Knowing how depression works can help you better support loved ones who are struggling.
By Dr. Richard W. Sears
Clinical psychologist and Zen teacher
Introduction
If you’ve never experienced clinical depression, it is hard to understand what it is like. Well-intentioned people will say things like, “just think positive,” or “just snap out of it.” Though they may not say it out loud, some people think a person with depression is just being lazy, or just trying to get attention. However, major depressive disorder is a serious psychological condition.
Before I became a clinical psychologist, I experienced a depressive episode after a divorce. The depression completely hijacked my thinking and feelings, and I even seriously contemplated suicide. A family member encouraged me to seek psychotherapy, and it really helped. This is what inspired me to become a psychologist, and I eventually became a board-certified clinical psychology professor. Through my research, writing, and international speaking, one of my personal life missions is to validate people’s struggles and walk with them on the path to recovery from depression.
If you know someone who seems depressed, it can be very difficult to understand, and it can be hard to know what to do. With more knowledge about how depression works, you’ll be in a better position to offer the most helpful support.
Understanding Clinical Depression
Depression is the second most common mental health issue (behind anxiety) and affects almost all human beings on the planet, who either suffer from it themselves or witness a friend or family member go through it.
Everyone has ups and downs, but clinical depression is debilitating, affecting the ability to do even the most simple daily tasks. People who have never experienced it often don’t realize how different it is from just “feeling blue” or being sad. You can’t just “cheer up” or watch a funny movie and feel better right away.
For clinical depression, you feel significantly sad for at least two weeks, and it can go on for months or years. Your range of emotions becomes constricted. You lose your ability to feel pleasure from the things and activities you used to enjoy. As the depression worsens, you may even lose the ability to feel anything at all. Despite being exhausted, you may wake up at 3 a.m. and have trouble falling back asleep. Or you may sleep 14 hours a day but still feel tired, because depression interferes with your natural sleep cycle. Memory and concentration problems become increasingly noticeable.
Of course, there are degrees of depression. In mild cases, you may still be able to function, but you feel down much of the time and don’t get much enjoyment out of life.
Serious depression literally changes your brain and how it perceives in three ways, which psychiatrist Aaron Beck called the “cognitive triad.” You develop a negative view of yourself (“I am worthless”), a negative view of the world (“No one cares about me”), and a negative view of the future (“Things will only get worse”).
These thinking styles matter. That’s because individuals with a negative view of self believe they are terrible people, they cannot do anything right, and they are inherently flawed. They often also feel strong guilt for their faults, real or perceived. Those with a negative view of the world feel they cannot trust anyone, and that no one will ever help them. They may believe that the whole world is “going to hell in a handbasket,” and that it is not a safe place.
A negative view of the future, or a sense of foreshortening of your future, leads to a feeling of hopelessness, which can be an important indicator of how depressed a person is. If they can tell you about all the plans they have for their life—the places they want to go, the people they want to see, and what they want to be doing five, 10, or 20 years from now—they are probably not very depressed. On the other hand, if they have trouble imagining tomorrow, or even five minutes from now, they are probably deeply depressed.
This is why suicide starts to become an attractive option. When people feel horrible about themselves, see everything in the world as going to hell, and can’t imagine a future where things are better, the idea of not feeling anything at all starts to become alluring. Sadly, this is more likely to happen as the depression just begins to lift and the person gets more energy, but hasn’t yet let go of the cognitive triad. In deep depression, a person can become immobilized, where not only moving but even thinking can feel like it takes too much energy.
What You Can Do to Help
Active depression is definitely something people need help moving through, because they lose their motivation. Sad feelings, negative perceptions, exhaustion, and withdrawal from activities lead to a downward spiral. The more depressed they feel, the less they want to be around people, the less they want to do things that used to be fun, the less they want to do anything, the more depressed they feel, which makes them even less likely to engage with life.
Knowing how bad depression feels, people don’t want to acknowledge that it could be happening. It is crucial to notice when depression is starting, so active steps can be taken to pull out of it before sliding down into a pit of despair. Here are some ways you can offer support as a friend or family member.
1. Encourage them to seek professional help. People who suffer from chronic depression may not even realize that they don’t have to feel that way. Since depression makes people think things will never get better, they often don’t bother to seek help. The best thing you can do is patiently but firmly encourage someone with depression to seek professional help. There are a wide variety of effective psychotherapy approaches for the treatment of depression. Encourage the person to look for someone they feel a connection with so that they will be motivated to stick with treatment.
