Ask HN: How to help someone going through depression? | Hacker News Reader

Ask HN: How to help someone going through depression?

32 pointssongzme27 comments

I have a friend who lives about an hour from me and I recently found out that he had secluded himself in his room for a few months. My friends and I have been trying to invite him to go out but he doesn't want to. All my friends are saying, "He doesn't want to hang out, just let him be", but I'm worried about his mental health. Today I invited him to my birthday dinner (6 people total, all of whom he knows) and he refused. His parents have given up on him, which is really sad for me to see. Is there more I can do to help?

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I'm sorry your friend is feeling that way. You're a good friend for wanting to help.

Don't push him to leave the house. It probably feels like too much effort to him just now. Go visit him. Don't force him to engage in conversation (again, too much effort), be willing to just sit together in silence or watching TV.

When you're depressed, engaging with other people is exhausting - but that in turn is isolating, which can exacerbate the depression.

So find ways to show him you care and are still his friend, without requiring a response or reciprocation. Text him a meme. Keep inviting him to events but be understanding that he probably won't go.

Invite him to hang out one-on-one (slightly less exhausting than groups); and if he isn't ready to leave the house, go to him, but as above don't expect him to engage. Just being present can help.

And speak with his parents. Maybe together you can get him professional help, because if he's having a major depressive episode as your description hints at, he'll need it.

As someone who has been on both sides of the depressed coin, this is what works for me when I'm on a down swing.

As a friend, offer up simple options. "Want to watch Planet Earth 2 for a bit?", "Want to take a walk to the store with me?", "have you heard this new album? want to listen to it?"

Honestly 30-45 mins of in person time is enough to help squash feelings of loneliness without adding on pressure to entertain or "fit in" if the person isn't feeling it.

Be consistent. It's hard to get fed up with someone who is depressed. But you being there is worth a lot even if they don't show it.

I’ve been walking alongside two people with depression. Being there for them on a regular basis, praying, and sharing the promises of the Bible and love of God have all helped them from going over the edge. I know because they told me so. I send them videos occasionally speaking some uplifting truth so they can see my face and hear my voice. But it’s mostly chat.

Being there is pretty easy as I am working on my computer anyway. So it’s not a huge sacrifice. But it would be worth the sacrifice anyways.

When you’re depressed you don’t want to interact with people. That’s the nature of the beast. Be there anyway, not pushy, but available, even if on the meekest of chat platforms.

I send my friends checkins twice a day and I recognize that just because they feel well today does not mean they are out of the valley. Depression comes and goes.

Edited to add: Being there helps a ton. It dispels the lie believed in depression that they are all alone. If you are a believer, share Bible promises. Or even if you are not a believer ;-)

Listening without judgment and sometimes (most times) not even offering any solutions but just being a shoulder, an objective truth speaker, making yourself available, are all strong weapons against chronic sadness. They might say, “I’m sorry to vent.” I reply, “NO SORRIES. This is a judgment-free zone. Be yourself. I am here for you.”

Hey downvoters: You don't have to agree with me. The OP asked what I was doing, I described it, and it's actually helping, according to those I am walking alongside. Could you be a bit more open minded? Thanks.

I absolutely second treating it like a regular medical problem and helping him find professional help.* I'd suggest looking for a good psychologist before considering psychiatry, just because meds are a much bigger long term commitment.

Another suggestion is exercise and meditation. Nothing strenous: if you can get him to even take a walk with you a couple times a week it'll make a difference. As for meditation, even a little bit can have a huge impact and I reccomend the excellent Headspace app.

* Of course this stuff can be expensive and he might not have insurance to help, so here's where you can step up and search for local, free programmes.

Ideally you'd get him to open up and speak to a therapist or doctor. But getting there is the hard part...

- Let him know there you are there for him. "hey buddy, I'm your friend and if you ever need to talk I'm here."

- Actively listen to him and validate his feelings. Don't critize just let him be. Ask questions like "how does that make you feel?" Don't offer solutions.

- Is there anything he is interested in? Gaming, walking, making things, painting, animals etc. Use that as a carrot help draw him out. Even if he goes out by himself. Just doing things will help.

