Clearly, there are limits to what a friend can do and how involved you can be, but helping a friend with severe depression get treated can mean the difference between life and death.
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Your friend has suddenly clammed up on you. You ordinarily speak, email or text each other every day, but when you called her three weeks ago after she was recently laid off from her job, she curtly said she was taking a nap and would call you back later. Your next phone message went straight into her voicemail.

You emailed her several times and realize she hasn't been online or simply isn't answering messages. She has had bouts of depression in the past and you suspect she may be depressed again. What steps can someone take to "cheer up" a depressed friend?

Depression is one of the most common mental disorders, affecting some 1 out of 10 Americans over their lifetimes. With the economy tanking and unemployment soaring, many more people are experiencing stressors that exacerbate the risk for depression and other mood disorders.

Everyone has days when they feel blue, but when someone is clinically depressed, the individual is no longer able to function effectively for a period of more than two weeks at work, school or home. It is unrealistic to think that a depressed friend will be able to simply "snap out of it" on her own.

The signs of depression (e.g., depressed or low mood, loss of appetite, fatigue, physical complaints, irregular sleep, irritability, loss of interest in people and things that were once pleasurable, loss of hope, etc.) may be obvious to a close friend, but figuring out how to respond isn't as straightforward. Stigma and denial prevent many people with mental or emotional disorders from reaching out for help.

Here are some suggestions on how to help a depressed friend:

1) Encourage her to seek help
The most important thing you can do is to encourage your friend to be evaluated by a mental health professional. When people are depressed, they may feel like there's no hope and have little energy to get help on their own.

Be frank and let your friend know you think she is depressed. Offer to assist with the legwork of finding a practitioner covered by her insurer or checking out public mental health programs. Explain that depression is a treatable illness. If she is already being treated and she doesn't improve over 4-6 weeks, suggest that she contact her doctor, who might evaluate whether a change in medication or other treatment is warranted.

2) Be there
Try to stay in touch, even if your depressed friend doesn't initiate contact or is slower than usual in responding to you. Because people with depression often lack initiative, they end up being alone ruminating about their problems. Offer to go for a walk in the park or to a movie together.

3) Provide support
Offer to help your friend with concrete tasks she can't seem to accomplish on her own. You could bring a meal or some food to her house, help with child care, or offer to help with chores, like laundry.

4) Listen patiently
Do more listening than talking. Be patient rather than pushy. Odds are your friend won't listen to you or realize the extent of her illness the first time you broach the topic. She may have excuses about why she doesn't need help or she may think she can conquer her problems on her own. Don't dismiss her feelings of hopelessness; explain that they are temporary and will eventually lift with treatment. If she resists your initial suggestions, try again but don't nag or set ultimatums.

5) Be prepared for a worst-case scenario
If your friend expresses thoughts of suicide or self-harm, be direct and ask her if she feels suicidal. If she does, remind her she is important to you and that she needs immediate professional help. Offer her the phone number of a suicide hotline. A free 24-hour National Suicide Prevention Lifeline (funded by the U.S. Department of Health and Human Services) is available to people in crisis (or their loved ones) at 1-800-273-TALK (8255). Calls are routed to local crisis centers.

Never allow the burden of having a depressed friend be yours alone. Be sure to inform someone else (e.g., her partner or closest relative). If you're her partner, tell her doctor.

Depression is an equal-opportunity disorder, affecting people of all ages, races and income levels, according to the U.S. Centers for Disease Control and Prevention (CDC) -- but the risk for depression is greater for women, those previously married, non-Hispanic blacks and individuals who either are unable to work or who are unemployed.

Clearly, there are limits to what a friend can do and how involved you can be, but helping a friend with severe depression get treated can mean the difference between life and death. The National Institute of Mental Health (NIMH) estimates that about 1 out of 5 individuals with depression receive treatment consistent with guidelines.

For more information about the signs and symptoms of depression, see:
CDC Depression Page
NIMH Depression Page

Irene S. Levine, Ph.D. is a friendship expert and the author/creator of

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