Girl with the Green Face, 1910, Alexej von Jawlensky. Photo: Alexej von Jawlensky/Wikimedia Commons

“I’ve started cutting my wrists,” my friend said on the phone one night. “I’m not eating. I don’t want to be alive.” We’d had many phone calls about her depression at this point; her parents knew, I had talked for hours on the phone with her childhood friend to compare notes, and she was on medication and seeing a therapist. We had been through so much together, but on this one particular call, I didn’t know what else to tell her. “That’s not good, and I don’t want you to do that,” is all I could think to say, and I felt a void in my lungs — as if all the air had been sucked out of my chest. “I’m so sorry, I want you to get better.” I left for college a few weeks later and found myself texting rather than calling her back, waiting days and then weeks to respond to her texts so that our friendship slowly melted away. We were, by the time she tried to commit suicide, out of touch except for birthdays: She always remembered mine. I always forgot hers.

Now I’ve experienced depression myself, and I have a handful of friends in various stages of depression, including one who has repeatedly called late at night asking me to “talk her off the ledge.” So many people around me are stressed out or on antidepressants, and I’ve wondered: How do you actually help someone with depression while remaining calm and grounded yourself? What should the follow-up texts and phone calls and agonizing weeks or months of recovery look like so you make the person feel better and not worse? What, in short, would a therapist advise here?

What follows is an exhaustive guide with evidence-based strategies and word-for-word scripts sourced from depression experts: things you can say and do if someone tells you they’re struggling or that they want to hurt themselves.

If you’re depressed: Send this story to people who care about you so they can know how to really help you. If you’re a friend (or family member, spouse, or co-worker) of someone who is depressed: Know it’s not entirely up to you to help them get better. But there is so much you can do, say, and know about depression to keep the relationship and your own well-being intact.

Depression, Defined

What is depression? What are the signs and symptoms?

Major depression is a mood disorder that causes someone to feel persistently sad for a long time (at least two weeks), and of the many symptoms, the most common signs you’ll recognize in friends are their being less social or less interested in things they usually like to do. A depressed friend might decline your invitations to meet up, cancel plans again and again, or ignore calls or texts. In person, that friend might snap at you, drink excessively, get upset about the smallest things, or seem more anxious, irritable, flat, and just really negative and down.

“Friends can sometimes take that personally and feel very impatient and frustrated, like, I don’t want to hang out with this person so much anymore,” says Dr. Laura Rosen, a clinical psychologist and the author of When Someone You Love Is Depressed. “That’s something people need to notice. If you feel different when you’re with them, depression might be going on.”

“Hey, I’m Worried About You”

How should you ask if someone is depressed? What should you say?

The wrong way to start the conversation is by focusing vaguely on how the person seems emotionally, which can sound accusatory, such as: “You’ve been so down/stressed/anxious/irritable lately … what’s going on? Are you okay?”

Open-ended questions are better, experts say, such as:

“How are you doing lately?”

“Are you struggling with anything? Can I help you?”

“You just don’t seem like yourself lately. Is everything okay?”

“Focus on specific behaviors so your friend doesn’t feel judged,” says Valerie Cordero, co-executive director of Families for Depression Awareness. “You want to try as much as possible to not put them on the defensive, and give them an opportunity to respond.”

Examples include:

“You used to love our nights out, but it seems like you’re not interested in coming anymore. Is something going on? Do you want to talk about it?”

“I know you got a raise recently, which probably came with a bunch of new responsibilities, and I’ve noticed you seem stressed out. Do you think you might be depressed?”

See what your friend is willing to share. If they don’t want to talk about it, or if they brush you off, just say, “I’m here for you,” and move on to another topic.

Portrait of a Girl, 1909, Alexej von Jawlensky. Photo: Alexej von Jawlensky/Wikimedia Commons

“Tell Me More”

If someone tells you they’re depressed, what should you say next?

