How to Help a Friend With Depression
Health Matters is a series of health and medical articles provided by Concordia International School Shanghai's community partner, United Family Hospital Pudong.
Meet the Expert:
Dr. Laura Jordhen
Chief of Family Medicine
UFH Family Medicine Fellowship-Preceptor
We’ve all been there--blue days, grief, sadness, stress… and many of us have been depressed. But what many of us don’t fully grasp is that depression is a real illness. Just like people coping with any other significant illness, people living with depression need understanding and support. It’s common to want to offer support, but many of us may not really know how.
What is depression, and how is it different from a bad mood?
Depression is more than just having an off day. It is an illness that may be brought on by stressful circumstances, or may occur for no clear reason, which can be really confusing people living with depression and their loved ones. Depression has a clear genetic component for many people living with the illness. Even nutrition can play a role. The challenge of depression is that the very part of us that can heal depression, the brain, is the part that is ill. Indeed, there are visible changes when imaging the brains of depressed people. For this reason, a person with depression may lack awareness of the severity of their illness and may have difficulty making the changes they need to heal. Friends can play an incredibly important role in supporting someone struggling with the illness.
Opening the Conversation
One of the most powerful things you can do to support a friend with depression is to let your friend know you are willing to listen. You might open the conversation by naming something you see—perhaps your friend seems tired or less focused. You can let your friend know you’ve noticed they might be having a hard time and you care and would like to be a listening ear. Depression is often hidden. People experiencing depression may not be fully aware of their symptoms, or they may be painfully aware but fear revealing their struggles. People living with mental illnesses, including depression, may feel stigmatized, and may feel their illness is shameful. One very real challenge of living with depression is that the perception that depression is not a real illness, or that someone with the illness may just be lazy or not trying hard enough.
What Not to Say
One of the challenges of living with depression is that making plans and being organized is difficult. Leaving the conversation with “let me know if there is anything I can do” is ok, but it’s important to be aware your friend still may be afraid or even too depressed to go about asking for help or making plans. It’s much more helpful to offer to get together when you aren’t rushed—and go ahead and make the arrangements with your friend’s permission. If your friend is really struggling, coming to her house and picking her up may be the kindest thing you can do because even simple daily activities like planning a route on the metro may seem overwhelming.
Once you get together, the most important thing to know is to be fully present, and listen. It’s more important to bring your attention and kindness than to worry too much about your side of the conversation.
There are a few things to try and avoid saying though. If you had a friend suffering from appendicitis, would you tell him to just focus on the good things in life, and not pay attention to the pain? Would you tell him to just not have appendicitis? No! We can see how this approach would be ridiculous. It’s the same thing for people with depression—telling your friend to just be happy and not have the feelings he is having is not helpful. You are motivated by good intentions of course, but it can make your friend feel completely misunderstood and even more alone.
It is important though to keep listening and paying attention to how your words help and make sure not to just give advice. In fact, advice is seldom helpful. When people are depressed, they don’t suffer depression due to a lack of knowledge about healthy behaviors. Telling someone all the things they should be doing, when they don’t feel like doing anything, can just seem more stressful. Instead of telling your friend to exercise, for example, try making a time to walk together.
What to Say
In some circumstances sharing from your own experience may be helpful—if you have felt the hopelessness of depression and come through it, it can help your friend to know you’ve been there too. Giving hope when it is hard to find is important. If you really haven’t been there yourself though, it’s ok to say you don’t understand exactly what your friend is going through but know her symptoms are real and painful, and you will stick with her through her illness.
Ultimately though it isn’t so important what you do say—it’s more important to listen, to validate your friend’s feelings, and let her know she’s not alone. Sitting together in silence can be more helpful than many words spoken out loud.
It is very important that someone suffering from depression has a medical evaluation and treatment. Having support from friends is critically important but isn’t a substitute for professional help. If your friend hasn’t yet made an appointment to see his primary care doctor, psychiatrist or psychologist, you can offer to make what may be a difficult first phone call, and offer to bring your friend to that first appointment. Even though your friend may know it is the right thing to do, getting organized to get to that visit can be very difficult.
Whether you’ve been depressed yourself, or you’ve only had the normal ups and downs of life, you can offer healing support to your friend. Your friend may be afraid or too overwhelmed to reach out. Showing up in your friend’s life with concern and compassion and not waiting to be asked for help is a true gift. You may fear upsetting your friend if you bring up the topic. It truly takes courage to have a difficult conversation. If you are acting with true concern and kindness though, the gift of kind attention that you give will be healing. It may even be life-saving.
Areas of Speciality: Family medicine, including well baby and well child checks, gynecologic care, preventive medicine and urgent care.
Education: Dr. Jordhen received her MD degree from Oregon Health and Science University in Portland, Oregon in 2001. She completed her residency in Family Medicine at the University of Wisconsin in 2004. She trained in the full-spectrum of family medicine in her residency, including inpatient and outpatient adult and pediatric care, as well as obstetrics.
Background: Dr. Jordhen is our Chief of Family Medicine and has extensive experience caring for patients of all ages throughout the life cycle. She developed an interest in international healthcare while studying in medical school and spent one year in India as a medical volunteer. Her patients say she is an excellent listener and communicator.
Dr. Jordhen brings her significant clinical expertise to United Family Hospital. She previously served as an affiliate professor at Oregon Health and Sciences University and now teaches Family Medicine Fellows at United Family Hospital, in addition to her regular patient care. She has given lectures at Rui Jin Hospital and Jiao Tong University Medical School.
In 2012, she was named one of the top family physicians in Portland, Oregon. She was also recognized as one of the best physicians in Changning District in 2016.
Dr. Jordhen has a passion for patient safety and evidence-based medicine, but enjoys developing a trusting physician-patient relationship the most.