Major Depressive Disorder

How to Help a Person with Depression

(A Portrait of Ellen)



By Louise from her own experience with depression
Written for Internet Mental Health
February 1998
  1. Encourage the person to seek medical aid, especially that of a psychiatrist. This specialist has the type of expert knowledge that is needed to treat depression. Most importantly psychiatrists know the types of medication that may be needed and the doses that may prove adequate. For antidepressants to work, the dose must be at a therapeutic level. General practitioners, however well-intentioned, often give doses that are too low. Even low doses of antidepressants have negative side-effects. To endure these side-effects without receiving any real benefit can be a particularly painful experience. It makes the person lose confidence in the medication that may be the only source of hope of being healed. If it is possible, attend the appointments with the psychiatrist. Knowing details of the disease and of the course of treatment can be very helpful. The depressed person can greatly benefit from having a friend who knows how the disease is likely to progress.
  2. Know details of the medication that the depressed person is receiving. This allows encouragement to be given. Antidepressants take from four to six weeks to have a strongly beneficial effect. The first three weeks of taking these drugs can be filled with ghastly side effects. The depressed person needs constant encouragement to persevere. At first the depression remains severe. To this is added a whole range of side effects: headache, dry mouth, muscular weakness, stomach pain, drowsiness. If one is anxious or affected by panic and fear, these early weeks of treatment can be very distressing. Constantly this person needs to hear: “trust! It will be all right. Don't give up!”
  3. Be ready for a whole range of moods. Depression can make each day a nightmare of variation. It may be that in the morning all is bleak and dark. A person may be so panic-stricken that even being alone for a few minutes seems to be impossible. This mood may last for hours. In such times be quietly and faithfully present. The depressed person does not want to manifest this behavior. No one wants to be afraid, anxious, panic-stricken. But it happens to the person. What gives strength is simple presence.
  4. During the dark and fear-filled times that a person is enduring, do not give advice on how to cope. Yes, the person should “smarten up, appreciate all life's blessings, pull up bootstraps and get on with life.” No one wants to do that more than the depressed person. But it is not possible at the moment.
  5. When the depressed person expresses fears about the future, give assurance that change will come. It seems to be impossible for the ill person. Keep emphasizing that it will be so.
  6. The depressed person may express suicidal thoughts. These should be taken very seriously. There are degrees of this type of thinking. If the depressed person finds life unbearable and “wants to die”, encouragement should be given with emphasis that life may change and become better. If the depressed person appears to be searching for actual means of committing suicide, the doctor should be informed. Here a test of loyalty may occur. The depressed person may feel betrayed by the friend who reveals the suicidal intentions to the doctor and lash out in anger. At this point there may be a great temptation to give up on the depressed person and leave. There would certainly be ample justification if one were to do that. But if the friend departs, the depressed person becomes more desperate than ever. Bear the anger, seeing its source as the disease, not the person.
  7. Even when medication is given, a depressed person may express wishes to die for weeks. Listening to such talk can be very wearying. Have a few answers that you always give. For example, “your life is precious.” “You have work still to do here on earth.” “God has a plan for you.” “If you are here, you have some purpose to fulfill.”
  8. A depressed person often rushes to person after person for help. This depressed individual tends to focus only on the terrible suffering that is being experienced. People soon grow weary of this type of conversation. Soon rejection after rejection occurs. The depressed person desperately needs someone to care, someone to hold onto. Most people cannot fulfill this role. If you are a casual friend to whom a depressed person is clinging, be merciful. Listen gently. Give a little of your time. Perhaps not much will be asked of you. You may not be phoned. You may not need to visit. But be gentle and understanding for the short time that is asked of you. Nothing hurts a depressed person so deeply as the sight of people avoiding encounters and fleeing away.
  9. If you are a close friend, let the depressed person cling for a time. It will not last. Above all be there when others reject the depressed person, as they will. Such rejections may bring many tears. They certainly add to the depression. Be one who accepts. Depressed people need to have their worth confirmed.
  10. A depressed person is often overwhelmed by irrational fears. Doing activities alone seems impossible. Staying alone, even more so. The person is fully aware that such fears are totally irrational. Adults feels shame and horror at their inability to do things that children easily do. Embarrassment at being afraid joined with true inability to be free from fear brings intense suffering. Be gently understanding of someone in this state. Do not comment upon it. The person knows how irrational the behavior is. Just understand that the fear is real and be merciful.
  11. A depressed may find it very hard to live alone. If possible, stay with the person. If this is not possible, perhaps contact several friends and see if each could take one evening.
  12. As treatment proceeds, the depressed person will improve. It is important to know that recovery is very slow. Casual friends will expect a complete recovery. They will breathe a sigh of relief and have no further tolerance of any signs of depression. But depression likes to cling. A person can feel almost normal in the evening only to find the next morning that all is bleak once more. The depressed person needs to receive understanding of these mood swings with constant assurance of hope.
  13. One feature of depression is an inability to make even the simplest decisions. When a depressed person does make some choice, the one not chosen immediately seems to be the correct one. For the normal person for whom decision-making is easy, such indecision causes contempt and scorn. Depressed persons need help in making decisions, which still must be their responsibility. The agony and suffering that accompanies such decisions is very real. Patience and tolerance prove most helpful.
  14. The depressed person often feels quite worthless. All life seems to be a failure. Give constant assurance of the person's past activities and future productivity.
  15. If you have friends who have also suffered depression, be willing to let them speak to the depressed person. Often someone can get through the darkest days because there is a network of those who have walked the same path.
  16. Share in activities with the depressed person. Often this individual finds it terrifying to be at home alone. Be ready to do what seems to soothe anxiety and bring some peace. Invite the depressed person also to share in your own activities in order that your patterns of activity are preserved.
  17. Above all, patience, patience, patience. Depression is a disease. It is marked by a chemical imbalance in the brain. No one ever wants to be depressed. No one can simply throw off a moderate or severe depression. It would be nice if someone could. “Being there” is the most important thing, being there patiently with gentle understanding. Depression brings an agony within in which death seems to be a blessed relief from anxiety, fear, and loneliness. It takes a great friend to stay with someone in this state, to stay without lecturing, without condemnation, without exasperation, without fleeing.
  18. Why would one choose to help a depressed person? The answer is hard to give but love is certainly a factor, loving concern for a fellow human being who has been struck by a terrible disease. We human beings are frail; we seem best when we help each other.

Conclusion

The sub-title of this article is: “A Portrait of Ellen.” I have suffered a severe depression and am only now starting to feel the positive effects of antidepressants. My greatest blessing during my illness has been a friend called Ellen. All the points I have made above are simply descriptions of her behavior to me. Without her I would not have survived this ghastly illness. She listened and listened to my desires for death without losing patience. She guarded me carefully so that I would not do myself harm. She affirmed my worth when I completely doubted it. She helped me bear the worst side-effects of the antidepressants. She did not expect me to be cured in a short time. She constantly gives me hope that all will not be as bleak as it sometimes seems. She shows genuine happiness when I seem to have improved. She has taught me what courage, fidelity, and true Christian charity are. She has shown how generous and noble a human being can be.

to top


Internet Mental Health (www.mentalhealth.com) copyright © 1995-2011 by Phillip W. Long, M.D.