- Read up on the topic and find books that might help. I like The Chimp Paradox books :)

> - Is there anything he is interested in? Gaming, walking, making things, painting, animals etc. Use that as a carrot help draw him out. Even if he goes out by himself. Just doing things will help.

I would vouch for that one too. Although everyone is different, this one worked for me, so I can share how it was looking from my perspective. Long story short. In my 20s I had also experienced a period of time (more than half a year) that I was spending a lot of time closed in my room, learning for studies and working on own projects, spending almost all the time in front of pc. This was also a way to escape from "problems, being always busy. As a result, I was also escaping from people as I was quite often feeling in a very low mood and did not want to share it with my friends. I always wanted my friends and others to see the positive me, the strong, successful one, not the low one with "problems". So I was awaiting for the magical moment when I will once again fell good, but, without success. Hence, as my mood was going down I was also more and more isolating myself, reducing the contact with people, and falling more and more into anhedonia.

At that time what I really needed is exactly someone to be there, just like that. And to one again be able to enjoy the time. Fortunately I had few wonderful friends I could count on and who were really pushy to see with. Just passing by to chat, to go out even to take just a regular walk around the neighbourhood or to play together on the console. The final goal was to feel the unconditional acceptance, everyone has both good and bad moments in life and not always success is surrounding us. Moreover, it was great to stay in the "outside" world and to finally enrol into doing some exercises, together with friends. Step by step.

Get him professional assistance. I gave up and walked away when my friend did what yours is doing. He was totally alone Don't know if he died or what. Have regretted it for 40 years.

There is an awesome video from a suicide helpline first responder at DefCon [0] on possible ways to speak to a friend who is feeling suicidal.

Firstly to be clear - this talk is not for talking to people who are literally about to commit suicide, it's for if you've got a friend who seems very depressed and might be heading down a path to suicide.

Obviously this is more extreme than just depression, but it is a great talk about how geeks can build trust and talk about difficult subjects with their friends. It gives a framework that you can assess how depressed/at risk your friend is.

I did know a friend who was very reclusive after getting fired from his first job after university. He had no job and did practically nothing for about 7 years despite lots of conversations with his friends to try and make progress. He eventually and slowly turned things round getting a job and is now happily married. So it can turn out for the better and it can also take a very long time. So be prepared to help for the long-term over years and don't expect one magic solution. One difference to your friend though is that the parents of my friend did not give up on him.

[0]: https://www.youtube.com/watch?v=fHRMSDPfE5A

It's very easy to be afraid of approaching or pushing someone in that state to see you, out of fear of pushing them away. Two weeks ago I lost a friend (who was in an eerily similar situation to your friend) to suicide. I am finding it incredibly hard to forgive myself for not doing more, or pushing harder.

I fell into the trap of thinking that being more persistent in outreach would ultimately hurt more than it helped.

If you're in a society with suicide helplines, or social services that are affordable, I'd recommend reaching out to them for advice on how to get through to your friend. It's impossible to know how close to the edge he might be, but members of those organizations who speak to depressed or suicidal people on a daily basis may be able to provide you with advice on how to handle outreach, especially since he may not be reaching out to them directly.

It's unlikely that he will be open to engaging in a group situation. Reach out one-on-one, or visit in person.

Don't make the same mistake I did. My friend secluded himself out of the dumb idea that time apart would make his eventual suicide easier on his friends. It didn't, and there's nothing I can do now.

I’m sorry you lost your friend, but you didn’t make a mistake. You did what you could, what you thought was right. It’s not your fault that you didn’t have hindsight, and it’s not your fault that you didn’t or couldn’t know what your friend was going through.

That said, I agree with you on being persistent in helping friends who are or may be clinically depressed. Let me warn that I am not a trained medical professional, but just a person diagnosed with depression so I want to offer my insight on this being persistent thing.

For you or for anyone in a normal, rational, state of mind, if you asked me to come out and do something with you and I said no, you’re probably just thinking “Alright, I’m sure he has some good excuse. I don’t want to push him.”

For me, when I was going through my darkest times (I am now on medication and have weekly therapy sessions), my read on that situation was 100% different.

First, the excuse:

“No thanks. I’m just so busy with ____ right now. I can’t do it. Maybe next time.”

