Understanding & supporting someone with depression

It can take a LOT of courage for someone to confide in someone about a mental health problem. The problem with mental health problems as opposed to physical ones, is that it will make you feel guilty for asking for help. It will make you feel like you're not worth help, like none of these problems are real and that you're making them up, or being pathetic for not being able to cope. You really believe that this is not an illness in your brain, but that you are just being worthless/lazy/pathetic. The reality is that it is as much a physical illness as a mental one. Scans of people's brains with and without various mental illnesses show a marked difference in the make-up of the brain and the chemicals within it. It affects the way you think and process information, and skews everything about yourself into a negative. You get trapped in negative cycles of thinking, and no matter what other people say, your brain creates and maintains new pathways of these negative thoughts and ideas, allowing them to grow and become stronger over time.

It can make everyday tasks feel completely overwhelming, so you leave them, and it then makes you feel like a failure for leaving them and not being able to do them, which creates a vicious cycle which is extremely difficult to break. Personally, when things are bad it can actually be very useful for people to treat me as if there's nothing wrong, as the more I focus on the bad things, the more credence I give to those thoughts and it increases the spiral of negativity. Distraction, and becoming involved in everyday things can really help sometimes.

There are other aspects, such as becoming very drained from social situations, sometimes just from being around one or two people. It can be very hard to say that you need to leave a situation, especially if it's just people being lovely to you, because your brain makes you feel guilty for not wanting to be with them. People making it clear that there's no pressure to be there *can* help, but depressed brains often don't believe things that other people say. Being offered the option now and then to be on my own without having to bring it up myself can be really useful, not necessarily as a direct 'do you want to be on your own?' question, because again my brain would tell me that saying yes would be interpreted as selfish and uncaring, but being around other people who occasionally say things like 'I might go and read in my room for a bit', etc makes it feel like a more normal thing to do.

Also, it can be hard, but keep in mind that this is an illness. It can feel frustrating that your best efforts aren't making someone feel better, but depression is not sadness. It is a chemical imbalance in the brain, which cannot be fixed simply by hugs. Treatment of some kind is the key. Medical care is needed - they cannot 'sleep it off', 'snap out of it', or 'decide to get better' any more than someone with a broken arm can make it get better any faster. Try not to feel bad that your support can not solve their problem.

Depression can make you lose interest in things you once cared about, believe that you have no friends and that no one cares about or wants to be around you. I find that when I'm feeling low, I believe that no one would want to be around me when I'm like that, because I'd bring everyone down and ruin their time, and that they must be frustrated with me for not doing things, seeing them often enough, or for not 'trying hard enough' to get better. Making sure you keep in contact - inviting them to things, just checking up on them or calling for a chat - is so important. Even if they don't come to things, it's really helpful to know that people still care and are thinking about you. Keep inviting them to things, even if they hardly ever accept. Offers of help with practical things like tidying or washing up are always helpful, but a lot of people won't take people up on non-specific offers like 'call me anytime' or 'I'm happy to help with things if you need'. Specific plans like 'I'll come round at 10 on Saturday and help with the washing up, and then we can have a cup of tea and chat' will be much more likely to be accepted, although will still be difficult.

The main thing is not to give up. It's extremely hard to accept help, or to believe that people really do want to help, and that's not because they don't think you're a nice person. Their brain changes the way things are processed, and it can be very hard to recognise a healthy thought to one that comes from the brain changes that depression causes.

Things I've found helpful in the past are group classes of things like CBT, and mindfulness. Group classes are especially helpful because they allow you to see that you're not alone, that this is a real illness that other people suffer, and is not just you being useless/lazy/pathetic.

Oh, also - praise small goals. Sometimes getting out of bed can feel like an insurmountable challenges. Sometimes just making sure you eat is tough. Depression can make the smallest tasks seem enormous. On days like this, reminding them that they are ill, and that little things like this are accomplishments in themselves and not to beat themselves up for not being able to do much is really helpful.

It can be hard to understand how difficult depression makes things, especially as it's not something you can see. Please do not doubt what your friend tells you about how hard things are, or not being able to do things. This will only add to their negative thoughts about being worthless or pathetic. Yes, it can feel hurtful when someone consistently cancels plans, or doesn't do simple things, but it's simply the way their brain is working at that time. Letting them know that there's no pressure to do anything they don't feel up to is enormously helpful.

Let them know that they are not alone in this, that they are important to you and that you care. Reassure them that they are not going crazy, they are simply ill. It can feel like you can't trust your own brain, or you believe empirically all the harmful thoughts it creates. Tell them that you're not going to leave or abandon them because of this, and that once they're recovered both of you will still be here.

If they ever talk about suicide or self-harm, stay calm. Firstly, self-harm is generally a way to prevent suicide. Its purpose is not to kill, but to save. Personally, it can feel like cutting and letting some blood out can release the huge build-up of feelings I'm not able to deal with, so I feel calmer and more grounded and stable afterwards. It can be different for everyone of course, but for most people I know, death is not the intention. Make sure they are doing things safely, and encourage them to see a doctor to get help. Self-harm can quickly become an addiction, where it is the only way you can cope with overwhelming feelings.

