Synopsis: Helping someone you care about who is depressed can be a challenge, but your informed persistence can make all the difference. This article addresses ways of supporting the people you care about in their fight against depression.

BY LEN LANTZ, MD / 11.1.20; No. 40 / 7 min read

Disclaimer: Yes, I am a physician, but I’m not your doctor, and this article does not create a doctor-patient relationship. This article is for educational purposes and should not be seen as medical advice. You should consult with your physician before you rely on this information. This post might also contain affiliate links. Please click this LINK for the full disclaimer.

Keeping hope for people who have none

I have a friend and colleague who summarized the importance of what we do in psychiatry in one statement. She said, “We are the guardians of hope for those who have lost theirs.” People who have depression can struggle tremendously because they do not believe anything will work. Sometimes this is due to trying a few things and being disappointed with the outcome. Other times, it is due to the person engaging in substantial self-blame, because of which, they don’t access treatments that really work.

This is where you come in. You can be the guardian of hope for your friends and loved ones who are depressed. You can be the person who assures them that it is not their fault that they have depression but it is their responsibility to do something about it. You can help them recognize their chronic irritability and sadness as an illness that has many effective treatments. You might be the only person in their life who can break through their denial and speak the truth that they must take one step at a time to get better. You can help them with each step and share effective treatments with them.

Where is the best place to start?

Helping your loved one develop an easily accessible safety plan is the first step. Make sure that you are a part of the safety plan. If your loved one is able to remain safe or notify others when they are struggling, then you have more time to implement any number of strategies. Please see my article “Your Safety Plan for Suicide Prevention” for more details on safety planning. If you know someone who is depressed and is unable to maintain safety, then you may need to increase the intensity of treatment by utilizing acute psychiatric hospitalization or residential treatment. Sitting with them and ensuring they have a complete and accessible safety plan is an important step in treatment, especially for people with suicidal thoughts. Another critical component of enhancing safety is reducing access to lethal means. You can be the friend who stores their firearms for them until their depression is in remission and their suicidal thoughts have resolved.

Provide them with a list of strategies

When you start sharing with someone a variety of strategies that help depression, be prepared to have them shoot down your ideas. Keep in mind that depression can interfere with positive memories. Sometimes people remember accurately and sometimes they forget. Do not take their insistence that something didn’t work as gospel. Help them compare their report to the data and their treatment records. For more information on this, please check out my article “How Record Keeping Can Help Treatment-Resistant Depression.”

It is not unusual for me to hear a patient who relapses back into depression say, “Well, I’ve tried everything and nothing works.” Both parts of this statement are often untrue. Usually, they have not tried everything. Of the things they have tried, they have likely experienced at least a temporary or partial improvement with one or more treatments that can shed light on a strategy that will work.

Your friend or loved one might resist your help. Be positive and persistent. I’m not suggesting that you talk them into retrying a medication that clearly didn’t work or made them worse, however, sometimes people with depression avoid returning to mental health treatment due to a negative experience with a psychiatrist or psychotherapist. If that is the case, possibly one of the best things you can do is help arrange for them to see someone completely new.

What are they willing to try?

There are many strategies for treating depression. Two of the most effective strategies are psychotherapy and the use of antidepressant medications. Just because a few medications were ineffective or caused side effects does not mean no medication will work. Regarding therapy, there are many evidence-based therapies to choose from in the treatment of depression. If a previous approach was ineffective, it is possible to find a different one that will resonate better with your loved one.

In the last year, I’ve written more than 20 articles on dealing with depression. Feel free to read these articles to your friend to see what treatment method piques their interest. In addition to therapy and antidepressants, treatments that have a large positive impact on depression include daily exercise, behavioral activation strategies, transcranial magnetic stimulation (TMS) therapy and electroconvulsive therapy (ECT). For example, with TMS therapy, I’ve helped people who have been depressed for decades and have tried dozens of psychiatric medications that were ineffective.

You can encourage your loved one to try things they have been avoiding. Let them know there is help and there is hope. Remind them regularly that there is always one more thing to try and that new treatments are being developed every year. You can tell them about the amazing depression treatment emerging from Stanford by sharing my article “Stanford’s SAINT Study: a TMS Breakthrough for Depression?”.

Be a coach who will not give up

Family and friends with depression might need you to intrude into their world and motivate them. That is the sort of thing that a coach does. A coach does not enable unhealthy behavior. Coaching can be uncomfortable and intrusive at times, but someone who is depressed requires proactive involvement from others to get better.

