How to Help Someone With Depression

An 1894 painting by Walter Langley

Depression is a state and condition of body and mind characterized by low mood, troubled thoughts, and a lack of energy, initiative, and decisiveness. Depression can be particularly difficult to deal with when someone close to you, a friend, family member, or co-worker has it.

Here I offer a few tips from my own personal experience, both as someone who has suffered from depression and who has at times been able to help, or unable to help others close to me who have been depressed.

Before you start reading though, I want to offer the most important piece of advice: while it is always good and honorable to want to help a person as much as possible, and to do your best to help that person, it is not your responsibility to do so and it does not necessarily mean you did anything wrong if you were unable to help them. Psychological conditions, like any kind of illness, can be unpredictable. In order to protect your own well-being, it is imperative that before you start trying to help someone, you understand and embrace the fact that you may not be able to help them.

General things to do to help

• Tell the person things that you like and appreciate about them. Give them direct, sincere compliments. Anything can help, from telling them that you appreciate something that they did, to saying that you think they are skilled or talented in certain ways, to little things like telling them that they look good or that you like something about their outfit. The best compliments, however, are the ones that tend to make a person feel good about deeper qualities. When a depressed person exhibits strength of character, perseverance, kindness, integrity, intelligence, good interpersonal skills, or any general skills or virtues, try to point these qualities out to the person. Don't just tell the person that they have some good quality, show them and explain to them how they have this quality. Give them clear examples and sound reasoning so that it is easy for them to accept and believe the compliment. The idea of these compliments is to nurture and strengthen the qualities in a person that will most help them to overcome depression.
• Give the person easy opportunities to get out and about and do things. Invite them to things that you think they will be likely to enjoy, and be a bit more persistent than normal about bugging them to get out, as depressed people have a tendency to come up with reasons not to get out and do things. Activities that involve light to moderate physical exercise are often the best options as exercise is one of the best ways to alleviate depression; outdoor activities involving exposure to natural sunlight and a change of setting are also good ideas.
• Take care of yourself first. If possible, make sure that you are in a positive, constructive, empowered mental state before you talk to someone who is depressed. Depressed people sometimes have a way of "sucking" others into their depressed mindset. If you become irritated or annoyed with someone because they are depressed, it is a sign that you have already been sucked into their negativity too far. Do not hastily express your frustration to the depressed person, as this can alienate them or worsen their depression. Instead, take some time away to recover your own sense of well-being.
• Believe in the depressed person. If you label a person as "a complainer" or "negative" or "selfish", or if you make generalizations like "you are always so depressed", you are not only making it more likely that that person will stay depressed, through what can become a self-fulfilling prophesy, but you also increase your risk of becoming depressed yourself: the patterns of labelling or making overgeneralizations are cognitive distortions which are characteristic of depression. If you believe in the depressed person's ability to overcome their depression, you will help them to pull themselves out of their depression. When the person exhibits negative thoughts or behavior, attribute these thoughts to the depression, not to the person themselves.
• If you have to interact with a depressed person while you are tired, irritable, in a bad mood, or just feel generally "off", let the person know why you feel off, and let the person know that it is not because of them. Depressed people have a tendency, often very strong, to attribute other people's negative moods to their own actions and behaviors, which causes them to sink farther into a state of despair. By letting the person know when you are feeling off or stressed, physically or mentally, you help prevent this from happening, but you also establish a more healthy pattern of interpreting the world which can set a positive example and can actually help lift the person out of their depression.
• Eat with the person. Offer to take the person out to eat, and/or to cook a meal for them or with them. In many cases, depression is caused or exacerbated by poor diet and irregular eating habits. A healthy diet can be a powerful depression-fighting tool. Key foods to eat for depression include fatty fish, whole grains, and fresh fruits and vegetables. People often eat more regularly and digest their food better if they have a regular routine of eating with people they like and are comfortable with. Making yourself regularly available to eat with a depressed person can not only help them to eat better, but can also help them by giving them routine and positive social contact.

Listening with empathy, but with a filter

Listening is a skill, and I see listening to a depressed person as a bit of an art. A depressed person's narratives of their situation, their life, their feelings even, can be riddled with distortions, sometimes severe, which paint an overwhelmingly negative picture of their experiences. Depression has a way of diminishing or filtering out positive experiences, and making a person focus on and magnify or exaggerate negative ones.

Active, empathetic listening, in which you demonstrate an understanding of the feelings a person is experiencing, can be immensely healing. With depression, however, there is a danger with such listening: the danger that you listen (or respond to the person) in such a way that reinforces untruthful negative aspects of their thinking.

Sometimes, extended listening without interruption can actually be among the worst things that you can do to a depressed person, although this is highly situational, and dependent on the individual. The harm with such listening is that if you listen passively, it can come across as validating the truth of the specific things that the depressed person is saying, which in many cases can strengthen and worsen their depression.

I find the gold standard for listening to a depressed person, is to empathize with the emotions that the person is feeling, but without agreeing with specific thoughts that seem to contain distortions. Ideally, you can actively listen by asking questions to make sure that you understand exactly what the person is thinking and feeling, but in such a way that gently demonstrates the subjectivity of the person's narrative.