There are also a number of good medication options, so encourage the person to seek out a consultation with their primary care provider or a psychiatrist. Their provider may also recommend light therapy, which can help “awaken” the brain if they suffer more often from depression during the shorter days of winter.
A medical checkup is also important. Sometimes there are underlying issues like hypothyroidism, sleep apnea, vitamin D deficiency, or medication side effects. For example, I once had a client who was doing all the right things in therapy but not getting better, and she discovered that depression was a potential side effect of the beta-blocker she was on. She had a very difficult time withdrawing from the medication, but when she did, her depressive symptoms began to lift almost immediately.
2. Help them get moving. Aside from the medical aspects, the most important thing in the treatment of depression is “behavioral activation,” which basically means to get moving—both literally (as in exercising or just getting out of the house) and metaphorically (as in moving toward something you value, like family, career, or spirituality). This can be challenging to do, as nothing feels very important when you are depressed.
Normally, if you don’t feel like doing something, you choose not to do it. But in depression, you don’t feel like doing much of anything. You have to decide to do it anyway, and know that you may not feel any better after doing it. It can take a while for the feelings to catch up.
Since the person will not feel like doing anything, encourage them to break tasks down into smaller pieces. For example, I once worked with a man who was overwhelmed by how messy his house was. I suggested that cleaning out a desk drawer might be a good start to get moving. He immediately said, “The problem is, it will just get dirty again.” This is very typical depressive thinking, but it is like saying, “Why bother eating? I’ll just get hungry again.” The point is to just get moving, despite what our thoughts and feelings may be telling us.
3. Offer validation and encouragement. As noted earlier, people with depression tend to think very negatively. It can be frustrating to figure out how to respond to these negative thoughts. The most important thing is to avoid the temptation to argue with them. If you try to tell them to just cheer up, or think positive, or see the bright side, their brains will likely only fire back with more negative thoughts.
The best thing to do is acknowledge the thoughts and remain encouraging. Here are some examples.
If they say, “I don’t want to see a doctor. It won’t do any good,” you can reply, “I know your brain is telling you it won’t do any good, but things are not getting better. You have to do something different since what you are doing is not working.”
If they say, “I’m just worthless,” you can say, “I know that’s how you feel right now, but that’s the depression talking. I love you, and I am here for you.”
Of course, thoughts of suicide are the hardest to hear from someone you care about. It may be helpful to say something like this:
“When you are depressed, you feel terrible about yourself, you think the world is an awful place, and it feels like things will never get better. To your mind, things probably seem pretty hopeless. I’ll bet the thought of not feeling anything probably feels pretty attractive to you right now. However, the real problem is that you are depressed. Depression hijacks your thinking. People who are depressed tell themselves they are no good, and they feel like things will never get better. If you can hang in there a little while, and postpone the permanent solution of escape through suicide, there are proven treatments for depression, and I’ll help you find someone to talk to.”
Of course, you should seek professional help if someone is seriously suicidal, and you may even need to take them to the emergency room. If you’re not sure what to do, there is a free service called the National Suicide Prevention Lifeline at suicidepreventionlifeline.org or 1-800-273-8255.
4. Foster social support. Numerous studies have shown that social support helps prevent and moderate the effects of depression. Since a big problem with depression is getting lost in the negative thoughts in your own mind, being around other people helps to refocus the mind on more important things, and can remind the person that they are so much more than their depression.
Of course, the problem is they won’t feel like being around other people, so do your best to gently encourage them to go out and do things with people. The hardest part is getting moving, but they will often acknowledge later that they were glad they went. It is ideal if they have close friends and family members to do things with, or a supportive group like a spiritual community. However, even getting out and taking a walk or going to the park with someone can be helpful.
While it is helpful to listen to their struggles with depression, don’t be afraid to talk about other subjects. One of the goals is to awaken other parts of the person’s brain so their only identity is not that of a “depressed person.”
5. Take care of yourself. Lastly, be sure to take care of yourself. People with depression can be very challenging to be around, even for the most loving and well-intentioned person. Since these disorders hijack people’s thinking patterns, their ongoing negativity and pessimism can be hard to deal with. Progress can also be very slow for someone with depression. Even with professional help, it may take weeks or months to show improvement, so great patience is required.
Make sure you remind yourself of the things you are grateful for in your own life. Seek out your own support from family members and friends. Engage in fulfilling hobbies. Make sure you get enough rest.
You can provide support, but clinical depression is a serious disorder that requires professional help. It can be very difficult to see someone you love suffer, but if you don’t take care of yourself, you may begin to get overwhelmed yourself, which will not help anyone.
Originally published by Greater Good Magazine, 06.22.2022, under a Creative Commons license.
