How to help people with depression

How to help people with depression

Some of you asked me how to help someone with depression. I’m not an expert, this is just what was helpful for me, but everyone is different. I have a lot to say about this, so here goes.

If you’re friends with someone depressed, don’t stop being their friend. It’s a powerfully lonely illness. I lost a lot of friends while I was depressed. It sucked. It made it easier to believe my life was meaningless. It’s hard to reach out to friends when you lack energy and feel worthless to be around. It’s understandable to not want to be around someone who exudes negative energy. It’s scary, and feels contagious to be around a Debbie Downer.

By all means protect yourself first, if it’s too toxic and you need to step away for your own sanity, do it. For sure consider counseling. Even the most mentally healthy people with perfect friends can benefit from counseling anyway, best $15 copay you’ll ever spend.

But how can you be friends with Debbie Downer? First, give up on feeling like you have to fix them or convince them to be happy. It probably won’t work, and you’ll feel exhausted and frustrated. Sometimes when well meaning people would list the thousands of blessings I should be thankful for, it kinda just made things worse. Like I didn’t have the right to be depressed, and I just felt guilty and selfish. If they open up about things, all you have to say is “that sounds painful.”

The Extreme Stuff.

If you sense that they are unsafe, ask them! No, it will not put ideas in their head that aren’t already there. Also, it’s impossible to say the “wrong thing” or that anything will be “your fault.” Depression kills people, not friends checking in. If they are unsafe, get help. Seriously though, asking doesn’t hurt. Asking helps! You don’t have to freak out, most people that talk about it don’t do it. The more they talk about it, the less likely they are to do it. In psychiatric care settings it’s a subject that groups are actually encouraged to talk about. It’s kind of normal to want to kill yourself when you are in excruciating pain and hopeless. Left alone in silence with that kind of thought process can be scary, you can feel like because you feel that way, it means you have to do it. Talking about it disarms it. Talking can help you realize that feeling suicidal is just a feeling, that it doesn’t demand you act on it. It just means that you’re in a lot of pain, and there are other ways to learn to cope with it.

National suicide hotlines, honestly, are a bit of a crap shoot. Often you talk to a volunteer who may or may not be the most capable. Most counties have a mental health crisis number you can call 24/7 and speak to a REAL and EXTREMELY HELPFUL therapist. Seriously. I cannot thank these people enough. They are able to assess how unsafe you are and help develop a plan to keep you safe. They do NOT automatically call police and have you locked up in a psych ward, they actually do just about everything possible to avoid that outcome. These people are extremely patient. You do not have to wait until you are really suicidal to call. Sometimes you are just having an extremely bad panic attack or an extremely painful intense moment at 2 am and need help that can’t wait til the next counseling appointment. Usually what they do is help you plan how to be safe for an agreed upon amount of time, and what you will do if you still feel bad or worse. Like maybe you’ll agree to get a piece of string cheese and glass of water and call back in 20 minutes if you don’t feel better. Maybe you’ll decide you are feeling a lot better and think you can make it 3 days til your next regular appointment, but that you will call back if you feel worse.  

If your only option is a national hotline, by all means call it and they may be able to help forward your call to a crisis line. Whatever number you or your friend call, if there is no specific plan, call back. Call another line. Or just go to the ER, usually the ER will get county mental health involved and they can access those resources. Obviously if shit looks scary, just call 911.

Guns and depressed people just don’t fucking mix. I’m a huge fan of our 2nd amendment right and am not looking to debate it just… Don’t let depressed friends around guns. Lock yours up. Lock up the ammo separately. Even if your friend isn’t currently suicidal, they need to be separated from guns. Offer to babysit a friend’s gun, offer to let them borrow a fishing pole if they’re bummed about missing hunting.  If you’re feeling a little depressed, get rid of your gun. The earlier in the disease process a person is separated the better, because as a person gets sicker the instinctively want to “keep their options open.” If someone is indignant about giving up a gun, get REALLY CONCERNED.

Suicide is largely impulse driven. The more a person has time to think or work elaborately to kill themselves, the more likely the impulse is to pass. It’s totally a myth that a suicidal person will just “find another way.” This sort of objection prevented barricades from going up on the Golden Gate bridge for decades, so it was EXTENSIVELY researched. The barricades DO save lives. I could provide a lot of insight into what goes thru the mind of a severely depressed/nearly suicidal person but it’s some scary disturbing stuff. Just trust me, I never attempted to kill myself at all, but if I had access to a gun or the Golden Gate Bridge, I might be dead.

The less extreme parts

Between being dangerously depressed and just severe to moderately depressed is an expanse of pain, intense loneliness, and extreme lethargy. This is where friends can be super helpful and you don’t have to get sucked down into Debbie Downer’s spiral.

Encourage them to get help. Get to a doctor, get to a therapist. A primary care provider can be a good place to start, as they can help refer to a therapist or psychiatrist. I caution against seeing a PCP just for a prescription for an SSRI alone except in extremely mild cases. Firstly, you gotta have therapy. Therapy is as good or better than meds, and combined the best way to go. Secondly, it’s good to have a psychiatrist (MD or NP that is trained to prescribe psych meds) because they are able to better diagnose and offer appropriate treatment. For example, most PCP’s will prescribe an SSRI for anything, but for someone who is actually bipolar an SSRI can be super dangerous. Also, a psychiatrist will be better able to fine tune the right medication for the right person. (P.S. What’s the difference between a psychiatrist and a psychologist? For our simple purposes a psychiatrist is a doctor that prescribes psych meds, mostly anymore they do not provide psychotherapy or counseling. A PMHNP is like a nurse practitioner that specializes in prescribing psych meds as well. A clinical psychologist provides therapy, the talking part. There are a bunch of other types of providers that can provide talk therapy, and many are excellent as well.)