An example of this would be, if a person says: "I went to the meeting, and everyone was really cold and unfriendly towards me. I could tell they disliked me and just wanted me to leave. I felt horribly uncomfortable the whole time." If you passively listen, this might validate the negative thoughts like "they dislike me and just wanted me to leave". Some more positive ways to actively listen while subtly questioning the negative thoughts, might be to respond: "So you got the impression that they didn't like you very much?" (this shows you understood what they said, but you mildly understate it, changing "dislike me" to "didn't like you very much", and by communicating that it's the person's impression, rather than objective truth) or "What specific things did they do, that led you to think that they wanted you to leave?" )(This steers the conversation in the direction of specifics, and away from broad, general statements, and this shift can steer people into a more positive mindset.) You might also want to connect or show the person you relate (this can help them feel solidarity) if you have situations where you've felt similarly, like: "I've gotten that sense with some groups of people I've been in, and it feels really awful to me too." (This communicates that it's "getting a sense" or impression rather than an objective truth, but it also communicates that you understand and relate to the feeling.)

Questions to ask to help a depressed person feel better

Asking pointed, specific, simple questions can be one of the best ways to bring immediate relief to someone who is feeling depressed. The goal of the questions is to use the Socratic method to help a depressed person realize that their depressive thoughts are irrational, and to help them think more positive and more rational thoughts. Asking questions is important, as depressed people tend to respond more negatively to any statement, and will often mentally reject any statement you make that does not fit with their negative picture of the world. If you press too hard with statements that contradict their negative view, they may become angry with you, or they may simply shut down entirely, stop listening to you, and close themselves off. If instead you ask questions that lead them to make those same statements themselves, as a response to your questions, they will be more likely to accept them and believe them. There are, however, a few cases where it can be helpful to be very direct and assertive, and disagree with what the person is saying, which I describe below.

• Ask a person for counterexamples to negative overgeneralizations. For example, if someone says: "I've felt miserable this whole month.", ask them at what time during the months they felt happiest. If someone says: "I haven't gotten anything done today.", ask them if they have at least gotten a few small, simple things done. So long as you are not irritating or annoying the person, try to press for them to give more examples. The longer you can get them thinking of positive counterexamples to their depressive overgeneralizations, the closer they will be to realizing that their generalization was not true, and the better they will feel.
• Ask the person for alternative interpretations for events. Depressed people often interpret situations in a more negative light. For example, a depressed student may fail a test and think "I am so bad at this subject." or take it farther and conclude: "I am stupid." or worse: "I'm a failure, I'm not going to amount to anything." If you ask this student: "Do you think the test was hard?" they will often admit: "Yes, it was really hard.", or you could ask: "Do you find you learn well from this particular teacher." and they will admit: "No, I don't understand this teacher's explanations." These alternative explanations of failing the test emphasize that there are many contributing factors to a person can fail a test, and that it is not rational to conclude that you are bad at a subject just because you failed a test. Note that if a person is depressed, it is not a good idea to explore the question of whether they could have better prepared for the test, as if they focus on the interpretation that they failed because they did not prepare enough, they may feel guilty and sink back into depressive thoughts.

While these approaches can often help, they don't always help. Make sure to read the person's reaction, and don't continue asking questions if they seem annoyed or seem to be feeling worse in response to what you are asking.

Things to avoid saying to a depressed person

Before I get into specific things to avoid saying, I also want to emphasize that it is important not to talk down to a person, not to treat them like they are crazy or there is something wrong with them, and also, not to talk or act as if the person is a mess.

Depressed people often feel like a wreck, they feel like their life is falling apart and they are unable to cope with things. While you certainly do not wish to downplay the person's feelings to the point where they will feel like you are not listening to or acknowledging them, you want to be careful that you do not lead the person to feel that their feeling that their life is a mess is justified. The best behavior is to listen, but keep emphasizing the positive so that the person gradually starts to realize that they are actually better off than they initially thought.

• "Just cheer up." or "Just snap out of it." - If someone is depressed, the point is that they do not know how to easily snap out of it, or they would. Saying this can frustrate a depressed person: they may feel irritated or angry with you, disconnected from you, and they will likely feel like you do not understand what they are going through. Instead of saying this, you need to show them how to snap out of it.
• "No one likes a complainer." - This is a terrible thing to say because it insults the depressed person, labelling them as a "complainer", and then implies that no one likes them. Depressed people often feel down in the dumps because they already feel like no one likes them, so this sort of comment will just fuel their depression, making it worse. Furthermore, this statement contains two distorted thinking patterns: labelling and overgeneralization, which are actually characteristic of depression. Thus, this sort of statement not only makes a person feel worse directly, but it reinforces two negative thought patterns that are often at the root of a person's depression.
• "Stop focusing so much on yourself." - Depressed people have a tendency to get focused on themselves. However, if you point out that the person is doing this, it is unlikely to help. Depressed people know that they are focusing on themselves and often they feel guilty about how they have not been pleasant to be around for this and other reasons, but they feel overwhelmed with negative emotions and troubled thoughts, and feel like they cannot focus on others. You are unlikely to help a person by telling them that they are focusing on themselves; instead, you need to show them how to focus on others in ways that make them feel better.
• "You should see a counselor." or "You need to see a counselor." - Counselors can be very helpful for overcoming depression. However, these two statements, which are commonly made by friends or family members to depressed friends, can come across as one of the most hurtful and destructive statements. The wording of these statements is very important: the word "should" is a moralizing, judgmental word which is actually frequently tied to depressed thinking and cognitive distortions. Similarly, the word "need" implies that the depressed person will be unable to get better on their own--a belief which will make the person feel more hopeless and depressed--and which is actually not true, as a large number of depressed people recover without counseling. Ironically, the statement: "You need to see a counselor." is one that many depressed people will listen to and believe (because they know they are depressed), and then believing this statement will just make them feel more depressed because now their image of their own abilities and mental state is even lower than before.
  
