Depression is a family disease. And I am not talking about the genetic components that might come with clinical depression, though those certainly are a contributing factor. I am talking about the effects we all feel we have a depressed friend or family member. And let's address one thing before we dive more into this. If you happen to be somebody who is struggling with depression, this blog post is not meant to exacerbate any shame that you might feel about your symptoms of depression. Know that in order for people to love you well they take the risk of being affected by when you are going through a hard time.

I know for myself that whenever a loved one is struggling I might experience a bit of a dip as I reflect on my care for that person. But this is what it means to be in relationship with others. We sign up for the hills and valleys and when it comes to the people who mean the most to me, I never feel inconvenienced by crawling into the pit with them, whether it's because of a severe depression or simply because of a bad day.

When it comes to understanding how to be a support to a depressed person, I am reminded of a Brene Brown quote that I've always enjoyed: "Rarely does a response make something better. What makes something better is connection." But so often we choose the former over the latter. We look for those little things we might be able to say that are going to take somebody out of a depressive mood. As if they just need to hear the right thing to defeat their negative thoughts and then they will be able to return to enjoying their everyday life. But what people are truly needing is a safe space to feel what they are feeling and in order to do that they need connection.

Diagnosis

I think that it is important to note that just because somebody is experiencing depression symptoms, does not mean that they are experiencing mental illness. A friend reached out to me years ago because he was "not doing well" with the death of his father and was feeling in a depressed mood following the funeral. I asked him how he was supposed to be feeling about losing his father at a young age, to which he replied, "probably depressed." Sadness is part of the human experience. This world is filled with pain and nobody makes it through unscathed. If you have ever decided to take the risk to love somebody you know that pain is on the other side if things to not work out.

That being said, there are certainly different types of depression. The most common diagnosis that people are going to receive when it comes to depression is major depressive disorder. In order to meet the criteria for this diagnosis, five of nine components must be present.

1. The person must be experiencing a depressed mood most of the day, nearly every day. In other words this must be happening on a very consistent basis.

2. The person has a loss of interest in what otherwise seemed to be pleasurable to them and this experience takes place nearly every day.

3. A 5% increase or decrease in body weight in one month, or decrease or increase in appetite nearly every day.

4. Consistent oversleeping or undersleeping.

5. Consistent bodily agitation or slowness. This must be observable by others and not just be a report firsthand by the person.

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or feelings of guilt that are not appropriate.

8. Diminished ability to think or concentrate, or indecisiveness.

9. Suicidal thoughts or otherwise recurrent thoughts of death.

Even within this diagnosis there are different subsets that depend on whether the depressive episode is singular or recurrent, as well as the severity of the episode. Another diagnosis that may at times look similar to major depression is bipolar disorder. The big difference that is going to exist here is the appearance of manic episodes. I've often found bipolar to be one of the most misunderstood diagnoses in mental health.

People often think that bipolar looks like having sudden mood swings from being calm and happy to very angry out of nowhere. When people are making these sort of descriptions to me my mind tends to move more in the direction of a personality disorder then a mood disorder such as bipolar. Bipolar and major depressive disorder are both going to include depressive symptoms and those can look virtually identical, which is why the most important thing to take note of is whether or not manic episodes have occurred. These can look like excessive spending, risky behavior, needing little to no sleep and still maintaining high amounts of energy, or acting outside of one's values. I've also seen manic episodes manifest in what seems like more productive tasks such as cleaning the entire house at 2am or creative writing for eight hours straight.

Knowing this difference in diagnosis is key because it greatly changes when are going to be considered effective treatments for each. Even just as a supportive friend of family member, you might notice that the depressed person is suddenly wanting to do a lot and talking with a bit more spark in their voice. If this is somebody who is battling a more typical depression, you might see this as some good news. If it is somebody struggling with bipolar, you might be a bit more cautious and keep an eye out to see if a manic episode might be beginning to take root. It's important to note that we don't want to be judgmental about somebody's mood if they happen to carry a bipolar diagnosis and some of these guidelines might be better suited for somebody who is not engaging in and treatment options at this time.