“I think it’s really important that you don’t feel like you have to fix it, but just be curious and listen to your friends’ experience,” says Rosen. She advises asking questions like: “What has it been like for you? Are you able to function at work? How are you doing at school?” These should lead into the most important question to ask: “Has it ever gotten so bad that you feel like hurting yourself or you want to end things?” A lot of people wrongly think that asking about suicide will give someone the idea to do it. But experts say that’s not how suicide works and that it’s really, really important to ask about suicide directly. By not asking, you could isolate a friend even more, and cause the person to spiral even further into suicidal thoughts.

Unless you’re a mental-health professional, it’s not worth following up with hyperspecific, nitty-gritty questions like “When did you start feeling bad? or What makes you feel worse?” — because whatever the person says will put you in a position of needing to share advice you’re not qualified to give.

“The next step would be trying to see if they’ve actually been clinically diagnosed,” says Cordero. “Have they done any of the screenings?” Suggest they take an online test — it’s the same quiz they’d take in a primary-care doctor’s office, where people are encouraged to start seeking help for depression in order to rule out any other medical conditions.

What If They Are Considering Suicide?

If a person says they’re suicidal, what should you do?

“This is when it goes from an optional good idea of talking about depression to something that can be lifesaving,” says Dr. Ken Duckworth, a psychiatrist and the medical director of the National Alliance on Mental Illness. There are two kinds of suicidal thoughts you should listen for: passive or active. A person with passive suicidal thoughts might say, “Sometimes I wish I wasn’t here anymore” or “I wish I didn’t have to wake up in the morning.” A person with active suicidal thoughts is plotting an actual, specific plan.

If someone is passively suicidal:

“It’s still important to act, but it’s not like you have to get to the emergency room immediately,” says Cordero. “Again, ask: Have you been clinically evaluated? Are you in treatment right now? Who else can I call that we should talk about it with?” The next step is making sure they see a doctor and have a support system of people to reach out to for help beyond just you.

If they’re actively suicidal, but it doesn’t seem like they’ll act on it:

Make a safety contract with your friend before you let them leave you. The first part of the contract, according to Rosen, is: “Can you be safe now?” Followed by: “If you can’t be safe, what’s your plan? Will you call me? Will you call your mom? Will you call 911? I need to know that if you get to that point, you have a game plan.”

If they’re actively suicidal and seem likely to hurt themselves or someone else:

Call 911 or the National Suicide Prevention Hotline (1-800-273-8255) and say something like this to the operator: “I’m with a friend, and I’m concerned she’s suicidal. I need help. I’m worried she’s going to hurt herself. She can’t promise me she won’t.” “Somebody will come and evaluate the situation, they’ll take the person to a hospital emergency room to meet with a psychiatrist and let that person make the ultimate call,” says Rosen.

“If the person can’t say they’re going to be safe, that’s when you don’t leave them and you call 911,” says Rosen. “But if the person says, ‘You know what? I’m really feeling bad but talking to you has helped, and I think I’m just going to go to bed now,’ that’s okay.”

“Who Else Will You Talk to About This?”

Make sure you’re not the only person who knows.

If your friend is depressed or suicidal, however the conversation goes, there can be great pressure if you think you’re alone in supporting the person. Cordero says it’s important to help the person identify a support network by asking questions like:

“Who else have you talked to about this?”

“Have you talked to your mom or X or Y person?”

“Who else do you think could also be involved in helping to support you?”

“If they can name other people, great,” she says. “Otherwise, you can make suggestions.” Parents, a significant other, another friend, or a therapist are all good contacts. If you’re asked not to tell anyone, keep your word unless you think they’re suicidal. “The one time it’s okay to break that confidentiality is when you feel like they’re going to be of harm to themselves or to someone else, right?” says Rosen.

If your friend already has a therapist, and you know the person’s name, another thing you can do is call the therapist’s office and leave a message. The therapist can’t share any information with you due to HIPAA privacy laws, but nothing prevents the therapist from listening to you and incorporating your thoughts into your friend’s care. The therapist may not call you back, but at least you know that the therapist knows.