Check in with your friend regularly about:

• Suicidal ideation and safety planning

• Regular attendance of therapy

• Daily medication adherence

• Getting out of bed, taking care of hygiene and putting on clean clothes daily

• Eating regular meals even if their appetite is low

• Maintaining a regular sleep/wake schedule

• Taking care of their non-psychiatric physical health (for example, diabetes care)

Encourage and remind your friend regularly about:

• Their importance and uniqueness

• Your belief in their ability to get unstuck from areas in their life that drive their depression (addictions, toxic relationships, etc.)

• Daily exercise

• Your ability and willingness to help them problem-solve potential barriers to treatment, such as cost, scheduling, childcare or transportation

• Your willingness to advocate for them with their doctors/therapists on their progress in depression or in receiving help for other conditions like anxiety or insomnia

Who can help you?

If you are quite worried about a loved one or friend, it’s best not to support them alone. Expanding the group or team of people who help will reduce your risk of burnout by sharing the load. Part of improving depression involves enlarging, not shrinking, a person’s world. Decreasing isolation and expanding opportunities for human connection is incredibly powerful. The treatment team can be quite large and involve professional and natural supports.

Examples of professional supports include:

• Specialists, such as psychiatrists or psychiatric nurse practitioners

• Psychotherapists

• Primary care providers

• Case managers

• Peer supports

Examples of natural supports include:

• Other family/friends

• Neighbors

• Coworkers or work supervisors

• People from a faith community

• Mental health advocacy groups like the National Alliance on Mental Illness (NAMI)

A note about confidentiality

As a family member or friend, you are not bound by state or federal rules surrounding patient confidentiality. HIPAA privacy rules do not affect your ability to share important information, such as addressing medication nonadherence or a safety concern. You can always leave a message for a therapist or doctor if you have something meaningful to share about a loved one.

A story about a depressed friend

“Suzie” was 35 years old and had gone through a recent divorce. Her kids alternated weeks with her and her ex-husband. This was her week without the kids, which was 5% relief and 95% misery. When she didn’t have the kids, she didn’t get out of bed except to go to work and didn’t eat much or exercise. Suzie had experienced her first episode of depression in the 10th grade. The depression went away by the end of her junior year of high school and didn’t hit her again until shortly after the delivery of her twin boys. An antidepressant relieved her postpartum depression and kept her out of depression till this past year, when it no longer seemed to help. Her best friend Janie knew all this. Janie was Suzie’s rock and Suzie didn’t feel she would have survived without her friend’s availability, support and encouragement.

Suzie felt like she had become Janie’s “project,” which she hated and appreciated at the same time. Over the past month, Janie had started calling her every day when her kids were with their dad. Janie would not give up. The phone call usually came by 9 am and the questions were often the same. It usually went something like this: “Hi Suzie, are you up? Be honest, are you in bed or out of bed? Get out of bed! I’m swinging by your apartment at 10 so we can go for our walk. Hurry up! You have a lot to do before I get there. I’m not getting off the phone until you are out of bed. Okay? Thanks! See you soon!”

Janie was so convinced that Suzie’s depression would get better, it seemed like she had been brainwashed by a cult. She had even roped other friends and Suzie’s sister into connecting with Suzie on her days off. Janie was persistent in asking what Suzie’s doctor was doing with her meds, if she was taking her medication and if she was being honest with her doctor and therapist about how she was doing. She even called Suzie’s therapist and ratted Suzie out when she tried to hide in bed all day last Saturday. Janie was constantly sharing stories about new treatments for depression and articles that she thought would be encouraging. The thing that felt a bit unbelievable to Suzie was that it seemed like the things Janie was getting her to do were actually starting to work.

You can help friends and family who suffer from depression

There is no need to feel helpless in the face of others’ depression. Despite resistance, you can help your family members and loved ones. Meeting them where they are and nudging them to start taking healthy steps is a reasonable starting place. They might have forgotten all the things that could help them and you can be the person to remind them that there is always a legitimate reason for hope, holding on and persevering no matter how dark the depression is. You can hold on to hope for them and remind them of things that work. Your persistent encouragement and checking in with them will make a difference. Your active involvement and connection to them are meaningful and your efforts to connect them to others who are willing to help will encourage them until they can do it for themselves.

For further reading, check out:

• Len’s article, “Finding a Good Psychiatrist”

• Len’s article, “Finding Quality Psychotherapy – Moving Beyond Talk Therapy”

• Len’s article, “The Most Important New Findings in Depression”

• A Guide to Rational Living by Drs. Ellis and Harper (See Len’s Book Review)

• Mind Over Mood, Second Edition: Change How You Feel by Changing the Way You Think by Drs. Dennis, Greenberger and Padesky (See Len’s Book Review)

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