A hard truth: Depression is common and the number of people in the U.S. with depressive symptoms is on the rise.
While you’ve likely felt sadness or loss, if you haven’t experienced depression, you might not know what to say to a friend who has.
“Major depressive disorder is different than the occasional dips in mood we all experience in response to everyday stressors or tough things that happen to us,” says Dr. Nadejda Bespalova, an acting assistant professor in the UW School of Medicine Department of Psychiatry and Behavioral Sciences.
Depression affects your mental and physical well-being. It can cause low energy, inability to enjoy activities you previously liked (called anhedonia), muscle aches, excessive sleep or insomnia, lack of appetite or overeating, and suicidal thoughts. These episodes can start in response to a specific event or they can come out of nowhere, Bespalova explains.
If a friend or loved one starts to show signs of depression (or if you know they’ve been dealing with depression for a while) you can be a source of love, care and acceptance — even if you haven’t experienced depression yourself.
One way to do so is start and continue having supportive conversations.
Don’t say: “You seem different. You should see someone about this.”
When a friend is experiencing depression, they may cancel on events, stop replying to texts and calls, and disengage with loved ones. It’s understandable if these changes in behavior make you feel shocked, hurt or like you are helpless in the situation.
That said, calling out your friend’s behavior isn’t helpful. Even if they are acting differently, stating this can come across as accusatory and it can make your friend feel defensive or even worse about themselves, Bespalova says.
You should also avoid commenting on any physical changes, such as losing or gaining weight or appearing disheveled, as this can exacerbate negative thoughts and feelings your friend is having and further lower their self-esteem.
Instead say: “I’m worried about you. Are you getting help with this?”
The difference in these phrases may seem subtle, but the idea is to focus on how you feel about your friend instead of labeling or unintentionally judging their experience.
By asking if they have help, you are approaching your friend with curiosity and care. This lets them know that you understand what they are going through is serious and you want to listen and make sure they have support.
Starting with a question also helps you learn more about your friend’s experience. Maybe they’re already speaking to a therapist, loved ones or spiritual figures — or maybe they are cut off from support. Either way, it’s important to ask instead of assuming you know how your friend is doing or what is best for them.
If your friend wants to see a mental health expert, you can offer to research nearby or telehealth therapists or figure out insurance. It’s equally important to avoid pressuring or harassing your friend to seek help if they aren’t ready or interested, as this can cause more harm than good — though there is one critical exception.
“In general, you always want to take someone’s lead and value their autonomy and privacy. If someone is so depressed they are suicidal, however, that’s a problem and they need help,” says Dr. Laurel Pellegrino, a psychiatrist who sees patients at UW Medical Center – Roosevelt.
If your friend starts talking about death or suicide, gives away their belongings or exhibits other warning signs, seek support for you friend. You can call a suicide prevention line with them or call emergency services and ask for a welfare check. In an emergency, call 911.
Don’t say: “When I feel down, yoga/a hike/meditation/etc. always helps me feel better.”
We often provide these suggestions because we want to give an actionable solution or a quick fix to make our friend feel better — but when it comes to depression, it’s not that simple. Depression is different from a bad day, so what lifts your mood when you’re feeling down won’t necessarily be helpful for someone who is experiencing depression.
What’s more, giving these types of suggestions may make your friend feel like you aren’t listening to them or recognizing the complexity and depth of what they are going through. While you are trying to help, your friend might instead feel isolated or like you don’t want to be around them if they aren’t able to switch to a happier mood.
If you do have a history of depression, then you can share your own experience and what has helped you, Bespalova says.
Instead say: “I am here for you. What can I do to help?”
The idea is to center the needs of your friend and let them know you care about how they are feeling.
“Get their input on what would be helpful instead of suggesting what you like to do to lift your mood,” Bespalova says. “This way, the focus is on them and not you.”
If your friend isn’t sure what will help, there are some tried and true options. You can drop off nutritious, easy-to-reheat dishes; see if there are chores you can do for them to make day-to-day life easier; or, if they are open to it, share some helpful resources.
Don’t say: “Let’s get some drinks/weed to help you relax.”
Alcohol and other mind-altering substances are often portrayed in media as a way to unwind or cope with stressors. But the reality is drinking or smoking can make your friend feel worse.
“Remember that alcohol is a depressant and there are lots of unknowns about the effects of cannabis on depression,” Bespalova says.
Instead say: “Could we get lunch sometime/go to a park/[insert easy activity].”
Try to find low-effort activities that will help get your friend out of the house.
Some ideas include bringing lunch to a park for the two of you to eat or going on a short walk around the neighborhood. No matter what you choose, Bespalova recommends removing pressure by letting your friend know that it’s OK if they say no or cancel.
And if they do cancel, try not to take it personally. Remember that your friend canceling or saying no to activities isn’t a reflection of how much they care about you, it’s simply the fact that doing activities can be overwhelming and hard when someone is depressed.
Don’t say: “Just think about all the good things in your life.”
“I see this very commonly and it is another statement that can feel minimizing and invalidating of the person’s experience,” Bespalova says.
Similarly to suggesting an activity to make your friend feel better, asking your friend to think of silver linings or note gratitudes ignores the painful thoughts, emotions and physical effects they are experiencing.
Instead say: “I am sorry you are going through this. I am here for you.”
Acknowledging your friend’s feelings — whatever they may be — can help them feel seen.
Depression is painful. You don’t need to (and shouldn’t try to) put a positive spin on depression. It’s OK to acknowledge that what your friend is going through is hard.
Pellegrino recommends reflecting back what your friend is telling you with statements like “It sounds like you are feeling miserable,” or “It seems like it’s been hard to enjoy activities lately.” This lets your friend know you are listening and taking what they’re going through seriously.
“We have to hold hope for people who are depressed because they can’t be hopeful, but if you start with that, there’s going to be a gulf between you and they’re going to feel invalidated by that,” Pellegrino says.
Once your friend feels understood, you can share that you believe they will pull out of depression, even if they don’t feel that way right now. Just remember that having this hope doesn’t negate the painful reality your friend is currently experiencing. It helps to hold space for both: the fact that things are hard now and that you believe they will get better.
Keep the conversation going
A key to being there for your friend is recognizing that it will take more than one conversation to help them feel better.
“Unfortunately, depression is not cured quickly. Even if someone starts on medication or therapy, it can take weeks to months to feel better or be in remission,” Pellegrino says.
Let your friend know that you will be there with them even in difficult moments — and then do just that. Be with them and continue to remind them that you care about them.
As for the times when you don’t know what to say, it’s OK to be honest about that too.
In the end, your presence and desire to show up and be with your friend will speak volumes.