Head of a Woman, 1911, Alexej von Jawlensky. Photo: Alexej von Jawlensky/Wikimedia Commons

What to Say to Someone Who Is Depressed

How do you tell the person that things will get better?

Don’t say:

“You have so much going for you.”

“Just know that I care about you.”

“Come on, stop being so down.”

“Wouldn’t you feel better if you didn’t drink so much or sleep all day?”

The first example suggests you know more about their situation than the depressed friend does. The others instill guilt and shame. In general, it’s better to avoid giving advice that suggests specific ways a friend should change thoughts or behavior — the only true advice you can give is that the friend should talk to a doctor and therapist, and you can encourage your friend to continue reaching out to you and other friends and family when that person needs someone to listen. Instead, say something like:

Do say:

“It makes sense to me that you’re just really not feeling like yourself.”

“You feel really miserable right now, but you have to remember it will get better. I know that. I can promise you that.”

Rather than giving the person a pep talk, these examples reflect back what you’re hearing and offer specific ways you might help. “What I hear from depressed people is that to have somebody say get over it is not very helpful and actually really annoying,” says Rosen. “It’s more helpful to say, ‘I can see what a hard time you’re having, but I’m going to be here. I’m going to see you through this. You probably don’t believe this, but it will pass. I know it feels really bad.’”

“I Think You Should See Someone”

How do you get someone to consider therapy?

When people are depressed, the smallest tasks can feel totally overwhelming — even just Googling therapists or picking up the phone to make an appointment. I hesitated to offer to help my friend with this, thinking it felt weird and invasive to get into her health-insurance status, but Cordero says all you really need to know is the name of the insurance provider and plan. Ask: “Can I call and try to set up a first appointment for you?” You can search for therapists online and make a few calls and say to receptionists: “Are you accepting new patients? Do you accept X health-insurance plan?” You can send your friend the names of three or four people to look up online, and offer to make the first scheduling call or help your friend get there or sit in the waiting room.

If people are resistant to the idea of therapy, you can frame it as a normal checkup. “Explain that the brain is an organ that can get ‘sick’ just like any other organ of the body,” says Dr. Ronald M. Podell, a psychiatrist and the founder and medical director of the Center for Bio-Behavioral Science in Los Angeles. If finding a therapist isn’t feasible or financially an option, your friend can try anxiety or mental-health apps.

When to Check In

What should follow-up texts and phone calls look like?

There’s a fine line between checking in and making a person feel policed or hounding that person with questions like “Did you take your medication? Did you go to therapy?” But overall, it is good to follow up. You could try setting a calendar reminder to text a friend every Sunday night, when anxiety for the week sets in, or invite the friend to hang out more often.

“Depressed people will tell me that just knowing a friend is thinking about them, maybe a friend invited them to go see a play but they’re really not up for it, they say it was nice just to be thought of,” says Rosen. “You’re much less likely to get depressed if you have a good support network, and the more social support you have, the more likely you are to get better.”

If you’re worried about a friend ignoring your texts, or how often you should check in without being annoying, ask directly about your friend’s boundaries and set your own. You could say: “I want to text you every week, but if you don’t answer me three weeks in a row, is it okay for me to call your mom? Is it okay for me to do X, Y, or Z?” As time passes, if you worry you’re being overbearing, you can say, “Am I bothering you by texting so much? I’m just thinking of you.”

Where to Hang Out

What kinds of activities should I suggest?

Going to see a movie is easy because it doesn’t require a lot of talking, or you can offer to take a walk or hang out at your friend’s house. Playing sports or going to a spin class could be too much, says Rosen. If it’s overwhelming to your friend to hang out in a large group, you could suggest a quieter alternative: “I know you don’t feel like going to the bar tonight with everyone, but would you want to meet me for dinner before then, even if you feel like going to bed early?”

