When you think of someone living with depression, you might picture someone at home, curled up in bed and unable to leave. However, not everyone with the condition fits that mold.
People with high-functioning depression, a subtype of the disorder, are able to meet goals and keep up with their daily routine, and they seem to enjoy success in life, explained Charlene Sanuade, a clinical therapist at CS Counseling and Therapy. In other words, the condition can essentially hide in plain sight, making it difficult to help, be compassionate or even acknowledge that someone needs support. But it’s absolutely vital that you do.
Here’s how experts say you can recognize the signs and help someone living with the issue.
1. Educate yourself
When attempting to support someone through high-functioning depression, it’s best to educate yourself about the condition.
“Part of the struggle with this type of depression is that the person struggling is usually doing so in silence,” said Tanisha M. Ranger, a psychologist and owner of Insight to Action LLC.
“For instance, a person with high-functioning depression may not be a bawling, puddle of sadness and despair, at least not in front of you, but are they relentlessly self-critical?” Ranger continued. “Do they seem unable to experience or express joy? Are they particularly snippy or irritable? Are they perfectionistic or do they seem unable to just take a break and relax? These are all signs that they may be struggling with this particularly insidious form of depression.”
It’s important, however, to not attempt to play therapist or put yourself in a one-up role as an expert after you learn about the disorder.
“You may understand generalities but every person’s struggle is uniquely theirs,” Ranger explained. “Education about depression ought to be for your own understanding of what might be happening for your friend. Be open to hearing that you don’t have it right and willing to learn what it’s like for them specifically.”
2. Listen without trying to fix anything
It is human nature to want to jump in and help fix things, but it may not be a solution that your friend is after.
“The urge to fix others comes from wanting to soothe our own unease or anxiety. Take a step back and let your loved one lead the way, in their own time,” Sanuade said.
Lisa Hutchison, a licensed mental health counselor in Middleborough, Massachusetts, said that if friends trust you with their feelings, it’s best to allow them to speak without judgment and to refrain from sharing your input.
“When you listen in this way, your friend feels your empathy and arrives at their own solutions,” Hutchison said.
Ash Nadkarni, an associate psychiatrist and instructor at Harvard Medical School, added that it’s also important to recognize that a solution that was right for you in a specific scenario may not necessarily be right for someone else. “Every person is an individual,” she said.
3. Be specific with your support
When volunteering to be a support system for a person with high-functioning depression, it’s important that you spell out exactly what it is that you are offering.
“Depression often comes with a sense of being overwhelmed and being unable to make decisions,” said Cyndy Adeniyi, a licensed professional counselor in Jonesboro, Georgia, and someone who lived with clinical depression for over 20 years.
Instead of saying “call me if you need me,” be more specific. Try offering to talk or say, “If you need a ride to a doctor, call me the night before and I’ll take you,” Adeniyi advised.
4. Offer to do fun things together
Depression pushes people into isolation and robs them of the energy needed to do fun things. At the same time, connecting with people and engaging in fun activities helps ease the condition.
“Inviting someone to do something fun one-on-one can really make a difference,” Adeniyi said. She suggested inviting your friend out for lunch, a movie or a walk. But one-on-one attention is really key in this scenario.
“If you invite them out as part of a larger group, they have a tendency to cancel or not interact with the group,” she said.
5. Ask the right questions
Too often people ask those experiencing depression things like, “What’s wrong?” “Why aren’t you happy?” or make statements like “Your life is great” or “Can’t you just move on or get over it?” But, according to Erika Martinez, a Miami-based licensed psychologist, phrasing your concern like this will likely make someone with depression feel worse. Instead, she suggested using prompts like “What’s going on?” “What do you need to feel better?” or “Is there something I can do to help?”
6. Validate their feelings
“The biggest thing I wish my family and friends would have done was validate my feelings,” said YouTuber Cassandra Bankson, 25, a resident of San Francisco who lives with depression. That means you shouldn’t dismiss what your loved one is going through.
“I understand my depression and its causes and triggers might seem irrelevant, overdramatic, or not such a big deal in the context of their lives. But to me, it is huge, ominous and pressing,” Bankson explained. “When my family and friends said, ‘It’s not such a big deal,’ that just made me feel misunderstood, and I would push them further away. Just validating my feelings, enforcing that it is OK to feel them for whatever reasons, and OK to ask for help and work through them would have been momentous.”
7. Try a little act of kindness
Being supportive involves having stamina and refusing to give up while simultaneously giving your friend the space that person needs. Continue to reach out and offer to come over, perhaps to cook or do dishes, Nadkarni suggested.
“Remember when you were little and your parents made you a cup of tea when you were feeling down or maybe cooked you your favorite meal? Helping someone who’s depressed feel at home and cared for can make a big difference,” she explained.
Nadkarni added that part of the reason such acts of kindness make a difference to someone with high-functioning depression is that these are people who are used to taking care of others, who retain a high level of control and who use mature defenses such as humor or altruism to cope with negative feelings.
“Caring for such a person can better help them tolerate a sense of helplessness and feel OK with not always being in control all of the time,” she said.
8. Don’t give up on them
Ann Ragan Kearns, 26, experienced depression after her mother passed away in December 2016. Kearns, who lives in New York, said it was important to her that her loved ones realized that she was going to have a mix of setbacks and achievements. She felt most supported when her friends and family were patient and didn’t give up on her.
“Let your loved one know that they are not alone and that you are there for them,” Kearns said. “A simple check-in is all it takes to let someone know that you are thinking about him or her and you care and that you support him or her and love him or her.”
Kearns added that the tough thing about living with high-functioning depression is that she isn’t the “typical” example of someone who has a mental health condition.
“Friends and co-workers might not be able to recognize your symptoms, sympathize with you or even believe that you have depression, as you are not showing typical behaviors of depression,” she said. “You’re not what society recognizes as depressed ― you’re not skipping work, withdrawing from social activities and so on. Just because you have depression doesn’t mean you can’t succeed at work or be successful in other areas of your life.”
9. Don’t take their mood personally
Someone experiencing any type of depression can feel down for no apparent reason. But it’s important that you recognize this often has nothing to do with you.
“Assuming that their mood or behavior is due to something you did or didn’t do is not helpful and breeds resentment on both sides,” said Bianca L. Rodriguez, a licensed therapist and founder of You Are Complete. “You end up thinking they are punishing and withholding and they end up feeling like you’re selfish and self-centered.”
10. Highlight external support systems
As much as you might want to, you can’t support your loved one completely on your own.
“You might ask if your friend is in treatment, therapy, on medications, etc., to get a sense of if he or she needs or wants care, needs a recommendation of a provider, or prefers a friend to accompany them to an appointment,” said Deborah J. Cohan, an associate professor of sociology at the University of South Carolina, Beaufort.
You can also encourage them by reiterating the benefits of professional treatment.
“Let your friend know that you care about their well-being and that there are so many different ways of improving it these days, from coaching to mindfulness practices and even nutrition-based approaches,” said Teodora Pavkovic, a psychologist and life coach. It’s also crucial to encourage your loved one to do some research on what kind of treatment or support would suit them best and offer to help them in any way you can, Pavkovic added.
11. Speak up if you think they might be at risk for self-harm
“It’s OK to share with your friend that you are concerned about them,” said Lakiesha Russell, a licensed therapist at The Evolving Chair. Russell suggested talking with your pal about putting a plan in place to help when crisis mode hits and asking how you can be a part of that plan.
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HELLO to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.