How to support someone with depression

Need to know

Depression can creep slowly into a person’s life. Often unseen at first, it begins to permeate the way a person thinks, feels, behaves. Over time, it can grow bolder and weigh more heavily, until, at its worst, it surrounds the person. The metaphorical dark cloud becomes visible – if you are looking for it – in someone’s movements, choices, words and expressed feelings.

The mental health condition called depression is characterised by persistent low mood and a loss of pleasure or interest in activities. But it is also much more than that, and it can show itself in different ways. It can look like someone sleeping too much – or not sleeping at all. It can look like someone struggling through the day without any energy, or struggling to get out of bed, to wash, dress or eat. It can look like not responding to messages, cancelling plans. It might manifest in tearfulness, a loss of patience, or seeming detached. Depression can show up in all of these ways, or others. And yet it can also look like someone seemingly coping day to day, getting up, parenting, working or studying, with subtle symptoms that only you and those close to them see.

You’re likely reading this because depression, or the possibility of depression, has touched your life in some way. Maybe you’re concerned about a partner, a child, a friend, a sibling or a parent. Depression is reported to affect around 280 million people worldwide, making it one of the most common mental health conditions. Considering these millions of individuals and all the people who care about them, it is very likely that most of us will have some experience of depression – either ourselves, or as a supporter – at some time in our lives.

So thank you for being here, for wanting to know more, for being open to offering support to someone experiencing depression. Support matters. The experience of depression can convince a person that they are alone in what they’re feeling, that they don’t matter, that no one cares. When you offer support, especially when it gets tough, that sends a message to the person with depression that they are loved, and that they do matter. This helps combat the dispiriting ‘voice’ of depression, creates space for compassion and connection, and offers hope for recovery.

This Guide will help you better understand what depression is and, crucially, how you can help.

Understanding depression: a brief look

Let’s further consider some of the varied ways depression shows up and what to look out for, turning to several types of symptoms and ways of thinking about them:

• Emotional symptoms: someone with depression might feel extremely sad – but they could also be feeling numb, flat, detached, anxious, irritable, on edge, guilty, ashamed, afraid or overwhelmed. Depression can coexist with grief, trauma or other mental health conditions, such as generalised anxiety disorder, obsessive compulsive disorder or eating disorders.
• Cognitive symptoms: depression can temporarily impact how a person thinks, including their attention, memory, information-processing, decision-making and problem-solving. People commonly report that their thinking processes feel slowed-down and foggy, and they find it hard to pay attention or are forgetful. Depression also shapes what a person thinks: someone might have frequent negative thoughts, hopeless thoughts, anxious thoughts or critical thoughts, whether about themselves, others, the future or the world. At a more severe level, these might include thoughts about self-harm and suicide.
• Physical symptoms: among these possible symptoms are fatigue and lethargy; feeling achy or heavy in the body; a loss of appetite or, conversely, an urge to eat for comfort; or disrupted sleep patterns (sleeping too much or too little). If anxiety is also present, one might experience symptoms such as a racing heart, breathlessness or a tight chest.
• Behaviours: common signs are withdrawal and avoidance (eg, pulling away from, declining or avoiding social activities, hobbies or family time); appearing restless or agitated; lack of self-care or personal care; increased use of smoking, alcohol, drugs, gambling, food or sex as a way of coping; and self-harming behaviours or suicidal behaviours.

When mental health professionals diagnose depression, they commonly use the criteria set out in official texts such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD). In the current version of the DSM, a diagnosis for major depressive disorder requires the presence of core symptoms – low mood and/or loss of pleasure – as well as other symptoms such as changes in appetite or sleep, fatigue, feelings of worthlessness or suicidal ideation. These symptoms must cause distress or impairment and last for a two-week period.