That’s even if I bothered giving an excuse. Most of the time I saw the text message and just ignored it. More on this later.

Next, the aftermath of hearing you accepting my excuse (or not following up, if I ignored you, again more on this later):

Internally: “I guess he didn’t want to hang out after all. If he really did, if he really cared about me, he wouldn’t take no for an answer. He knows I’m in a bad place right now. He knows I’m having all these issues. He knows _______. Why doesn’t he care? Why doesn’t anybody care? Do I have any friends who care? Do I even have friends? What am I doing with my life? What’s the point of my miserable life?”

Now here’s the thing. You might read this and think things like “I didn’t sign up for this. Why should I have to do that? Why should I have to accommodate him so much? It’s his problem, he just needs to get his shit together.”

1. It’s not his problem. It’s not his fault. He can’t help it. His mind isn’t functioning properly. He can’t just magically get his shit together. If he could, he wouldn’t be in his situation.

2. You put up with it because you’re a good friend. If your friend had a broken leg and couldn’t leave his apartment, you go over and hang out over there because circumstances are preventing him from physically leaving. In this case, circumstances are preventing him from making rational choices, so sometimes you just need to make them for him.

I’m not advocating power of attorney or anything like that. I’m saying that when I was in my state, doing ANYTHING felt like climbing Mount Everest. Seriously. Picking out a T-shirt? I was so mentally exhausted. Being asked if I wanted to watch a movie? I might as well roll over in bed and cry instead of deciding. Which is what I did, most of the time.

On the other hand, if you pushed him harder and he committed it, you would probably have felt even more guilty. You did what you thought was the right thing, don't blame yourself.

You've gotten a lot of great suggestions in this thread. One thing that helped someone I care about is this video: https://www.youtube.com/watch?v=pEbaff5VkMY

Another thing is try something really small like going for an ice cream or doing something HE/SHE used to love to do.

Worse thing you can do is just let him be, that is more so YOU don't feel bad rather than helping him. Take small positive steps forward. Even a regular phone call that's predictable would help.

I did that for about 6 months in my early 20s. Keep bugging him, reminding him that he has friends. But be patient. He isn't going to come out until he's damn well good and ready to come out.

Go see the friend. Be present. Don't try to fix things. If asked directly, suggest seeing a mental health professional. That's the only consistently sound advice about depression most people have.

Good luck.

See if you can get him into a therapy/depression online chat room.

Use that as a path to go see a professional therapist and psychiatrist.

A small thing that could help. Woebot is an automated agent that delivers CBT training that appears to be effective in significantly reducing symptoms of depression in young adults.

https://woebot.io/

Has an iOS and Android app.

I can't speak to Woebot specifically, but I'd exercise caution when investigating chat based therapy. I feel like if you care enough to ask on HN, you checking in on him would quickly surpass what a bot could do.

As for chat based therapy with humans behind them, I'd advise steering clear of them completly:

- They explictly don't provide professional care or verify the credentials of their staff.

- They're incentivised, not to give you the best care, but to keep you in the system for as long as possible since you getting better = churn.

- I believe that getting sub-standard care from systems like these might dissuade your friend from seeking the actual, professional help he might need.

Maybe you're using "chat based therapy" to mean something specific, but some talking therapies have excellent evidence (large amounts of robustly analysed data across a wide range of different people with different types of depression) and eg cognitive behaviour therapy is about 60% effective. CBT combined with anti-depressant medication with some social intervention (housing, employment, social activity, debt, etc) is about as good as we can do at the moment.

In England if you get CBT from the NHS you're getting it from someone with a qualification and a professional registration, working for an organisation that has safeguarding policies and their own registration. (Although some English IAPT is over the telephone, or self guided on computer).

If you're talking about non-specific counselling then I agree - the evidence for that is weak at best.

I agree about Woebot. I haven't seen much evidence and it's worrying that people always overplay the efficacy of an intervention, until we get a good trial to show it's not that brilliant.

You're right, I probably used the term wrong. I was specifically addressing text based therapy apps such as BetterHelp and Talkspace.

[1] https://theoutline.com/post/3462/the-sketchy-world-of-text-t...

[2] https://www.theverge.com/2016/12/19/14004442/talkspace-thera...

