Dear Alice,

I am actually asking for a friend of mine since this situation is getting worse, and I don't know how to help. The problem is that my friend is very depressed, and has very, very low self-esteem. While sometimes able to be cheerful and "happy," he claims to rarely feel that way and mostly just hates himself. He has mentioned suicide, although I think this is more an expression of the extreme self-hatred he feels than anything. I comfort him and often tell him how wonderful he is — what a good person, good qualities, etc., but I suspect he does not believe me at all. This has been going on for a long time now, and I think it stems from a somewhat unhappy childhood and adolescence. I don't know how to help him and I don't know what to do. I feel like being strong for him is just not enough, and I can't quite convince him that counseling may do some good. It seems to me that, recently, he has been feeling even worse about himself, to the point where nothing will comfort him. He cannot afford counseling, and he has no health insurance. Is there anything you can suggest for me to tell him or suggest to him? Any help will be greatly appreciated, because I just don't how to help him. Thank you so much.

— A friend on-the-line

Dear A friend on-the-line,

Your friend is lucky to have such a caring pal in you. Sometimes though, even super friends like yourself need to reach out for more information and assistance in helping a buddy — so kudos to you on that front. Getting back to your friend: everyone feels "blue" at certain times during their lives. In fact, feelings of sadness or discouragement are perfectly normal, especially during particularly difficult times. However, there’s a difference between being bummed and suffering from depression. Folks experience depression in different ways, but certain signs may be a red flag that a person is dealing with more than just low-spirits. By learning more about how to recognize the signs of depression and where to find additional resources for help, you can continue to support your downtrodden comrade.   

Before talking more about the signs of depression, it’s crucial to talk about how to handle disclosures of suicidal thoughts. Though you may think that your pal is really just down, make sure to take any talk of killing oneself seriously. If you notice any other warning signs, reach out for help immediately. You can do this by calling the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or by calling 911 if there’s an immediate emergency. Contacting your friend’s family or a health care provider could be a good idea as well.

With that said, it sounds like you’ve noticed that your friend is having a hard time right now. While you say that your pal is very depressed, keep in mind that depression can only be diagnosed by a mental health or health care provider. Depression is a real illness and no two people living with depression experience it the same way. But, there are some signs and symptoms to look out for that are commonly associated with a depressive episode (though not all features are present in every episode or for every person):

  • Feelings of sadness, tearfulness, emptiness, or hopelessness
  • Angry outbursts, irritability, or frustration, even over small matters
  • Loss of interest or pleasure in most or all normal activities
  • Sleep disturbances, including insomnia or sleeping too much
  • Tiredness and lack of energy, so even small tasks take extra effort
  • Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people
  • Anxiety, agitation, or restlessness
  • Slowed thinking, speaking, or body movements
  • Feelings of worthlessness or guilt, fixating on past failures
  • Trouble thinking, concentrating, making decisions, and remembering things
  • Unexplained physical problems, such as back pain or headaches
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts, or suicide

List adapted from Mayo Clinic.

If you’ve observed any (or all) of these features in your friend, he may really benefit from getting help. Depression is treatable and many find that talk therapy, medication, or a combination of treatments, do wonders to help them feel more like themselves.

It sounds like you’ve talked to your friend about seeking out counseling, but he hasn’t seemed interested in it. Have you talked to him about the reason(s) why? Is it because he doesn’t know what to expect? If he’s open to it, you could offer to go with him to a counselor's office or perhaps you could just sit with him while calling a help-line. Or, could it be that the ability to pay for counseling is holding him back? In that case, there are a number of resources out there to help folks looking for affordable counseling. The Go Ask Alice! Q&A Finding low-cost counseling outlines a few options to check out.

Ultimately, it’s good to remember that it’s up to your friend to make a change. It sounds like you’ve been a great source of support to your pal so far, even if it doesn’t always feel like you’re being heard. And, as much as you want to help, there’s only so much a friend can do. Seeking out additional assistance is totally okay and it may be time to involve other people (such as a member of your friend's family or a mutual friend) if you feel like your friend is not heeding your concerns. You might also consider speaking with a counselor yourself to relieve any anxiety you may be feeling and to talk further about how you might help your friend. 

Best of luck as you continue to support your bud — just make sure to take some time for some self-care in the process.

Alice!

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