During the publicity that attended the recent suicides of Anthony Bourdain and Kate Spade, people were urged to "reach out" to loved ones they suspect are suffering from depression.
There's good reason for this nudge – more than 16 million American adults suffer from major depression each year, with only 35 percent of those affected turning to a mental health professional for treatment. This, in spite of the fact that effective treatment can lead to complete remission, thus a vastly improved quality of life.
Still, a lot of people are confused or anxious about how to handle a potentially depressed loved one. How can you tell if someone is really depressed? And how exactly should you approach the person? What if they get mad at you for asking? Although a lot of variables are at play and it's impossible to predict a reaction, experts insist that it's always better to make a true, caring effort.
"People who complete suicide are ambivalent up to the end. They want the pain to end and if there were some other way to end the pain than kill themselves they would take that. There's always hope," says Matt Onorato, director of social work and an adjunct clinical assistant professor at The Ohio State University Wexner Medical Center's Harding Hospital. "You make a small gesture of 'Hey, I'm here if you need me,' and that could stop someone a week later from trying to kill themselves. The small things we do make a huge impact."
How Do I Know if Someone Is Dealing With Depression?
Almost all of us get "the blues" at some point, feeling down about our lives or ourselves. The difference with depression is that this feeling does not lift and is not improved by spending time with friends or doing pleasurable activities.
"People who are seriously depressed experience it for longer (more than two weeks), and it gets in the way of their life functioning in some way," says Dr. Catherine Burnette, assistant professor at the School of Social Work at Tulane University in an email interview.
Some fairly well-known symptoms of depression include sadness and loss of interest in hobbies enjoyed in the past; weight gain or loss; trouble sleeping or excessive sleep, as well as difficulty concentrating, fatigue and suicidal thoughts or comments. General irritability is a lesser-known, often overlooked, symptom.
Verbal statements of feeling empty or worthless, are also important to note, as well as physical ailments. "Pain, fatigue, headaches, stomach aches can be caused by depression," says Dr. Anamara Ritt-Olson, Ph.D., clinical assistant professor at Keck School of Medicine, University of Southern California. "If you see that person not doing the things that they used to love to do and they just can't seem to move forward, it is probably serious."
How Do I Reach Out?
A lot of people are scared to approach a loved one about depression or suicide, whether it's because they don't want to offend the person, are afraid to make the situation too "real" or are worried they'll get yelled at.
"Anytime a sensitive issue is brought up, the potential for defensiveness or anger is there," Burnette explains, noting that you're not necessarily in for a fight, however. "Everyone responds differently, and many people may be relieved to talk about their struggles, especially if a non-judgmental and sensitive approach is taken."
In the event that the person does react unhappily, choose your words thoughtfully. "I would suggest saying something like, 'I understand you are going through a lot but when you yell at me or blow me off, it makes me feel sad,'" says Celeste Viciere, LMHC, therapist and host of the Celeste The Therapist podcast in an email.
There's no guarantee that one talk will result in action, however. "Sometimes, if a friend seems to blow you off, you can affirm that you just care about them, and are there if they ever want to talk," Burnette says. "Your friend may not respond immediately, but your care may have left an opening for future conversations."
When you do initiate the conversation, calmly express concern. Then, let them do a lot of the talking. "I do suggest to family members that you try to listen first before you go into problem-solving or suggesting," Onorato notes. "When you're listening, you validate that they feel that way."
Once they've had their say, psychotherapist Dr. Laura Dabney recommends asking probing questions such as:
"How bad does this get?"
"Does it ever get worse than what you're telling me?"
"Are you aware of having a lot of guilt or shame?"
"All of these are how I help people open up about depression," she says in an email.
What Not to Say
The experts agree that some of the worst things to say are "Get over it" or "Look on the bright side of life!" "Or something like 'I was really sad once and I just took daily walks then I was all better,'" says Ritt-Olson. "Depression is an illness that is systemic and very personal, it can take over the whole body. It needs treatment tailored for that person."
"It's also important to not tell them to 'snap out of it' or minimize what they feel by saying, 'It's not that bad.' From your reality, it may not seem that bad, but you have to understand that they are fighting an internal battle that they may not be able to grasp, so it can be overwhelming," adds Viciere.
They've Agreed to Seek Help. What Do I Do Next?
Once everyone's on the same page there are a bunch of treatment options, depending on how severe the situation is. If the person is suicidal, The National Alliance on Mental Illness (NAMI),Mental Health America (MHA), Suicide Prevention Lifeline and Substance Abuse and Mental Health Services Administration (SAMHSA) all offer 24-hour access to trained professionals and other resources. Federally funded out- and in-patient programs are available to uninsured individuals, with payment based on a sliding scale according to income.
If the situation is less urgent, talk to your friend about the option they are most comfortable with. This may start with a trip to the family doctor, particularly if your friend doesn't want to see a therapist. "Often, it's viewed as more acceptable to see a primary care doctor," says Onorato, noting that the longer relationship typically means there's more trust there.
Primary care doctors are also able to screen for depression and prescribe medications, and can refer patients to mental health professionals. "A[nother] benefit of going to the primary care doctor is ruling out any medical causation. Sometimes, low iron levels, anemia and thyroid problems can mirror depression or coexist with it," he says.
Many employee assistance programs offer free or reduced cost counseling sessions to staff and family members, so be sure to check your specific plan for counseling and other resources. This benefit also points to a general shift in how depression is perceived in modern times.
"I think culturally we're becoming in America more comfortable talking about mental health, depression and suicide," Onorato says, "People are being more open and knowing that there is help out there, that you won't be judged and are not alone."