The Do's and Don'ts for Supporting Someone with Depression
As many people continue to navigate the precarious waters of life during a pandemic, it is important to be mindful of the possibility that there will be an increase in people struggling with mental health issues. The increased stressors many people are facing during the pandemic will invariably lead to more folks needing mental health support for depressive symptoms and mood disorders.
Whether you are suffering from a depressive episode yourself or have friends and loved ones suffering with depression, it is important to understand what depression is and how to best treat depressive symptoms. Research shows that time and again that one of the most important factors in helping someone going through a depressive mood is having social support and loved ones who are understanding, empathetic, and compassionate. While many people hear the terms “depression” or “depressed” and think about sad feelings, it can be so much more than that.
Thus, before I talk about the best ways to seek help for yourself or to support a loved one with depression, first we need to review the most common symptoms of a depressive episode.
Common symptoms of a depressive episode include:
1. Depressed mood
2. Loss of interests or pleasure in activities you normally enjoy (i.e., anhedonia)
3. Significant weight and/or appetite changes
4. Diminished focus and concentration
5. Sleep difficulties, restlessness (insomnia🡪 under-sleeping or parasomnia🡪 oversleeping)
6. Feelings of fatigue and loss of energy
7. Recurring thoughts of suicide or death
8. Feelings of worthlessness.
9. Extreme lack of motivation.
For a clinical diagnosis of Major Depressive Disorder, a constellation of many of these symptoms, must be present for at least two weeks.
The most common cycle of a depressive episode starts with facing multiple stressors, which leads to having many negative thoughts that often include
1) irrational and often exaggerated thought patterns (i.e., cognitive distortions, such as “Nobody likes me.,” “I’m not good at anything,” “the world/my life/ the future sucks so what is the point of living,” “I will never be happy,” etc.)
2) Heightened feelings of sadness, irritability, anger, hopelessness, and loneliness.
3) Physical symptoms of: fatigue; sleep problems; poor concentration.
4) Behavioral/ maladaptive coping responses like: social isolation and avoidance; abuse of drugs, alcohol, food, gambling, gaming, social media/internet, shopping; neglecting daily tasks like: doing work, cleanliness, hygiene.
The most efficacious/effective treatments for depression are a combination of psychotherapy (especially Cognitive-Behavioral Therapy; Interpersonal Therapy) and medication (especially SSRI’s), and there is some evidence for psychotherapy alone as well as medication alone being helpful in treating symptoms. Electroconvulsive therapy has shown short-term effectiveness, but also comes with higher safety risks, side effects, and high relapse rates. Physical exercise has been shown to be helpful as an addition to therapy and medication for moderate to severe cases while being very effective with “milder” cases of depression. Thus, it is extremely important to still get outside and get exercise even during the pandemic and cold winter season.
There are many ways to provide social support to our family/friends/partners with depression…but there are some important things to consider. In short, it is often more about what not to do as much as it is about what to do to be a positive social support.
First, one must recognize that depression is an illness. Just like a cold or flu, a person cannot simply choose to “get over” depression and it takes time to heal and recover. Second, we must make a point to reach out. Many folks with depression tend to isolate themselves, and you can check in regularly, invite them to talk, and reemphasize your support. Just listening and being present can be incredibly helpful. You do not have to fix their problems and may even disagree with some of their thoughts, but validation and acknowledgement that these experiences are real is a key aspect to letting the other person feel understood. Third, try to avoid offering advice or “trying to fix it” for them. In essence, providing emotion-focused coping instead of solution-oriented coping through empathetic understanding can go a long way to helping the person feel understood without feeling like they are being judged or guilty for feeling depressed. Do not minimize their pain, and do not call them a “victim” or invalidate their very real experiences. Avoidance of judging, criticizing, guilting or shaming them even if they choose not to respond to your help can be challenging, but essential. Encourage professional help. Fourth, help them find providers, low-cost options, and be resourceful. Further, help them find community organizations and mental health support groups. Fifth, avoid the “tough love” approach. Being impatient, pushing their boundaries, using silence, being callous, or giving them an ultimatum is not just useless; it is hurtful & harmful. Instead, choose to be patient! Patience communicates to your loved one that you will unconditionally be available and there for them. With patience comes hope.
Finally, make time for self-care. Supporting someone with depression can be tiring, frustrating, and emotionally draining. Give yourself permission to take a break for yourself and make sure you are taking care of your own mental health. By providing self-care, it will allow you to be more effective in creating a healthy environment and safe space for yourself and your loved ones, and ultimately give you the best opportunity to model and show the necessary empathy, compassion, understanding, & validation your loved one needs to help them get through and adaptively cope with depression.