The single most useful thing you can do for somebody with depression is stay in contact reliably, and make the contact require as little of them as possible. Almost everything else people reach for, advice and encouragement and perspective, is aimed at changing how they feel, which is the one thing you cannot do from outside.
That is not a counsel of despair. It narrows the job to something you can actually deliver, and the thing you can deliver turns out to matter more than the thing you cannot.
Why encouragement lands badly
Because depression already runs a commentary about being weak, self-indulgent and a burden, and most encouragement gets filed under that commentary rather than against it.
“You have so much to be grateful for” is heard as a correction. “Others have it worse” is heard as an instruction to stop. Even “you seem better today”, which is meant kindly, can register as pressure to keep performing an improvement that is not there. None of this means the person is being difficult. It means the message is passing through a filter that is part of the illness.
The reframe that helps is to stop trying to move their mood and start reducing what the day costs them. Mood is not under your control or currently under theirs. [apa-depression-help]
A schematic of the pattern described in this article, not measured data.
The gap between those two views is the whole article. The most helpful thing is also the least satisfying to do, because it involves no cleverness and produces no visible result on the day you do it.
Make the offer specific
“Let me know if you need anything” is the most common offer and one of the least useful, because it hands back exactly the capacity depression has taken away. To accept it, the person has to notice a need, decide it is legitimate, initiate contact and impose on you. Four steps, each of which is effortful, and the whole point is that starting things has become hard.
Specific offers remove all four:
- “I am bringing dinner on Tuesday at seven, is that alright?”
- “I am going to the shop, I will get your milk and bread.”
- “Walk on Saturday morning. I will come to yours at ten.”
- “I have found three therapists near you. Want me to read them out?”
Each of those is answerable with one word, and a no costs them nothing. That is the design goal: make accepting easier than declining, without making declining feel like a failure.
Activity beats conversation
The evidence points here more strongly than most people expect. Behavioural activation, which works by scheduling activity before the motivation arrives rather than waiting for it, performs comparably to other established psychological treatments for depression in adults and is recommended as a first-line option. [mazzucchelli-help] [nice-ng222-help]
The practical translation for a friend is that a walk is often more useful than a talk. A conversation requires the depressed person to generate material, monitor how they are coming across, and produce an account of their own state, all of which is work. Walking somewhere requires them to put shoes on and be accompanied.
This also solves the problem of not knowing what to say, which is what stops most people making contact at all. You do not need a script for a walk.
What to say, and what to leave out
| Instead of | Try |
|---|---|
| ”Have you tried getting out more?" | "Fancy coming with me on Saturday? No talking required." |
| "You have so much to be grateful for" | "This sounds exhausting. I am not going anywhere." |
| "Let me know if you need anything" | "I am dropping food round Tuesday, is seven alright?" |
| "Others have it worse" | "You do not have to justify it to me." |
| "You seem so much better!" | "How has this week been, on the whole?" |
| "Just think positive” | Nothing. Sit with it, and say nothing. |
The last row is the one people find hardest and it is worth practising. Silence feels like failure to the person offering support and frequently feels like relief to the person receiving it, because it is the only response that does not ask them to do something.
Encourage treatment without pushing
Steady encouragement helps and repeated pressure does not, and the difference is mostly about who does the work.
Pressure sounds like asking whether they have made the appointment yet, every time you speak. It reliably produces defensiveness and, worse, gives them a reason to reduce contact with you, which costs more than the appointment was worth.
Lowering the barrier sounds different: offering to look up services, to sit in the waiting room, to be in the room while they make the call, to write down what they want to say beforehand. If somebody has already agreed that they should see a doctor and has not done it, the obstacle is almost never disagreement. It is the starting, and starting is the thing you can do alongside them. Our guides to how to deal with depression and CBT for depression are worth reading yourself so you know what to suggest by name, and the depression guide covers the wider picture.
Is the support you are giving sustainable?
Tick anything true of the last month. This is a reflection prompt about you rather than about them, and it produces no diagnosis.
0 of 6 ticked
People who reach this point tend to swing between over-involvement and withdrawal, and the withdrawal usually arrives at the worst moment. Put one of your own routines back this week and tell one other person what you are dealing with.
The item worth acting on first is usually the one about telling somebody, because carrying it alone is what turns a hard few months into your own low patch.
You appear to be holding this without it costing you much yet. Worth rereading if the episode runs past a few months, which is when the load usually starts to show.
When to seek help
Encourage them to see a doctor if the low mood has lasted more than two weeks, if sleep or appetite have changed, if they cannot work or manage daily tasks, or if they have stopped doing things they used to enjoy. If they will not go, going yourself to ask how to help is a legitimate appointment to make, and it is one many people do not realise is available to them.
Act rather than wait if they talk about not wanting to be here, about being a burden, or about people being better off without them, or if they start giving things away or settling affairs. Ask directly whether they are thinking about suicide. Asking does not plant the idea, and it is frequently a relief to be asked plainly by somebody who is not frightened of the answer.
Contact your local emergency services or a crisis helpline if you feel unsafe or have thoughts of harming yourself.
How MyFreud can help
MyFreud is a mobile app that helps you find solutions to problems that have affected your mind and productivity. Live coaching sessions are worth knowing about for both of you: for them because a session ends with an actionable plan rather than advice they already have, and for you because supporting somebody for months is a load that deserves its own hour with somebody impartial. Daily tracking is the thing that answers “are they actually getting worse or is this a bad week”, which is unanswerable from memory and obvious in a record. The notepad is where the specific offers go, so contact keeps happening on the weeks you are tired.
Download MyFreud and start today: App Store or Google Play.