Once it’s present, though, depression can last for weeks or longer. For some people, it may last for a few months, while for others it is a more chronic mental health condition that impacts their life for a year or more. Depression can also be a recurrent condition, with periods of depression (lasting weeks or months) and periods of recovery (lasting weeks, months or years). Sometimes, depression is a one-off episode that a person recovers from and does not experience again. However it presents, it can be incredibly difficult for the person with depression and their loved ones.

The causes of depression are highly individual, with many different possible factors. There are complex interactions between genetics, physiology, health and hormones, and life experiences (eg, upbringing, relationships, a history of mistreatment or trauma) along with thinking skills, coping styles and resources. Experts are learning more all the time about the interaction between these contributing factors. Depression can be an understandable ‘shut down’ response in the face of difficult or traumatic life experiences, or an overwhelming build-up of stressors, where a person’s resources, or perceived capacity to cope, do not meet the demands of the challenges they face.

Depression can always be viewed through a compassionate lens focused on what has happened to a person to lead to depression, rather than what is wrong with them. Depression often causes a person to think self-critically (eg, There is something wrong with me), rather than compassionately (eg, What has happened to me? or What have I been through that might be contributing to this?) For supporters, it’s possible to get caught in the same trap of thinking and feeling negatively towards the person with depression, rather than thinking compassionately about what might have led to it.

Why your support is important

With a general sense of what depression is, what it can look like, and why it might be present, the important question for you as a supporter is what you can do to help. And the good news is there are things you can do and say. My aim in the rest of this Guide is to give you tools you can start using today that will help you provide emotional and practical support to someone with depression. This can help that person feel less alone, and supported in a way that they need and can tolerate right now.

Providing support for someone with depression can be, quite literally, lifesaving. Whether it’s giving them an opportunity to express their emotions, ensuring they do not feel isolated, providing practical assistance or helping them access or accept professional support, what you offer may be invaluable. And, while it is not a responsibility that you should carry alone, supporting someone with depression can help reduce the risk of the depression worsening, provide some relief from the suffering, and create hope that things will get better.

What to do

Talk about the depression

To identify depression, and to be able to tackle it, people need to talk about it. Talking about depression can also help the person who’s experiencing it feel less alone.

So, do what you can to encourage open and honest conversation. If you’re concerned that the person you care about might be experiencing depression, but it has not yet come up, ask about it. Ask if they are feeling low, and if it seems like more than just a sad day. Let them know you are worried and what you have noticed. Be curious about how they think and feel about what is going on with them.

You might start by saying something like: ‘How are you doing? I’ve noticed you haven’t seemed like yourself, and wondered how you are feeling – if you are feeling a bit low.’ Depending on how they respond to this, you might go further and ask: ‘Do you think you might be experiencing depression?’ or ‘I’m worried that you might be experiencing more than sadness… maybe this is growing into depression?’ Very importantly, let them know you are not judging what they are experiencing, and that, if they aren’t ready to talk about it now, you’ll be there when they are ready. Be open to the fact that they might not identify with the language or labels of ‘depression’ right now (or ever), and that is OK. You can still talk about symptoms (such as sadness, poor sleep or worry) that they might be struggling with and how these are affecting them.

If depression has already been identified, don’t pretend it’s not there. Talk to them: ask them about it and how they are doing. When you talk about depression, try to use externalising language that separates the person from the depression. This helps you communicate in a non-critical way, and it can help both of you move towards the idea that depression is something you can tackle and face together. For example, you might ask: ‘How is the depression making you feel today?’ or ‘What is it saying to you?’ Similarly, you could observe how ‘It looks like the depression is making it hard for you to do ___ or ___.’

Support them in getting external help

In some cases, the care and support of loved ones and the passage of a difficult time may be enough to lift depression. In other cases, a person with depression will need more than just time, self-help or your personal support. They may need additional external support. The need for such support can depend on the extent of the depression, how well a person is functioning, and what help they feel they need. It also depends on how safe or unsafe they feel; if they’re having thoughts about self-harm or suicide, support from a mental health professional is critical.

