Helping someone in the midst of a depression

In My Humble Opinion
1

Background: Some years ago, I met a woman online, we got along. We met in real life and we got along. We’re in different countries so we ended up as friends even though we have feelings for each other.
Over the past year, her mood has worsened. She seemed to have tendencies toward self-hatred since I met her but it’s gotten rather bad. She also has increasingly taken the worst interpretation of what others do and say, or her life. While she seems to be aware that something has changed, she seems completely unwilling to admit that some of her conclusions about how much her life sucks and she sucks are thoughts distorted by her depression.

I have tried many times to get her to see that it’s not as bad as she thinks but she seems to dig her heels in. I used to be able to bring her mood up by doing that, she said it helped her but it doesn’t seem to be helping her anymore.

I’ve had periods when I felt depressed but aside from some short bouts that lasted no longer than 1-2 hours, I’ve always been able to take some distance on my distorted thoughts and emotions. I’ve always been able to realize that it felt and appeared worse than it really was. I’d wake up the next day and think: “Life’s ok, it just seemed much worse because my brain chemicals and intrusive thoughts were pulling me down.” She does not seem to be able to do that and I have been getting sad, frustrated and angry over it.

A new thing that’s popped up is that she seems to be having a quarter life crisis. She thinks that because she hasn’t accomplished much to her liking, she might as well give up. I’ve tried to get her to start with small goals and work her way up but that’s unsatisfying. It has to be big accomplishments now yet she won’t even work on smaller ones.

So, I think that’s a pretty classic case of depression. Financially, seeing a shrink and getting meds isn’t an option for her. For people who’ve gone through a depression or been around people who have, any advice?

2

Are you sure? You don’t need to see a psychiatrist to get antidepressants. Perhaps there’s some kind of a low cost clinic that would treat her? There’s plenty of generic antidepressants.

I think finding a way to get her medicated may be the best thing you can do for her. Obviously you shouldn’t diminish her problems, but as somebody who doesn’t know her and will never talk to her… not accomplishing all your life goals by 30 is pretty much how most people’s lives go. If it’s ruining her life, medication may be needed to get her brain working more reasonably.

3

I have a medicine (Paxil) that is prescribed for depression by my primary care doctor, not a psychiatrist. I’m fortunate; this was the first one she tried, and it works great for me.

Obviously YMMV, but she does not need to go to a shrink. Meds are often used to get a person to the point where s/he is accessible to talk therapy. In my case just the drug alone keeps me going just fine.

4

You have to be incredibly patient.

The depressed mind is a poisonous genius at making excuses for itself. Depressed thinking is often robotic. You’ll hear a lot of “I can’t do it” on the basis of very weak reasons. To the sufferer, sometimes, just getting out of bed in the morning is as hard as it would be for an ordinary person to arrange a business trip to Dusseldorf (or, if they live in Dusseldorf, Anchorage.)

Most of the fun drains out of their life. They simply aren’t fun to be with. They react inappropriately to well-meant advice and urgings. “Hey, let’s go for a walk this evening.” “No! How dare you! Don’t you fucking understand?”

Obviously, no two cases are alike, and your friend might escape any or all of these symptoms. But these are pretty common.

The best advice I ever heard, from a psychiatrist, is: “Give advice only once.” Don’t repeat it, over and over. They heard you the first time. They may not act as if they heard you. They might very likely ignore your advice…but they did hear it.

Patience and kindness and more patience.

5

My family doctor put me on an SSRI years ago after a fairly simple series of questions. I was unemployed / underemployed and broke at time. The medication cost about a dollar a day (here in Canada) but it was worth every penny. I firmly believe that SSRI’s are life savers, ultimately a person has to change their life and ways of thinking about life to beat depression but the medication can get you back to a neutral mind set from where you can function normally again.

I understand it may be financially difficult, but a visit to the family doctor / GP to get things started is a priority. There are usually subsidized counseling services available too when she is ready.

When depressed having friends and family seek you out and interact with you is invaluable. She may not seek you out, and she may not be willing to talk for very long but it will be good for her when you call her up. You don’t need to give a pep talk or lecture all you need to be is be her friend. That being said talking to a depressed person can be like talking to a stone. It isn’t easy to keep a conversation going, but sometimes just saying hi is better than leaving them to drift indulgently in their dark mental soup.

6

A bootleg copy of “Feeling Good,” a journal, and some meditation apps helped pull me out of a mother of a midlife crisis. Mine actually wasn’t a primarily a chemical imbalance-- it was a set of poorly developed coping skills that weren’t ready for post-college life. Once I beefed up the coping skills, the problem was solved. I don’t think it will work that way for everyone, but it did for me. That quarter-life time really is a tricky time for a lot of people, as there is just such a gap between where you are and what your expectations were.

Feeling Good and it’s companion books (they are actually all pretty good) is a proto-CBT self-help book that draws on what is now the foundation of CBT. I found it life changing, but you do have to do their stupid little exercises (which are going to seem ridiculous to you when you read it, but which work.)

7

Do you remember what the questions were?

8

Looking at your third paragraph, it sounds like when your friend starts giving reasons for feeling depressed or self-loathing, you try to respond with logical rebuttals to everything she says. And of course if you can see logical flaws in what she says, it makes sense to try to explain those flaws.

But expert opinion that I’ve read is clear: you should not do this when speaking to a depressed person. The person must be allowed to say what’s bothering her without feeling that you’re trying to shut her down. After she’s explained what her thoughts are, the listener should try to work with her, not against her, to shift the thinking towards a more positive position.