Neat idea. I'd be a bit concerned about data privacy, tho.

Read the reviews: https://play.google.com/store/apps/details?id=com.woebot

I don't think there will ever be a one size fits all approach to treating people, especially depression.

Just being fully available and open to when they want to reach out and getting to them at the right times is almost a job in itself.

When I was recently going through a bad time (clinically depressed) I started withdraw myself from my social life. I started talking and opening up to my friends Less and lesse, because I didn’t want to bring them down with my problems. I started making up excuses to not go out with them, because I just wasn’t feeling well. When people came to me and asked me what’s up, I made up excuse after excuse of how everything is fine, I’m just stressed from this and that, I’ve just got this deadline, really don’t worry about me I’m fine.

Here’s the thing: I wasn’t fine. My brain was, in short, “broken” much like a bone is broken when you fracture it. My mind was broken after who knows how long of neglect to my mental health and well-being.

Every little thing required so much effort, that it was easier to just do nothing. Doing nothing was the most rewarding choice, but at the same time I knew that doing nothing would make the problem worse. Yet, I didn’t care. Much like a cigarette smoker might know it’ll increase their risks of cancer x fold, I didn’t care that not going out today will make me feel worse later on. That’s a problem for later on.

When my friends would ask if I wanted to go get dinner with them, I would politely say no. Every single choice that I was given, I would choose the easiest one because it gave me immediate results which made me feel better now. What I wish my friends would have done instead was not give me a choice. Tell me, “We’re going to dinner at x, and look I’m going to come over at 7pm and either we both go or we order pizza. But I’m coming over, cool?”

For me, what I needs was someone to push me. I wasn’t capable of pushing myself. I needed someone else to do it for me. More than that, I needed a swift reminder that there were people in my life that cared about me, and that I fit in and belong.

Remember that when you’re depressed your brain is literally not functioning properly.

In your mind, if you invited me to go out and do something with you and I said no, you’re probably thinking “okay well maybe he’s just not feel it now, maybe next time.”

In my mind, what was going through my head was something totally different: “I just don’t wanna go because it’s so much effort, so I’ll just say no. Wait, why is he saying that’s fine? What the f—-? Does he not care about me? Do I not matter to my friends that they can just write me off like that? Why aren’t they trying harder?”

And that thought process makes me withdraw from my friends even more. Remember: your friends mind isn’t functioning properly. It’s not his fault.

When you get some one on one time with him, the most important words you can say are some variation of

“Hey, I know times have been hard on you and I can’t even begin to imagine it. I just want you to know that I’m here for you. You don’t have to open up and talk to me, but I do care.”

Also, remember that his mind is an unstructured mess right now. One that that might help is for you to offer some structure. “Can we get dinner together every Thursday at 8pm?” You picking the time and date helps him because then he doesn’t need to think about those (and believe me, they are monumental decisions for people who are depressed) and it also gives him a sense of structure and something to look forward to every week.

In the long run, what he needs is therapy.

Some other things from my personal experience:

- don’t offer help and suggestions and advice

I hate and hated it when my friends would ask if I tried meditating, or say maybe start running, hit a gym, etc. Yes those things all make sense, and may have been proven to work, but here’s the thing: those things all take effort, effort that I just didn’t have to give. Yes, even the simple act of “sitting down and breathing a few minutes for meditation” required a monumental amount of effort. Does it make sense? No. But depression is not rational.

What was worse, was that these advice and suggestions weren’t new to me. I’ve done the research. I’ve googled “how to not be depressed”. I know that exercise is good for me etc. You telling me makes me feel like you think I’m stupid, or that you think you’re so smart for thinking up that advice, and so on and so on. Is my reaction like this warranted? No. But again, depression is not rational.

Instead of “maybe you should go running, there’s a lot of couch to 5k apps.” You say, “hey let’s start running together, every day after work at 6pm. In 5 weeks we’ll be able to run a 5k together!”

etc

Something that's obvious but sometimes overlooked is listening.

Some people are just not good listeners. Something to watch out for.

Also to summarize the above poster: don't be pushy. And I'll add don't be condescending or patronizing.

Small, frequent in-person interactions, that over time build up to doing active things together.

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