The external help they get might include assistance with childcare, cleaning or shopping, or arranging a break from studies or work. It could also mean speaking to a medical professional about diagnosis or medication. And it could mean going to therapy, in which case the person should see an appropriately trained professional, such as a clinical psychologist or psychiatrist with experience treating depression. The more severe the depression, the more a person is struggling to function in day-to-day life, or the higher the risk, the more important professional intervention becomes, alongside any other support. When things are very difficult – such as if a person is at high risk of suicide or self-harm – this necessitates interventions in the form of community/outpatient or inpatient care.

It is never too early for someone with depression to access practical or therapeutic support, although bear in mind that the person might not feel ready for this, even if it seems like it will be useful. Some people will want and benefit from support very early in the experience of depression, while others might not be open to it until much later. Having honest conversations about these possibilities, helping the person to make or attend appointments, or researching whom to contact are among the useful tasks that you might do, with the person’s permission.

If you do have conversations about getting support, do so gently and compassionately. You could say: ‘It seems like things are really tough right now, and I am wondering if ___ would help’ or ‘Would it be okay if I suggest some ideas that might help right now?’ If the person is not ready to accept or acknowledge a need for support, don’t get cross. Just let them know you understand, and that the support is there, or that you are ready to help them, if or when they need it. However, if the person is refusing help and you are concerned that there is a risk that they will harm themselves, it is critical that you contact crisis or emergency support services (such as those listed at the end of this Guide) to ensure they get the help they need.

Notice the negative, unkind and critical thoughts

In everyday conversations with someone who has depression – or when you check in on how they are doing – you might notice that they express highly negative thoughts about themselves or aspects of their life. As a supporter, you can be alert to the negative thoughts the depression brings up. Use externalising language, such as: ‘It seems like the depression is telling you really negative things today’ or ‘The thoughts that depression is bringing up sound so unkind and cruel; they’re not reflecting any of the good things you have done lately, have you noticed that?’ This can help the person recognise that it’s the depression that leads to these thoughts, rather than seeing these kinds of thoughts as an inherent part of who they are. Separating one’s thoughts from one’s self is a therapeutic process called defusion.

You can also ask permission to let the person know when you spot the negative depression ‘voice’ in the thoughts they’re having, so that you can combat it together. This helps the person feel less alone, and that they are not the problem, the depression is. Depression can make it hard for someone to always notice and challenge this negative voice themselves, and so they might accept the critical and unkind thoughts as accurate. Challenging this together gives them more of a chance to notice and respond effectively.

Ask about suicidal thoughts

Some people with depression have thoughts about suicide, and these can be very scary for a supporter. But if you’re worried that the person you care about might have thoughts of suicide, please don’t be afraid to ask, to have the conversation about them. Asking about suicidal thoughts won’t make someone suicidal. Not asking about them can be riskier.

To start a conversation, you might say something like: ‘I’m worried about you… I can see how horrible this is for you. Is depression giving you any thoughts about not wanting to be here, or not wanting to live?’

If the person shares that they are having such thoughts, here are some things you can do and say in that moment:

• Stay as calm as you can, although you might understandably feel overwhelmed, scared, frustrated or sad.
• Respond with compassion. For example: ‘Thank you for telling me. That must be so hard to feel that way. I am so sorry you are going through this.’
• Ask for more info: ‘I want to understand so I can support you. I want to help you feel safe. Can we talk about this some more?’
• Ask any version of the following questions:
  Do you want to act on these thoughts?
  Have you thought about ways to harm yourself?
  Have you thought about when you might act on these thoughts?
• You can also ask if they feel safe from these thoughts and what might stop them from acting on the thoughts.

If you are struggling to ask these questions, see if you can enlist another close friend or family member to have this conversation with you. You can also seek advice from a therapist, medical professional or crisis line. You do not have to do this alone.

