Helping a Friend in Despair

Source: Youssef Naddam/Unsplash

David Brooks wrote a poignant article in the New York Times about the death of his close friend to suicide after a long battle with depression ("How Do You Serve a Friend in Despair?"). Unfortunately, it may give people who are suffering from depression as well as their loved ones the unfortunate, and potentially dangerous, misperception that depression is difficult, if not impossible, to treat, and that the best a friend or relative can do is hang in there with them.

Nothing can be further from the truth.

We are living in a remarkable time when it comes to treating depression. There is a vast array of treatments available, many of which didn't exist just a few decades ago. We have dozens of psychiatric medications, including antidepressants, mood stabilizers, antipsychotics, sedative-hypnotics, anxiolytics, and psychostimulants, which can be mixed and matched to target specific symptoms of depression (which may vary, depending on the individual). There are also numerous psychotherapeutic approaches, including Dialectical Behavior Therapy (DBT) and Cognitive Behavior Therapy (CBT), that have proven track records in helping people recover from depression, especially when augmented with appropriate psychiatric medication. There are alternative treatments that can be considered, including Transcranial Magnetic Stimulation, Ketamine, Vagus Nerve Stimulation, and Electroconvulsive Therapy (which is much advanced from its infamous portrayal in One Flew Over the Cuckoo's Nest). Ideally, recovery from depression involves a comprehensive, integrative approach that may combine psychopharmacological, psychotherapeutic, social, spiritual, and body-mind modalities. Medication, psychotherapy, calming and mood-regulating practices like meditation, yoga, and Tai Chi, and alternative treatments, when needed, can all be successful in helping people overcome the devastating emotional, cognitive, and physical symptoms of depression.

Brooks doesn't say which treatments his friend tried to no avail. We don't know if his friend stuck with a medication regimen long enough for it to take therapeutic effect. Anxiety is such a strong component of depression that many people, if not given heaps of reassurance by their doctor that medication will work, stop taking psychiatric drugs before they have reached their therapeutic level. Instead, they cycle from one drug to another, never sticking with a treatment plan long enough for it to have an impact. We also don't know if Brooks' friend was prescribed the appropriate medication. A positive outcome often entails trial and error, and mixing and matching drugs to achieve an optimal targeting of specific symptoms.

No matter what the cause or severity of one's depression, no one should give up on seeking treatment. Recovering from depression is a process. It begins with a comprehensive consultation which cultivates a collaborative, trusting relationship with one's doctor and allows for an accurate diagnosis, a clear explanation of the condition, a map outlining what the treatment process will look like, and reassurance that there is an attainable destination at the end of the road. All of this takes time. If you feel rushed or "unseen" by your physician, then consult with another. The tools for good treatment are essential but so is the personal match between patient and doctor. Technique is important but it is within the context of a healing and supportive relationship that it is most effective.

How to help your loved one

Brooks writes, "how little the medical community knows about what will work." Given how many treatments there are for depression today that statement is misleading. There is no doubt, however, that how treatment is delivered is also key to its success. In answer to the question Brooks poses—"How to serve a friend in despair?"—I recommend becoming acquainted with the range of effective treatments for depression, helping your friend access them, and not letting them give up. Recognize that depression affects one's cognitive abilities. Depressed people feel hopeless about their chances for recovery. That is the very nature of the condition. It is not an objective or accurate evaluation. When your friend or relative feels hopeless, remind them that it is their depression "talking."

Help your loved one who is depressed find a healthcare professional who provides psychoeducation, reassurance, and a roadmap for navigating the route to recovery. Understanding the nature of depression, the possible treatment approaches, how they work, and how long they will take to become effective are essential ingredients in achieving a successful outcome. Knowing what to expect along the treatment route will relieve anxiety and prevent your loved one from panicking and stopping treatment before it becomes effective.

Also, monitor your own reactions to your loved one's depression. Depression can be contagious. It has a ripple effect. Like Brooks, friends and relatives may become frustrated, despairing, and worried that their friend can't be helped. But don't lose hope. With the help of a compassionate, supportive doctor who prepares your loved one for the treatment road ahead, monitors their journey and helps them over the speed bumps that may arise, they will overcome the darkness of depression. In fact, I've seen so many of my patients not only recover from depression but become their most fully actualized selves so that they can finally lead their best lives.

As Brooks discovered, when someone is in the midst of despair, they lack the energy or faith to follow the well-intentioned advice of loved ones. They don't respond to efforts made to lift their mood. But they do need to know that recovery from depression is attainable. Support your loved one by reminding them of that… over and over and over again.