The World Health Organization estimates that 350 million people have some form of clinical depression -- that's half of one percent of everyone on Earth. It is the leading cause of disability worldwide. But despite its frequency and long historical record, depression remains confusing and alienating.
It can be tough to understand what it means to have clinical depression, and why the symptoms present the way they do -- and therefore it can be really easy to accidentally be a dick to your friend with depression. So here's how to avoid it.
1. Don't trust the media's depictions of depression symptoms
Take a second, close your eyes, and try to think of what a depressed person might look like. Are they sobbing? Curled up in bed? Totally unable to laugh about anything ever? Are they wearing a great deal more black eyeliner than usual, or musing about the meaninglessness of life in a voice reminiscent of Eeyore?
Some people with severe depression will attempt self-harm or suicide, which is usually a pretty clear signal of their issues. But that doesn't happen to everyone; lots of people with depression have symptoms that are far less obvious, but still debilitating. American society is highly skeptical of the very existence of depression as a disorder; the media further distorts our view by presenting depression as a pervasive mascara-running death-obsessed sobfest.
While these symptoms may certainly be present sometimes, a great deal of people with depression usually look pretty normal. The symptoms of depression can be so insidious and subtle that even the sufferers can miss them.
My depression developed as intense fatigue and loss of interest in previously enjoyable activities. For others, it may involve increased substance use, weight gain, poor concentration, and sleep disturbance.
Furthermore, people with depression may sometimes be happy. Good days or weeks happen. At my very worst, I was sobbing every weekend and falling asleep at my desk each day, but for the most part I continued to meet pretty much all of my necessary deadlines. So just because we’re having a good time right now doesn’t mean that we’re not depressed.
2. Don't tell them to "just feel better" or imply that they're not trying hard enough.
This is something that every single person with depression has had to deal with, and it's one of the most frustrating things about living with the disorder.
When you tell someone with depression that they should maybe try harder to be happy, it's essentially like telling a diabetic that they could totally make an adequate amount of insulin if they just concentrated a little harder. Even if you can't imagine being depressed, try to have some compassion for your friend. They're trying as hard as they can to simply accomplish daily tasks. It seems easy to explain the symptoms away, but it is insulting, humiliating, and can end up preventing your friend from seeking help.
I wish I was exaggerating, but I'm not. I told my boyfriend about my depressed feelings several times while we were dating, and each time he ended up gently explaining it all away as me just being tired, undernourished, or a little bit dramatic. I loved him and I believed him because I could no longer trust my own judgment of reality, and I delayed seeking help for six months or more.
People who haven't experienced clinical depression have trouble understanding that it isn't just feeling sad. It's a complicated and debilitating illness that is caused by a chemical imbalance in the brain. The neurons responsible for firing those happy signals are severely underpowered.
There is a huge difference between depressed feelings due to a breakup and clinical depression.
At times they can look and feel very similar, but the former will fade relatively quickly and the latter will not. One of them is the direct result of a painful experience, and can result in a myriad of intense emotions and reactions; the other is a neurological imbalance that can result in the inability to feel anything at all.
3. Don't ask why they haven't cured themselves yet with [blank].
Allie Brosh of Hyperbole and a Half put it best in a recent blog post about her depression, using dead fish as a metaphor. These two panels are strikingly accurate depictions of what tends to happen when you try to talk about your depression (or dead fish); you take a risk and communicate something very personal, only to be met with a lot of platitudes from your friends about how they read somewhere once that [New Age “cure”] totally helps depression, and have you tried that yet? It’s roughly as helpful as cheerfully asking your pal if they'd like some bees because their fish is dead.
These quirky cures may be helpful in combination with therapy and medication, but there is really no easy cure for depression. I understand why friends propose yoga, or green tea, or acupuncture with rare Zimbabwean porcupine quills. They're confused as to why there isn't a direct cause for depression, and they're trying to help by proposing a solution.
But while the thought is appreciated, the presentation is immensely flawed, and it reveals a misunderstanding about how depression works. If it was literally as easy as running a few miles every day, then depression would not exist -- but it does. Depression is exhausting on virtually every level; suggesting that a cure is as easy as cutting out alcohol or cigarettes carries an implication that we're somehow doing this to ourselves, which is not the case.
4. Don't demonize the drugs.
If I could go back in time, I’d kill Zach Braff before he could make Garden State. The film was annoyingly twee, sure, but it also demonized antidepressants as personality-destroying misery pills. Garden State wasn't the only media piece to do this, of course, but it was certainly a popular one. Braff's character was misdiagnosed by his psychiatrist father and fed a steady stream of antidepressants to prevent either man from confronting the truth about his mother's death. But the film utterly failed to point out that antidepressants are common for a very good reason: they work.
Depression is tough to diagnose, and the medications can have some rough side effects if they're not working for you. Some people do have very negative experiences. However, there are millions of people for whom antidepressants have been miraculous. They calm anxiety, they stabilize your mood, and they give you a glimpse at the person you were before you became ill.
When people casually imply that depression is an invented disorder, or that people are weak or lazy for taking drugs, it continues to bring shame on a very real and very common mental illness, and prevents many people from seeking the help they desperately need. So stop it. Just...stop it.
5. Don't treat the person as if they're suddenly made of glass -- unless you ask and they tell you to do so.
Hearing a friend tell you that they're suffering from depression is big, important news. That friend has taken a risk by confiding something very personal and difficult, and you may be unsure how to react or what to say -- never mind how to treat them from now on.
People with depression do not tell others about it to brag, or to bring attention on themselves, or to fish for sympathy. They talk about it because they need a social support structure, and it's vital that their loved ones understand what's going on. However awkward it may feel for you to hear about it, know that it's a million times more awkward and frightening for the person with depression to speak about it.
So please don't freak out about what to say, or how to fix it, or if you might cause your friend to spontaneously leap off a bridge because of one misspoken joke. This is not about you. The best way to react is to ask if there is anything you can do to help the person, and to be prepared for the answer to be “I don't know,” or “Not now, but I'll tell you if I need to talk.”
Ask if your friend needs anything specific, and then go back to being their friend. That's what they need, most of all. Which brings me to:
6. Don't feel bad about laughing with them -- it's likely that it's the best moment they've had in days.
Depression is confusing for those who suffer from it, and it's also confusing for the people around them. Moods flicker from down in the dumps to genuinely happy, and a multitude of spaces in between. It may feel odd to go out with your depressed pal and find yourself laughing with them, teasing them as usual, or giggling over a cute dude at the bar. You might wonder if your friend is just putting on a show for you, or if they're secretly crying inside, or hating you because you're happy.
The answer is probably no. The genuinely happy moments with friends and loved ones are a powerful aid in treatment and recovery, and your participation in that moment of joy is one of the most powerful medicines that you could possibly imagine.