If you’re in any doubt and are worried about the risk of harm, reach out to crisis or emergency services for help. If possible, you can invite the person you’re concerned about to do this with you, or to do this themselves. Always take suicidal thoughts, intent or plans seriously, even if they have been expressed more than once before. It is a sign of how much a person is hurting.

Stay with them in the big feelings

Depression can bring some dark, heavy, painful feelings. One powerful thing that you can do is to be with someone when they are experiencing these difficult feelings, while resisting any urges you might have to minimise, dismiss, ignore, avoid or ‘solve’ the feelings. It can be helpful to simply listen to how someone is feeling and to acknowledge with compassion how hard that must be. ‘I can hear how heavy this is making you feel. It must be so tough to feel this way. I want you to know that I’m here for you.’ If you need to, take a deep breath and make space for whatever feelings this brings up in you as well.

When a person with depression has the space to be heard, when their emotions are partly held by others, it can help them to feel less alone, even in their darkest moments. To know that they are not a bad person for feeling the way they do, and that their loved ones are there for them even when they feel this way – this all helps combat the depression, which will try to isolate them and make them feel bad, unloved, unwanted.

Offer practical support

Depression can make everything feel harder and make day-to-day tasks overwhelming. Tasks can become harder physically (due to the lethargy and fatigue), emotionally (stress, anxiety, irritation and so on can all show up), cognitively (as one tries to problem-solve, make decisions, remember everything to do, etc), and behaviourally (it can be more difficult to make time for a task). Offering someone in this position practical support can lighten the load. That might include, for example, a food shop, lending a hand with childcare, or tidying the house. It could be a visit to cook the person a meal while giving them a chance to express what they’re feeling.

While it is important to encourage a person with depression to stay involved in doing regular tasks themselves (see the next step), at times, helping out with practical tasks is the compassionate choice – especially if the person is feeling increasingly overwhelmed. If a loved one were recovering from a broken leg, or a terrible flu, it is likely that you would help with tasks during the recovery process. By being present and listening to how a person is doing, you will get a better sense of how they are coping and whether they could use some assistance. It is always OK to offer support, and the person can choose whether to accept. Either way, they know you are there to help.

Encourage them to take action (with your support)

We’ve noted that depression can cause withdrawal, avoidance and inaction. Lethargy and fatigue can play a part in this, along with lack of sleep and appetite, the loss of motivation, and the onslaught of negative thoughts. When a person is struggling to function as usual and take care of themselves day to day, it can be really helpful to come alongside that person, acknowledge how they are feeling, and then ask permission to support them in taking action and doing a little more, with the aim of gently increasing their functioning (and their mood) again. ‘Can I help? Can I support you in doing some tasks? Can I suggest some things we can do together?’ Perhaps you’d propose sorting out the house (or one room) together, cooking a meal together, going for a coffee, or attending a social event for an hour together. You can start small, making it manageable and achievable, negotiating and figuring out together what it could look like.

This approach is based on the therapeutic principles of behavioural activation, or activity scheduling. There is evidence that being active and engaging in tasks, even in a gentle way, is often effective in lifting mood, far more so than inactivity. Generally, this often means encouraging: 1) exercise and movement, 2) social interaction, 3) activities that bring a sense of achievement, and 4) activities that the person typically enjoys or previously enjoyed. To make a habit of it, you might, for example, arrange to go walking in the local woods with someone twice a week, and these periods of moving, interacting and being in nature could provide a much-needed mood boost.

If a person is functioning fairly well, you might be looking at scheduling relatively high-level activities (such as taking a trip into town, or going to a social event). If a person is struggling to function (to get out of bed, eat, wash), you would likely start with basic self-care activities, such as getting some fresh air and some gentle movement, or a shower, with the aim of working up to higher-level activities or increased functioning.

Stay in touch

Depression can make it more difficult to maintain contact. If you’re a friend or family member, plans might be cancelled or never made. Messages left unopened or unanswered. Phone calls ignored. If you live with someone who has depression, you may find the person withdrawing to bed early, limiting their communication with you in any of the ways above, or pulling back from their relationships with others.

