How to help someone you live with who has depression

The coronavirus pandemic has meant sudden changes to our daily lives, with restrictions on free movement, imposed lockdowns and social distancing. Many of these measures will have taken a toll on people’s mental health.

These changes have increased our exposure to known risk factors for developing depression, such as physical inactivity, lack of structure and routine, lack of social support, loneliness, and limited opportunity to do enjoyable and valued activities.

Also, evidence from previous pandemics, such as Sars and swine flu, suggests that disease-containment measures, such as quarantine and social isolation, may be detrimental to mental health. There is growing evidence that the effect of these changes on people’s mental health across the age groups is significant, especially for those who are younger.

Rates of depression in adults and young people are already concerning, and are predicted by the World Health Organization to rise. By 2030, depression will be the highest burden of disease globally, which refers to the overall impact of a health problem, including the financial cost. So although the initial focus during the pandemic has understandably been on physical health, it is therefore crucial that we also turn our attention to people’s mental health, particularly as the two are related.

A lot of advice addresses the person with depression, but here we give advice on what you can do if you live with someone who is depressed.

Clues in their behaviour

Many people find it difficult to ask for help and to let others know how they are feeling. Don’t assume someone is OK just because they say they are. It’s better to ask more questions and risk being annoying than to miss something important, such as symptoms of depression. If they don’t want to tell you, watch their behaviour and notice anything unusual, such as sleeping much later, not eating, staring for long periods, cancelling and avoiding many things.

People’s feelings are often linked to their thoughts and behaviour, and this is demonstrated in the cognitive behavioural therapy model. When people feel depressed, they often experience repeating streams of negative thoughts. It can be helpful to encourage someone who is thinking this way to try to look at different sides to a situation. Useful questions might be: “What advice would you give a friend in this situation?” or “What would be a more helpful way of thinking about this?”

Depression gives rise to self-critical thoughts, such as “I’m no good”, “I shouldn’t feel this way”. Not surprisingly these thoughts then fuel the depression further. It’s helpful to let the depressed person know that you can see how they are feeling and that their feelings are understandable and valid, and will pass in time. This type of validation can help someone who is depressed refrain from criticising themselves for having difficult feelings and to develop more self-compassion.

People who are depressed commonly withdraw from other people and activities. By doing fewer enjoyable and valued activities, it can compound a person’s depression. Try to counteract this by helping the person to re-engage with things that are important to them. Start with small things such as putting some structure into the day and perhaps increasing exercise, or time spent in nature, if possible. Help the person gradually re-introduce activities and social contacts that they see as valuable. Make some small plans together for the future (short, medium and long-term).

A person with depression may commonly find it difficult to problem-solve, and daily activities and issues can quickly start to feel overwhelming. It’s helpful to stay calm and keep conflict and stress in the house to a minimum. Support the person to generate simple solutions to problems and encourage them to put these solutions and ideas into action rather than avoiding things.

Seek outside help

There are a number of other effective treatments for depression. Encourage the person you are supporting to seek extra help if needed. This might be in the form of online information and online courses for both adults and young people; through self-help books; or by contacting your local healthcare provider or mental health services in your area.

Remember, your wellbeing is extremely important when supporting someone with depression. Take time for self-care so you can model positive behaviours and be replenished enough to provide this crucial support.

Monika Parkinson receives funding from NIHR Doctoral Research Fellowship award to research depression in adolescents and family support.

Maria Loades receives funding from NIHR Doctoral Research Fellowship award to research depression in adolescents with fatigue.