Practical Advice on How to Help A Depressed (Possibly Suicidal) Friend
Robin Williams. Kate Spade. Now Anthony Bourdain.
Just three of many celebrities who have committed suicide recently.
While our hearts ache for those we loved from afar, the problem isn’t limited to the rich and famous. Statistically, death by suicide has risen by 25% since the year 1999, and suicide is in the top ten causes of death in the United States. It’s an epidemic.
As a therapist, I’m deeply concerned about this quickly escalating mental health crisis. If you yourself aren’t personally struggling with depression, I’m quite sure you know someone who is. That’s why I’m offering this practical advice on what to do when someone you love becomes depressed.
Don’t Pretend to Understand if You Don’t
Yes, you’ve been sad, but sadness is not depression. Depression isn’t being sad. If you haven’t struggled with real depression, you don’t understand. The problem is you think you do because you’ve been sad, and you draw on your experiences with sadness, thinking it’s the same. You give advice that drives your friend deeper into depression because they can’t do the things that have helped you overcome your short-term bout of sadness. It’s like trying to explain cancer to a five-year-old who has only had a cold. “Take vitamin C and you’ll feel better,” the five-year-old says. “Have some chicken noodle soup.”
Depression is much deeper and darker than sadness, and it doesn’t respond to the usual “feel better” advice. For example, depression is characterized by the inability to “snap out of it.” If you are sad, you recognize that you are feeling down and you can take corrective action. When a person is depressed, they also know that they are depressed but they do not have the energy, strength, or motivation to do the things that might make them feel better. In most cases, debilitating apathy accompanies depression. They don’t care; they can’t care. They no longer feel joy doing the things that used to bring them joy. Now they find it hard to even find a reason to exist.
The bottom line: if you’ve never truly experienced clinical depression, don’t try to relate. Just listen and support.
Important Things to Know About Suicide
Suicide tends to be impulsive. If you can get a person through the moment of impulse, you may save their life.
A suicidal person needs a reality check reminder. Not “you have so much to live for” because that falls flat. Instead think of pushing guilt trigger buttons. “You will kill your mom. You can’t leave your kids without a dad. Your friends will blame themselves for not doing enough to help.” Strangely, these statements work because you aren’t telling them that they have something to live for. Instead these triggers work because they still love their family and friends and don’t want to hurt them.
Remove any guns from the house and stay by your friend ‘s side. When someone is suicidal, you need to get them through that singular moment. Then, when you’ve gotten through the first moment, you need to get them through the next moment, and so on and so on until they begin to see their value again or they let someone help them.
Once you know your friend is contemplating suicide, you need to get the contact numbers of their mental health team. If they have a therapist or psychiatrist, let the people who are trained know what is going on. Friends/spouses of my clients worry that I am going to think they are being invasive and/or manipulative. You are not. I want to know.
I have clients that have tried to commit suicide. I’m not going to lie; I felt like a failure. But universally, when I have asked them why they didn’t reach out to me for help, they all have said, “Because you would have stopped me.” They intentionally didn’t reach out to me because they knew I would help them. So… CALL ME. Get them professional help!
If they do not yet have a therapist, get them to the doctor to ask for an antidepressant. Help them take the steps to find a therapist. They may be unable to take this action themselves and may claim they don’t need it. Remember: one of the signs of depression is exhaustion and the inability to do the things that will make you feel better. A good friend will take those steps with them.
Learn What Depression Support Looks Like
Support of a depressed person looks very different than support for a non-depressed person. For example, when you ask a depressed person how they are doing, you need to expect to hear they are struggling. Sure, you want them to get better, and that’s natural for you to want that, but a depressed person feels like a failure if you respond with disappointment to their report of feeling depressed.
Again, imagine you have cancer. Sure, everyone wants you to get better. They want you to beat the cancer. But when they ask you, “How are you doing?” you need to be given room to talk about how you feel about having cancer, right? You need the freedom to say, “My cancer is still here, but I’m taking the treatments and going to radiation and I’m hoping for the best.” You need to be allowed to be sad about having cancer.