This is the depression – but it can be hard not to feel hurt or rejected or to take it personally as a supporter. Remember, for the person who’s going through depression, the negative, critical voice can be so loud, the motivation and energy levels so low. It’s not specific to their relationship with you.

As a supporter, keep messaging, calling, talking and trying to make plans. Let the other person know you love them and you care. Let them know there is no pressure to reply, but that you are ready to meet or talk as soon as they are able to. Let them know you are there for them and you will keep being there for them. Just keep on keeping in touch. Importantly, if the depression lifts and the person does get in touch again, do not be critical about the fact that they’ve previously withdrawn. Be glad about the change and celebrate that they are able to be in touch again.

Remain kind and compassionate

At certain times, supporting a person with depression, you might feel worn out, annoyed, frustrated. It may feel difficult to remain empathic. You might want the person who’s experiencing depression to simply stop talking negatively, stop pulling away, start ‘trying’ to get better. Your inner voice could become critical towards the person more than the depression.

So, trying to stay kind and compassionate is an important – though sometimes really challenging – thing that you can do. You might have to remind yourself that depression can be awful and all-consuming, and that, for anyone suffering from it, it’s really hard to find a way out of it easily. Depression is complex, and there could be many reasons why a person is struggling.

Do your best to avoid adding another critical voice to the person’s already crowded critical headspace. But it is important to acknowledge, for yourself, your own thoughts and feelings in your own safe space, which might be with a friend, a family member or a therapist. You can also help yourself remain kind and compassionate by taking breaks, practising self-care, and seeking other kinds of support (see the Learn More section for more about this).

Above all, whatever frustrations or setbacks you might encounter, don’t give up. Depression can push a person away from their supporters and it makes the supporters feel pushed away. It makes it harder to hold compassion. It makes the sufferer feel alone, as if no one will want to stay with them through depression. It can drain your strength and empathy at times. And at these times, it is so important to look after yourself. Remember, you can’t take sole responsibility for making the person better. But you can keep showing up as a supporter, including in the ways I’ve described. So please don’t give up.

People do recover from depression, and there is hope for the person you care about. It may not be a quick or easy process, and it might take time to find the right combination of support, but recovery can happen. Your patience, understanding, compassion and love are the essential gifts you have to offer.

Links & books

For further reading about depression and ways to support someone who’s experiencing it, I would encourage you to read my book How to Help Someone with Depression (2021), which is also available in Spanish as Depresión: Cómo ayudar a alguien que lo está pasando mal (2023). Two other texts I’d recommend – which contain personal insights into depression and could be helpful reads for someone who is living with it – are Matt Haig’s memoir Reasons to Stay Alive (2015) and James Withey’s self-help book How to Tell Depression to Piss Off: 40 Ways to Get Your Life Back (2020).

For additional information about depression and how to help, I suggest checking out the online resources provided by mental health-focused nonprofits, such as this page from the Mental Health Foundation in the UK and the website of the Anxiety and Depression Association of America (which includes articles, videos and webinars).

My Empower Psychology website has a number of free resources and practices to help you with self-care. I would also recommend Suzy Reading’s book Rest to Reset (2023), on finding ways to rest even amid a busy schedule, and a book that I co-authored with Tara Quinn-Cirillo called Mental Health Microgains (2024), which gives you 50 small, five-minute practices to help you take care of your own wellbeing.

There are many wonderful podcasts out there that offer insights on depression, mental health and self-care, but for starters I would suggest Rangan Chatterjee’s podcast Feel Better Live More, which features a range of interesting topics and podcast guests, or the podcast created by my colleague Quinn-Cirillo, the Adversity Psychologist Podcast.

In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. Or text HOME to 741741 to reach Crisis Text Line.

In the UK and Ireland, the Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie

In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org