9

Pretty basic: Do you have trouble getting out of bed in the morning? Do you often feel hopeless or overwhelmed? Are you not finding joy in things you normally would? Do you feel angry a lot? Do yo feel like crying a lot? Do you want to be alone most of the time. Do yo feel many things just are not worth the effort? One important distinction they look for is whether there is a cycling between periodic highs and depression - Bipolar Disorder requires different treatment than depression.

10

Just the understanding that the way you feel is caused by an illness can be a major step in getting better. Have you talked to your friend about depression? If not, you could ask her whether she’s considered that she might be clinically depressed. Don’t just tell her she’s depressed - she might react defensively. It’s hard to bring up anything related to mental health without it sounding like you’re accusing the person of being crazy.

Do you know anyone who has suffered from depression? If so, it might help for your friend to talk with this person.

I agree with the others who have said you can’t talk someone out of depression with rational argument. Someone who is deeply depressed is just not capable of seeing anything in a positive light.

11

I agree with ITR champion. It’s very tempting to offer solutions or rebuttals, but that’s not what a depressed person needs. They need to feel heard and understood first, before they can consider a different point of view.

12

Having been through therapy for depression I can say that people trying to “cheer me up” was the worst possible thing. The best thing was a friend who would always let me vent and then say “I wish things would get better for you” or words to that effect and then would say something like “I’m sure things are going to improve for you”. I also appreciated people who would say “I can understand how bad that makes you feel” because when people try to logically say how wrong you are, that makes it so much worse. Validate her feelings, don’t try to deny them. In therapy learning that I was entitled to feel how I felt and then how to move on from that was the thing that helped the most. Many depressed people have a negative experience, react with sadness or anger, and then beat up on themselves for their reaction, leading to a truly vicious circle. Breaking out is by being allowed to be angry or sad and then and only then trying to move on.

I never took antidepressants but I know for some they are life-changing so certainly helping her to see that a doctor might help would probably be good. I also agree with whoever said don’t keep saying the same things over and over as that is very frustrating.

13

When I was treated for depression my family doctor would ask me questions from the Beck Depression Inventory. Wikipedia says there’s 21 questions and I’m pretty sure he only asked a few of them.

It was interesting, in hindsight, because he recorded my answers and asked me again after 6 months and a year. He showed me how much I had improved. I was depressed because I was overwhelmed by caring for a dying father and devastated by the knowledge that I had 50/50 odds of having the same genetic disorder he did. It seemed illogical that I would feel any better until either of those issues went away, but between medication and life settling down a bit, I did feel much better. Being reminded how much worse I self reported in the past helped clarify how much better I felt.

14

Michael, your friend’s brain is currently not in good working order. It’s difficult to get across just how much this fucks up their entire world.

Endogenous depression (that is, inborn clinical depression, not situational depression) creates a state of being that has nothing to do with externalities. It generates emotions of despair, self-loathing, grief, anger, hopelessness, cynicism, and exhaustion, and these emotions overwhelm the natural state of response we’re used to experiencing.

We learn from an early age that our emotions are in response to either internal thoughts or external events. If you’re angry, it’s because something happened which made you angry. We master our emotions by learning why they happen and how to cope with them. Depression, however, bypasses this entirely. The emotions it creates are independent of what’s actually happening. People with depression will say that they can’t do anything right, that they are all alone and have no friends, that they are failures at everything they do, and they’ll say this even when evidence to the contrary is staring them right in the face.

They aren’t lying. They are, quite literally, delusional. Logic doesn’t disarm these delusions. All it does is reinforce feelings of self-hatred and isolation. So, please, stop trying to argue your friend into feeling better.

Helping someone with depression from far away is very difficult, but it can be done. You have to be patient. You have to accept her without trying to change her. You have to be present. You probably won’t make things noticeably better, but you may very well keep them from getting worse.

I speak from experience. For most of the last year, I’ve been in the grips of a severe bout of depression. A member of this board contacted me, and for several months, emailed me almost daily. He didn’t try to solve my problems. He was just there for me. It was one of the greatest acts of loving-kindness anyone has ever done for me.

15

An excellent post, phouka.

I recall in the depths of my depression looking at or experiencing something that I knew should be beautiful, or at least pleasant, and being completely unable to enjoy it. Finally I realized “I am not well; I remember being well, and this is not it.” And I got help. That was about ten years ago. To this very day, and probably as long as I live, I can now enjoy the good things in life, accept my shortcomings and errors, and go on anyway.

People saying “Just snap out of it,” and the like, was the worst.

16

phouka, that’s the best description of depression I’ve ever read.

I’ll say again that just recognizing that you have a disease can really help. It’s the first step in getting treatment, for one thing. It can also give you hope that it’s possible to feel better. Once you understand what the problem is, you can start to see how the illness is coloring your thoughts and feelings.

17

People often try to show a person with depression that they have good things in their life but they cannot see or appreciate it due to brain chemistry issues. Telling a person with depression that they shouldn’t be depressed because of all of the good things around them is like telling an asthmatic that they should be able to breathe due to all of the air around them.

18

Whilst this may not help her an awful lot in the short term I think this is some good advice. I have suffered from depression in the past. It’s hard to say what will help pull her out of her current state. Meds may work, pep talks may work. However, I would advise that you remain in regular-ish contact with her even if for only brief periods and even if you feel she doesn’t wish for contact. She may in fact get out of her low mood by herself, if so then make sure you are around to help her at that time.

19

Well, update:

I’ve gotten her to see if her insurance might cover antidepressants. She’s making about 10$/h and living on her own so she doesn’t have much money.

Any idea how she could get access to antidepressants? She’s in Missouri.

20

Where in Missouri? The bigger towns should have public health centers (I just moved out of the state about 18 months ago).