  Suggesting that someone see a counselor is sometimes a helpful course of action, but it is important to be very cautious about how you bring this topic up, and how you choose to present it. A key is to come from a place of believing in the person's ability to overcome depression when you make the recommendation, rather than coming from a place of believing that the person has something wrong with them and is unable to help themselves. If you really believe that a person needs to see a counselor, I would recommend keeping that belief to yourself. What is more helpful to communicate is the idea that a person would benefit from seeing a counselor. However, even this sort of statement can sometimes offend. There is a stigma attached to counseling and pyschotherapy in our society, and unfortunately, many depressed people will respond negatively to any suggestion of counseling. When in doubt, it is almost always better to not bring the subject up at all. People will seek counseling on their own, when they want or need to.
• Nothing or tacit agreement. - Sometimes depressed people will rant onward at length about what they are upset about, how much pain they are feeling, and how terrible their life is. While some degree of listening can be helpful, when a person is going on and on about negative thoughts, allowing them to continue to speak, or giving the impression that you agree with them, can make them feel worse. The act of speaking a thought out loud can make a person believe that thought more strongly, and feel its consequences more strongly, so if a person is making extreme statements like: "I hate my life." or "I feel worthless." and you let them keep talking, they can spiral into a more severely negative emotional state. Also, if you let the person make negative statements about other people, they may feel guilty about these statements later when they feel better, which can make it easier for them to sink back into their depression later. When a person is making these sorts of strong, irrational, negative statements, it is very important to quickly, assertively, and authoritatively stop them. Interrupt them if necessary. If you are present in person, try to comfort the person with touch, and try to make eye contact with them if you can, and tell them very directly: "You are not worthless. You are a valuable person. I care about you. It is going to be okay." You may find it helpful to repeat statements several times. You also may find it helpful to move back into asking questions to try to draw the person into a healthier mindset.

Dealing with a depressed coworker

Depression can be particularly problematic in the workplace; depressed people often (not always) become considerably less productive, and their negative attitude can harm the morale and sometimes introduce tension and sour work relationships.

People can become depressed in association with events outside their workplace, or in association with work itself, but once depression takes hold, it often spills over into all aspects of their life.

Here are some of my recommendations for how to help a depressed coworker:

• Give the coworker specific tasks to do, if you are in a position (i.e. as a supervisor) to do so. Focus can be one method of providing immediate relief for depression. Depressed people often feel paralyzed by indecision. You can also help the person prioritize their work so that they can more easily focus on one task at a time.
• Take the person out to lunch or coffee. Ideally, go somewhere that you can walk to, as walking provides exercise which helps provide immediate relief from depression.
• Do your best to make the person feel appreciated and feel like an essential part of a team or organization. A strong sense of purpose and a feeling of accomplishment in one's work is a powerful remedy for depression.
• Be positive, both with the coworker in question, and others in your workplace, and think about what you can do to keep the workplace culture positive. Depression often flows through workplaces in ways that affect everyone; some people show signs of depression more easily than others. If one coworker is overtly depressed, it is highly likely that other coworkers are also struggling with negativity, stress, or depression-related thought patterns. By keeping the workplace culture as positive and constructive as possible, you can help not only the coworker you know is depressed, but all your coworkers and the organization as a whole.

Further Resources

For a radio program about depression, I recommend Combating Depression With Meditation, Diet which is an interview with Dr. Andrew Weil on NPR.

There are numerous outstanding web resources about depression. I recommend the following pages:

• Wikipedia's Pages on Depression:
  • Depression (mood) - This page focuses on the immediate mental state or mood, rather than the chronic condition or illness.
  • Major Depressive Disorder - About the more serious form of depression.
  • Mood Disorders: Depressive Disorders - A listing of different mood disorders bearing the label of "depression".
• Major Depression | PubMed Health - Information about depression and its causes, symptoms, treatment, and prevention.
• Depression - National Institute of Mental Health - A fairly in-depth page about depression, with extensive discussion and citations.
• Depression - Mayo Clinic - A page on major depression on this health-focused website, which I find to be a consistently high-quality source of information.
• Depression - American Psychological Association - I find this page's explanation of depression to be particularly easy to understand; this site also offers some deep and interesting advice that goes beyond what is found on most other places.

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