serious medical concern that one needs to get help for. With a depressed mood, the sadness typically returns back to baseline within a day or so.”
What are the Symptoms of Depression?
According to NAMI, here are the most common symptoms of depression:
- Loss of interest or pleasure in all activities
- Changes in one’s appetite or weight
- Sleep disruptions
- Feeling agitated or slowed down
- Fatigue
- Feelings of low self-worth, guilt or shortcomings
- Difficulty concentrating or making decisions
- Suicidal thoughts or intentions
Understanding Covid and Depression:
The Covid pandemic definitely had an impact on the number of depression cases and symptoms, says Dr. Crawford. “Symptoms of depression increased during the pandemic for both adults and kids,” she says. “For people of color, there was a 30% increase in symptoms of depression and anxiety. Among adolescents, there was a 31% increase in ER visits for mental health issues overall, and that includes depression. A number of factors contributed to this overall increase, but bottom line, people did not have access to all the outlets they usually use to manage their mental health, such as social support and connecting with others in person.”
Dr. Crawford adds that preventative measures like exercising and moving the body — which can elevate mood and protect against depression — were more out of reach, since people weren’t able to go to gym, do group fitness classes or go bike riding with their friends. “There was a loss of a sense of normalcy, plus maybe the loss of a job, or the loss of a loved one,” she says. “And a loss of a sense of peace and stability, which is so important. It took a significant toll on mental health.”
What to Say (and Not Say) to Someone Who Is Depressed:
You’re not going to be able to make someone’s depression go away — but by being supportive, you can help.
Offer your support with care
“One of the ways you can help is to ask, ‘How can I best support you in this moment?’ Empower them to share with you the help they need,” says Dr. Crawford. “For example, their biggest concern might be how they can’t be the best parent they can be in that moment, and maybe they’ll ask you to babysit the kids for an afternoon.”
Dr. Crawford adds, “If they decline, don’t take that as ‘They don’t need my help,’ and back away. Keep offering and asking. If they say no the first few times, they may accept the next time—they may be ready at that point to accept help. And in the meantime, you’re sending the message that you care. By offering help you’re letting the person know that you’re there for them. You’re sending the message that they matter, that their life matters.”
You can also offer specific suggestions in a non-pushy way — for example, “I’m running to the supermarket—can I pick up some stuff for you?” Or “I made two lasagnas—how about I drop one off for you and your kids?” Or you might ask them what time of day is hardest for them, and offer help that takes that into consideration. Again, don’t push it if they decline, but keep coming back.
Avoid phrases like “Think positively!” or “This will pass!”
“When we see a friend or family member in pain, we want to take the pain away from them,” says Dr. Crawford. “We may try to replace that pain with hope and optimism and try to infuse the person with positivity. But when you do that, what you’re doing is minimizing and invalidating their experience. And it diminishes the space for them to express openly what they’re feeling. They don’t need someone to solve their problems or to tell them to look at the bright side.”
Phrases like “Focus on the good things!” or “What do you have to feel depressed about?” are dismissive and, as Dr. Crawford pointed out, invalidate what the person is going through. And these statements may imply that they’re choosing to feel depressed, and if they just put their mind to it, they can think it away. It’s important to remember that depression is an illness, not a mood that they can talk themselves out of.
Hold back on offering solutions
Did you read something online that you think the person should try? Before you give a suggestion like “Maybe you should cut out caffeine and sugar” or “You need to check out this meditation I saw on Instagram — it’ll definitely make you feel better,” remember: You’re not their doctor, and depression is a serious illness that requires medical care.
“Be careful to not fall into the mode and trap of being a problem solver, and offering a whole bunch of solutions,” says Dr. Crawford. “When we do that, it’s often a reflection of our own anxiety and discomfort with the situation. It can feel intolerable for us to sit with the discomfort, and coming up with a plan for the person makes us feel like we’re doing something. But it’s better to try to sit with their discomfort and pain, and to convey empathy.”
Support their treatment plan
You may not agree with the help the person is getting from their healthcare provider — for instance, some people have a negative view of antidepressants. This is a key time to remember that it’s not about you. Dr. Crawford says, “It’s important for us to not just normalize the conversations around depression and mental illness but also to normalize the conversation around getting help, including therapy and medication. Be supportive, not judgmental, of the person’s choice of treatment—don’t treat them differently or try to convince them to do something different if you disagree with it. This is a medical condition and medical treatment is often needed, and it’s important to support their choice.”
Know the warning signs of suicide
People who suffer from major depressive disorder are at higher risk of suicide, according to NAMI. Here, the organization lists the warning signs to look for:
- Threats or comments about killing themselves, also known as suicidal ideation, can begin with seemingly harmless thoughts like “I wish I wasn’t here” but can become more overt and dangerous.
- Increased alcohol and drug use
- Aggressive behavior. A person who’s feeling suicidal may experience higher levels of aggression and rage than usual.
- Social withdrawal from friends, family and the community.
- Dramatic mood swings, which can indicate a feeling of instability.
- Preoccupation with talking, writing or thinking about death.
- Impulsive or reckless behavior.
Signs of imminent danger include talking about putting their affairs in order, saying goodbye to loved ones, giving away their possessions, a sudden shift from anguish to calm, and putting a plan in place to commit suicide.
If you or someone you know is in an emergency, call The National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or call 911 immediately.
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