A depressed person should never be shamed for still feeling depressed. Too often a well-intentioned friend responds to a depressed person with, “Oh, come on! You’re still down? Cheer up already!” That’s when a depressed person starts thinking, “My mental health problems are too much for this friendship. They would be better off without me. I’m a burden.” That’s when suicide becomes even more of a risk.
Support for a depressed person looks like this:
· Offer unconditional support. Let them know you will be there for them no matter how long it takes for them to feel better.
· Ask questions. Listen. Don’t give advice.
· Provide companionship. Most depressed people improve if they simply have a friend to spend time with. Isolation can be dangerous.
Make it clear that you care. You may be the anchor that keeps them tethered to this life at a crucial time.
Always Support the Use of Antidepressants
You may be opposed to use of medications, or a fan of all-natural solutions, or think your friend should go for a run instead of taking pills, but as a therapist I’m here to tell you that for some people taking psychotropic medication is literally life saving.
1. You might think they don’t need “happy pills” because they need to deal with the “real reason” they are depressed. As a therapist, I feel the need to point out how damaging people with this attitude are to my clients. Gee, they are depressed and wanting to kill themselves… let me tell you that I know from experience that you bringing up their childhood sexual abuse is not going to make them feel better. Please just stop. I can’t touch the “real issues” until there is a safety net. I’m not getting anywhere near the “real issues” until someone is ready, and antidepressants often provide the foundation a person needs to start to deal with whatever issues they may or may not have.
2. Stop asking all the time if someone “really needs” to be on their “happy pills.” If someone’s doctor/therapist has suggested they go on antidepressants, it happened for a reason. I’m trained in helping them change their distorted thoughts. You are not. It often has taken weeks, months, and for some clients years to get them to even consider going on antidepressants. One well meaning yet horribly shaming comment from you and I am back to square one.
3. Normalize it as a medical condition. Say things like, “People’s body chemistries are all different. If you had diabetes, would you wouldn’t judge yourself for taking insulin.” Rather than piling on with criticism, provide them support. The fact that they are seeking out help is a step in the right direction. Encourage them to keep seeking solutions. If you can’t say “I’m proud of you,” then don’t say anyhing.
Accept the Truth: You Can Only Do So Much
Clients are sometimes worried about even bringing up with me that they “don’t want to be here anymore.” It’s not that they want to actively kill themselves, but they wouldn’t mind if a bus accidently hit them. They wouldn’t want anyone to know that they killed themselves because they know that their loved ones would feel awful they hadn’t done enough to help.
That sentiment means they are tired of trying. They fear the depression will never lift. The pain caused by their depression is so painful and ever-present that they no longer want to endure it. They feel their depression is bringing everyone around them down, and they feel shame for struggling with depression.
But it can go from a passive “not wanting to be here” to coming up with a plan very quickly. Fighting depression is exhausting. After a while, they may truly begin to believe the people they love will be better off if they disappear. They want to give up. They may even feel frustrated that they are too sad and too tired to even take action to kill themselves. That’s how debilitating depression is.
When I hear a client say either of these things, I hospitalize them:
· “My mom won’t care if I kill myself.”
· “My kids will be better off without me.”
This is when a person is completely out of touch with reality and is feeling utter worthlessness. This is absolutely a sign that suicide is not if, but when.
If your friend/loved one says these things, you need to take them to the hospital. Do not pass go, do not collect $200. This is effing serious. You are officially out of your league. Your friend might be upset with you, but he or she will be alive. Down the road, they may be embarrassed, but I guarantee you they will forgive you because you saved their life.
(I don’t recommend calling 9–1–1 because police officers have different levels of training. I’ve seen them make a situation worse by escalating someone. But, if your friend won’t go, you do have to call the police. Yes, it’s that’s important. Don’t let your friend talk you out of it.)
You Have More Power than You Realize
When it comes to fighting depression, your concern is incredibly powerful. As a therapist, I ask you to be the person who cares enough to get involved. Be the person who asks, “How are you really doing?” Be the one who watches a movie with your depressed friend and offers to stay over just so they aren’t alone with dangerous thoughts in the middle of the night. Be the friend who says, “It’s time to get help.”
Your choices can save a life.
Dr. Caroline Madden is a therapist and author. https://amzn.to/2NnplCj