More threads by David Baxter PhD

David Baxter PhD

Late Founder
What to do When a Friend is Depressed
National Institute of Mental Health
June 2001

You know that these school years can be complicated and demanding. Deep down, you are not quite sure of who you are, what you want to be, or whether the choices you make from day to day are the best decisions.

Sometimes the many changes and pressures you are facing threaten to overwhelm you. So, it isn't surprising that from time to time you or one of your friends feels "down" or discouraged.

But what about those times when a friend's activity and outlook on life stay "down" for weeks and begin to affect your relationship? If you know someone like this, your friend might be suffering from depression. As a friend, you can help.

What is depression?
Depression is more than the blues or the blahs; it is more than the normal, everyday ups and downs.

When that "down" mood, along with other symptoms, lasts for more than a couple of weeks, the condition may be clinical depression. Clinical depression is a serious health problem that affects the total person. In addition to feelings, it can change behavior, physical health and appearance, academic performance, social activity and the ability to handle everyday decisions and pressures.

What causes clinical depression?
We do not yet know all the causes of depression, but there seem to be biological and emotional factors that may increase the likelihood that an individual will develop a depressive disorder.

Research over the past decade strongly suggests a genetic link to depressive disorders; depression can run in families. Difficult life experiences and certain personal patterns such as difficulty handling stress, low self-esteem, or extreme pessimism about the future can increase the chances of becoming depressed.

How common is it?
Clinical depression is a lot more common than most people think. It will affect more than 19 million Americans this year.

One-fourth of all women and one-eighth of all men will suffer at least one episode or occurrence of depression during their lifetimes. Depression affects people of all ages but is less common for teenagers than for adults. Approximately 3 to 5 percent of the teen population experiences clinical depression every year. That means among 25 friends, 1 could be clinically depressed.

Is it serious?
Depression can be very serious.

It has been linked to poor school performance, truancy, alcohol and drug abuse, running away, and feelings of worthlessness and hopelessness. In the past 25 years, the rate of suicide among teenagers and young adults has increased dramatically. Suicide is often linked to depression.

Are all depressive disorders alike?
There are various forms or types of depression.

Some people experience only one episode of depression in their whole life, but many have several recurrences. Some depressive episodes begin suddenly for no apparent reason, while others can be associated with a life situation or stress. Sometimes people who are depressed cannot perform even the simplest daily activities - like getting out of bed or getting dressed; others go through the motions, but it is clear they are not acting or thinking as usual. Some people suffer from bipolar disorder in which their moods cycle between two extremes - from the depths of desperation to frenzied talking or activity or grandiose ideas about their own competence.

Can it be treated?
Yes, depression is treatable. Between 80 and 90 percent of people with depression - even the most serious forms - can be helped.

There are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders. Some people with milder forms may do well with psychotherapy alone. People with moderate to severe depression most often benefit from antidepressants. Most do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life?€™s problems, including depression.

The most important step toward overcoming depression - and sometimes the most difficult - is asking for help.

Why don't people get the help they need?
Often people don't know they are depressed, so they don't ask for or get the right help. Teenagers and adults share a problem - they often fail to recognize the symptoms of depression in themselves or in other people.

Be Able To Tell Fact From Fiction
Myths about depression often separate people from the effective treatments now available. Friends need to know the facts. Some of the most common myths are these:

Myth: It's normal for teenagers to be moody; Teens don't suffer from "real" depression.
Fact: Depression can affect people at any age or of any race, ethnic, or economic group.

Myth: Teens who claim to be depressed are weak and just need to pull themselves together. There's nothing anyone else can do to help.
Fact: Depression is not a weakness, but a serious health disorder. Both young people and adults who are depressed need professional treatment. A trained therapist or counselor can help them learn more positive ways to think about themselves, change behavior, cope with problems, or handle relationships. A physician can prescribe medications to help relieve the symptoms of depression. For many people, a combination of psychotherapy and medication is beneficial.

Myth: Talking about depression only makes it worse.
Fact: Talking through feelings may help a friend recognize the need for professional help. By showing friendship and concern and giving uncritical support, you can encourage your friend to talk to his or her parents or another trusted adult, like a teacher or coach, about getting treatment. If your friend is reluctant to ask for help, you can talk to an adult - that's what a real friend will do.

Myth: Telling an adult that a friend might be depressed is betraying a trust. If someone wants help, he or she will get it.
Fact: Depression, which saps energy and self-esteem, interferes with a person's ability or wish to get help. And many parents may not understand the seriousness of depression or of thoughts of death or suicide. It is an act of true friendship to share your concerns with a school guidance counselor, a favorite teacher, your own parents, or another trusted adult.

Know the Symptoms
The first step toward defeating depression is to define it. But people who are depressed often have a hard time thinking clearly or recognizing their own symptoms. They may need your help. Check the following to see if a friend or friends have had any of these symptoms persisting longer than two weeks.

Do they express feelings of:
o Sadness or "emptiness"?
o Hopelessness, pessimism, or guilt?
o Helplessness or worthlessness?

Do they seem:
o Unable to make decisions?
o Unable to concentrate and remember?
o To have lost interest or pleasure in ordinary activities - like sports or band or talking on the phone?
o To have more problems with school and family?

Do they complain of:
o Loss of energy and drive - so they seem "slowed down"?
o Trouble falling asleep, staying asleep, or getting up?
o Appetite problems; are they losing or gaining weight?
o Headaches, stomach aches, or backaches?
o Chronic aches and pains in joints and muscles?

Has their behavior changed suddenly so that:
o They are restless or more irritable?
o They want to be alone most of the time?
o They've started cutting classes or dropped hobbies and activities?
o You think they may be drinking heavily or taking drugs?

Have they talked about:
o Death?
o Suicide - or have they attempted suicide?

Find Someone Who Can Help
If you answered yes to several of the items, a friend may need help. Don't assume that someone else is taking care of the problem. Negative thinking, inappropriate behavior or physical changes need to be reversed as quickly as possible. Not only does treatment lessen the severity of depression, treatment also may reduce the length of time (duration) your friend is depressed and may prevent additional bouts of depression.

If a friend shows many symptoms of depression, you can listen and encourage him or her to ask a parent or teacher about treatments. If your friend doesn't seek help quickly, talk to an adult you trust and respect - especially if your friend mentions death or suicide.

There are many places in the community where people with depressive disorders can be diagnosed and treated. Help is available from family doctors, mental health specialists in community mental health centers or private clinics, and from other health professionals.
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