Even if the person isn’t up for making plans, you can feel good about the mere act of reaching out.

Managing Your Own Emotions

Why is my depressed friend making me feel depressed?

When I experienced depression myself, people often said things that made me feel worse, and I could tell I was making them feel worse by continuing to just … feel worse. This cycle of reactivity between a depressed person and a healthy friend is described as “fusion” in Podell’s book Contagious Emotions: Staying Well When Your Loved One Is Depressed, published in 1992. “Depression was a contagious disorder,” Podell wrote. “It could spread just like any cold or flu, infecting all who came in close contact with it. Not only could the spouses of depressed people become distraught, but the children, parents, and even friends and co-workers.”

Studies since then have proved this is true: Having a close friend who is depressed appears to make you 118 percent more likely to become depressed yourself, according to one study, which also found that depression spreads more easily among women than men. In another study of college roommates, researchers said that depression becomes more “contagious” when a depressed person refuses to share feelings and remains closed off, which is why it’s important to talk to a friend you think might be depressed, and encourage the friend to open up.

“The bottom line is that the better you can feel about yourself, the better you’ll be able to function as a healing and supportive force,” Podell wrote. To monitor your own mental health, check out the full list of depression symptoms here and take the Families for Depression Awareness online test. And with your friend, think about how much you can really give. “If you’re in a vulnerable emotional or mental position,” says Cordero, “those are all things to take into account. How much can you be there for that person? If you’re not the kind of person who is able to support somebody like that or who has room in their life for that, then you have to be honest about where you are.”

“I Need Space”

How do I gently tell my friend I need a break?

If the friendship starts feeling taxing or one-sided, you can gently nudge your friend to start reciprocating or say you need a break. Rosen provided these examples:

If your friend has vented to you for over an hour, you could say, “You know, we’ve been talking about this stuff for a really long time. I really want to tell you about what’s going on with me at work because I could use your advice.” If you live with the person, you could say, “I’m going to get some fresh air and take a walk” or “I’m going to go to a yoga class, but I’ll be back later.”

“You can be supportive for so long, but it’s hard to do all the time,” she says. “I think it’s really important for the non-depressed person to still go out with friends, take a walk, or have something separate from the depressed person.”

What If You Already Let the Friendship Slip?

Should you reach out to someone if you hear about a suicide attempt?

Be open and honest, and don’t expect a reply, Cordero advises. “Let’s say for example you’ve heard that a person you used to be close to had a suicide attempt, and you feel bad about it but you haven’t really been in contact. You have to approach it delicately, and you can’t expect the person to want to re-engage with you at this point when they’re maybe at their lowest.

“It could be something like, ‘Hey, Sarah, I heard that you’ve been going through a tough time lately and I know we haven’t been in touch. I still really care about you, I want the best for you, and I appreciate the friendship we had. I’m thinking about you.’ See where it goes from there. You can’t just assume that you can step right back in and save the day. Open the door, and see if they’re open to reestablishing the relationship and having your help.”

What If My Friend Never Recovers From Depression?

And nothing I do helps them get better?

Even if you do everything right, even if you follow all of these steps exactly, nothing is guaranteed to “work.” The silver lining is that anyone with a mood disorder has a better chance of recovering with a support system, rather than without one.

“It’s really important to take care of yourself because people may frustrate you by not seeking help,” Duckworth says. “Just remember that if they’re resisting your best efforts to love and support them, there may be reasons for that. It’s not your failure.”

“It certainly does not have to be the end of a friendship if you just learn how to be supportive, and you’re willing to help the person and they are open to it,” Cordero says. “There’s no reason why you can’t still be friends and still have a positive influence on each other’s lives.”

A year after learning my friend had tried to commit suicide, the one I lost touch with, I called her to apologize for letting our friendship fall apart. I told her I had felt depressed myself recently, and that it reminded me of how I felt on her phone calls ten years earlier. “Why didn’t you call me?” she asked. “I wish you had told me.”

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