How To Support

I find that there is a bit of a hierarchical order that should take place when depression starts to creep it's way in. As mentioned before, certain life events might bring upon some depression and if we engage in healthy grieving and coping strategies, we might reach the place where we get to say how time heals all wounds. But if symptoms of depression are continuing to stick around, I find that most people want to engage in some lifestyle changes as the first line of defense. And as a mental health provider, I beleive that this is actually a fairly good first step. If you are sleeping 12 hours per day, never exercising, have no semblance of a balanced diet, and are engaging in substance abuse, perhaps making some behavioral changes can have a huge impact on the way that you are feeling. At time the depression is stemming from a lifestyle where depression thrives.

Now, it would be a bit myopic to suggest that somebody who is feeling depressed just go for a jog and eat some more kale. Although I do see some reports going around on social media that if you take a cold shower every day it will solve all of your problems. But starting off with taking care of our own wellbeing is a good place to begin. As a part of being that supportive person, offer to engage in these lifestyle changes. A quick text saying "meet at the gym in the morning?" might be what somebody needs to get out of bed in the morning.

If and when we feel like this has been completed, it might be time to seek out some professional help. The final step that we will get to is using psychopharmacological interventions, such as antidepressant medication, and we will discuss that at length, but I want to quickly mention that if depressive symptoms are at the point where thoughts of suicide are feeling heavy and taking place more often than not, a psychiatrist might recommend beginning a medication in conjunction with therapy. I believe the best way that we can be supportive when somebody is engaging in mental health care is to take all of the stigma out of it.

People can sometimes feel that they are imposing by asking about how somebody's therapeutic process is going. I have found that most people want to be able to talk about what they are learning and experiencing in therapy. If your friend is wanting to set boundaries and not speak about it, just let them know that you're free to talk if they ever change their mind. Additionally, being able to speak about your own therapuetic journey (if you've ever been on one) can go a long way. The first time that I decided to seek out counseling my dad told me about how he had been to counseling before. It helped me to feel less alone and like I didn't have to pretend to have it all together anymore.

Lastly, medication is one of the most important components of one's treatment plan. Working with a good psychiatrist is important, though some depression medications can be managed by your primary care provider. One of the more common classifications of medication are selective serotonin reuptake inhibitors (SSRIs) but this field continues to advice. Alternative treatments such as ketamine infusions and psychedelics are becoming more mainstream with promising research currently taking place.

Your Job

Know that first and foremost, your job is to be a good empathetic listener.

Dr. Teresa Wiseman outlined four components that must be present for empathy to exist.

1. Being able to take somebody else's perspective.

2. Staying out of judgement.

3. Recognizing the emotional experience that somebody else is having.

4. Being able to communicate and vocalize that emotional experience.

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When my wife and I experienced a miscarriage, the last thing that we wanted was for somebody to tell us to look on the bright side or how things were going to work out. We were in pain. We were angry, sad, disappointed, scared and we wanted to been seen in those emotions. The best thing that people were able to do with us was just sit in us with that pain and help us put language to it. Not take it away from us. Remember, rarely does a response make something better, what makes something better is connection.

When we are in pain, the last thing that we want to do is fight for the feelings that we are having. Even if there is so much else to enjoy in life, pointing these things out can actually create some more shame for that person. They already know that there are things in life to enjoy and already feel bad about not being a good enjoyer of life. Continuing to point this out not only is an invalidating experience but also a shameful one.

Resources

If you or somebody else you know is experiencing suicidal thoughts, please immediately call 911 or the national suicide prevention lifeline by dialing 988.

If you are looking for a group that can help, I would recommend our DBT group. Additionally, our intensive outpatient program is also a good option for if life is becoming unmanageable due to mental health concerns. Or you can always drop us a line and we're happy to help get you pointed in the right direction.