It’s SUPER nice to have a friend or family member who can help you make and get to appointments. When you are fairly severely depressed, just getting out of bed can be difficult. Making 10000 phone calls trying to find anyone who is taking new patients is overwhelming. Physically getting there is equally hard. More importantly, it is comforting not doing these things in secret or alone. And as a friend, you might find it easier to be around someone seeing that they are actually taking steps to take care of themselves. I once had a friend actually tell me “I can’t handle being around you because I think you are depressed and I won’t be your friend until you get help.” I could sort of understand her point, but it felt like blackmail and kinda hurt. It might have been more constructive for both of us if she said “I think you need help, more help than I can give you. I will drive you to an appointment.” If I said no, she could have kindly just ghosted me. But that was totally fair of her still. Like I said, protect yourself first.

Day to day stuff. 

Your instinct is a to fix. You probably have a thousand great ideas.

You: “Hey let’s go to the gym, you just need to get exercise!” Debbie Downer: “Fuck that, this is bigger than a few jumping jacks will fix, and I can’t get the energy to walk across my room.”

You: “Get dressed, lets go out and go to the movies, meet a bunch of people for lunch.” Debbie Downer: “I’m surgically attached to my bed. And my jammies. And there is not enough makeup in the world to hide this mess. And I can’t handle being seen by anyone right now.”

You: “Have you tried going gluten free keto vegan? Did you hear about wearing copper ankle bracelets? Did you hear that antiperspirant makes you depressed? You can take 3 tablespoons of vinegar 3 times a day. That helped my sisters ex cousin’s boyfriend’s mother. I read about it in GOOP.” Debbie Downer: “Thanks for the advice. Remind me to call you when I’m due for my flu shot.”

You: “You just need some cheering up with a funny movie.” DD: “You mean like Dancer in the Dark, Full Metal Jacket?”

You: “You just need to date more.” DD: ………

Ok, but your friend Debbie Downer does need to get out of the house. Debbie does need healthy food and fresh air. Debbie probably needs clean jammies. Debbie does need distraction. Debbie needs social interaction but probably can’t handle much public interaction. Debbie does NOT need your pity, and you don’t have to be catering to her illness by bringing her pizza in bed. But there is only so much Debbie might be capable of.

Pets are always awesome. Tell Debbie you need her company while you take Fifi for a walk. Tell her you need her to play with Mittens. Tell her you need her help cutting up veggies for a stir fry you’re going to make. Anything you can disguise as needing help with is good. Places to go where a person can get away with looking or acting a little off is always good. Instead of getting coffee, get drive thru coffee and drive around a while. Walmart is the perfect insane asylum if retail therapy is needed. Target if you’re too good for that.

Family is surprisingly good. If you have a trustworthy family, make Debbie come over. Let Debbie just be Weird Aunt Debbie. When I was still pretty sick, a friend of mine was in town. The kind of friend that who has been my friend for forever, though we rarely talk and see each other very infrequently. She invited me over for a family dinner, though I’m really not close with her family at all. I told her I was a mess, she reassured me it was ok. Indeed I was a mess. I looked like a mess, I acted weird I’m sure. But I trusted her, so I trusted her family. And basically everyone just treated me respectfully and continued dinner like normal. I hadn’t been eating much and the food was delicious and plentiful, I hate more than I’d eaten in weeks. I don’t know, I’m pretty sure I made an ass of myself and made people uncomfortable. But at the time it felt really special. I felt lucky to have people around to take me as I am and feed me dinner. I had my own family too, but with being so sick, and relationships strained, it was hard for us to be together without drama. Feeling a surrogate sense of family was really touching. Even now, occasionally work stresses me out and leaves me shell shocked. I am extremely grateful for my neighbors who invite me to just hang out for dinner.

This is all fairly female specific kind of stuff. I don’t actually know the first thing about depression and men. I don’t know what kinds of things depressed dudes are into. I don’t know how male friendships work. I don’t know how men do “self care.” But for sure, don’t go pound beers. Don’t suggest getting laid.

I imagine that depression for men is pretty difficult. The triggers are all probably pretty similar: loss, abuse, failing at something, substance abuse. As it is, men are less culturally allowed to experience and express pain and failure. Which has got to be excruciating because pain + non acceptance = suffering. Acceptance and expression are healing. Don’t tell Dougie Downer to man up, put on his big boy pants and stop crying. Go fishing. Fix cars. Bring him over for a family BBQ. Mostly remind him it’s ok to need help. IDK, I sound really sexist here so I’ll stop.

 

The bigger picture

Don’t judge. Educate yourself. You heard Susie takes Prozac? Who cares, Susie and most everyone you know. Sally cuts her arms, “Oh God, isn’t she the little attention seeker?” No, she probably just emotionally hurts so bad she can’t even escape with drugs so she escapes with physical pain. “Billy took a bottle of tylenol, he wasn’t even trying to kill himself he just wanted attention.” Ok, why would someone resort to risking death and permanent disability for attention, why did they get to the point where they felt they had to scream that loudly for help? Why didn’t they think anyone would listen if they asked in a healthier way?

More to come on that subject.

Your own best friend

Most of the above applies to what to do if you are the one who is depressed. Be kind to yourself. Don’t try to fix yourself. Be gentle with yourself. Ask for help.

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