We have a very strong self-preservation instinct. Even in our most suicidal moments, where everything feels hopeless and nothing seems worth living for, there is a human element that still tries to keep us alive. In general, we will try to get help to preserve this part of us. If someone tells you they are feeling suicidal, it is because this part of them is trying to help. They want to find a reason - any reason - not to go through with things. First off, don't panic. Don't make them feel guilty for feeling like this, or tell them how selfish it is. Their brain is ill and they need help. Ask if they have a plan, and if they have the means to carry it out. Most of the time, this won't be the case.

If they have a plan, ask what it is, and if they are alone. See if there is anyone they could ask to come over and be with them. They don't need to tell them they are feeling suicidal if they don't want to - it can feel very embarrassing to admit for some reason, like you're letting people down. Most of the time, simply having someone around until the feeling subsides is enough. Often, just the act of talking to them will help the feelings to subside. Keep them on the phone (or talking, if you're with them) about anything they want to talk about. Ask them questions, keep them talking. The few times I've called samaritans with these feelings, 5 or 10 minutes later I've felt ok again, and safe enough to be on my own again, or calm enough to call a friend to get someone to come round.

If talking doesn't help, you can tell them you're phoning an ambulance. Keep them on the line and keep them talking and calm while you call the ambulance on another line. If you can't do this, tell them you'll phone them back in X minutes, and ask them to keep the phone by them so they can answer.

Most of all, be understanding. They're suffering from a horrible illness where their brain has stopped them from being able to experience any pleasure at all, only suffering. This is their desperate attempt to stop the mental pain they've been going through, and not an attempt to get attention, or a selfish act. The brain stops you from being able to feel anything sometimes, even love for those you normally care about.

Latest update

Since the drama with my parents' company I've been seriously low. Every moment I'm on my own I immediately stay crying, and being alone especially at night feels very scary. My dreams have become more and more painful and upsetting, and I'm scared to go to sleep. I feel like I'll never get over this, and have completely lost the ability to function properly. I either keep myself busy the whole time and pretend nothing's wrong but break down every second I'm alone or not distracted, or I'm completely overwhelmed by the depression and anxiety. Every time I look at my phone in terrified it'll be my parents telling me again what a let down I am, or that they're firing me or disowning me, which leads onto all the worries about sorting out benefits etc and all the stress related to that and job hunting etc when I really feel like I just can't do any of that at the moment. I can't do anything, everything is just too much to cope with. I feel like I'm losing control, like I'm on the verge of some sort of breakdown.

Stuff and things and shit.

Trigger warning: suicidal ideation, self-harming thoughts

So, for the past few days I've been feeling rather low, and unable to do anything. I was asked to do some work for my parents' company and agreed to it, thinking I'd be feeling better. Last night, when I realised that things were in fact getting worse, I let them know that I didn't think I'd be able to manage it, having not been able to leave the house, and seeing as just eating had been a real struggle. I was told that I couldn't let them down because this was important to the company. I told them I knew that, but I really wasn't feeling up to it. I told them that driving when I feel low tends to make me feel suicidal and I feel unsafe when on the motorways. I was told that I should just find someone else to drive me, and to make sure I got the work done. I was told I was being selfish and inconsiderate to let them down again and that if they lost the business and had to sell the house and animals it'd be my fault. It's not like I felt guilty already. They kept saying everything possible to make me feel guilty, and my dad said it was implausible that I'd been able to go to London last weekend, and was seeing a partner tomorrow, but couldn't do the work for them. I tried explaining about my mental health being ups and downs and coming in cycles, and my dad basically told me that he didn't care, that I needed to do this, and that was that.

So today I've been ridiculously low. I woke up to 6 messages about how selfish and inconsiderate I was, how I needed to call them because it was VERY important, and a number of missed calls. They've been trying to call me all day and I really can't face any more of hearing what a let down and disappointment I am to them. I agonised for ages about telling them I couldn't do the work for fear that they'd react badly because they seriously don't understand mental health, and it seems I shouldn't tell them when I'm ill in the future. Just feeling sick with worry and self-hated and anxiety and loathing.

It took me hours to get dressed this morning, and when I finally got into my car to drive to CBT, I was fighting the urge to crash my car for most of the journey. While there the thoughts got more and more overwhelming until all I could think about was ways to kill or main myself. I had to sit with the counsellors for about 45 minutes after the session until I felt safe enough to drive home without killing myself. Most of my thoughts today have been about stabbing something sharp into my carotid artery so I could bleed out, or repeatedly stabbing myself in the stomach.

The CBT therapist made me call a friend before I left so that I'd have someone around when I got home and be a little safer, and I feel a little calmer, but the thoughts are still there. I'm also terrified that my parents will just turn up at my house to shout at me and tell me what a disappointment and a let down I am and probably fire me, because they obviously care more about this one job getting done than my health.

I've arranged to be driven over to my partner's later so I don't have to drive myself in case the feelings don't go away, or driving exacerbates them, so am safe for now, and will have someone looking after me for tonight, tomorrow, and a bit of Saturday.

Faking it?

I don't really know what I feel anymore. I feel like I probably recovered from depression and now am just being pathetic and lazy and flakey and letting people down. I'm not suicidal atm, just apathetic and tired all the time, and lacking in motivation or purpose. I want to be able to make myself leave the house, but there's no reason to, no point - I don't have Dorian to walk anymore, and I don't care enough about anything else for it to feel important, even though I know there are things I should care about and want to try to get done, but I just don't give a shit about any of them. I feel like a fraud, and need to just pull myself together and stop being so useless and pathetic. I also just feel like crying all the time for no reason. Ugh. I'm so completely useless.