Friend is depressed—How to help?

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, 

It's great that you're taking an interest in supporting a friend in need. Feelings of sadness or discouragement are perfectly normal, especially during difficult times in people's lives. However, there’s a difference between being down and living with depression. Certain signs may indicate that a person is dealing with more than just low spirits. You also state that your friend has mentioned suicide. As someone who cares about this person, it can be critical to address this directly. Often helping in your role as a friend involves some of the strategies you’ve already described: recognizing signs of depression, responding to a friend in crisis, and making referrals to resources that can provide more support. However, if you begin to feel overwhelmed or like you could use support when addressing your friend, consider seeking assistance from a mental health professional or a trusted friend or family member of your friend to help you through the process. 

Before talking more about the signs of depression, it might be important to first talk about how to handle disclosures of suicidal thoughts. Though you may think that your friend’s really just down, it’s vital to take any talk of a friend disclosing they wish to end their life seriously. If you hear a person talk about suicide or if you notice any other warning signs, you may consider asking them directly “Have you thought about ending your life?” or “Do you have any plans to end your life?”. Getting clarity on what they’re communicating to you is key so that you’re not guessing what their intentions are. If you believe they're at immediate risk for self-harm, staying with your friend (if it's safe for you to do so) and reaching out for help are advised. You may want to call the National Suicide Prevention Lifeline at 988 or calling 911 if there’s an immediate emergency. 

With that said, it sounds like you’ve noticed that your friend is having a hard time right now. While you say that your friend is very depressed, keep in mind that depression can only be diagnosed by a mental health professional or health care provider. However, 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 
  • Anxiety, agitation, or restlessness 
  • Increased feelings of worthlessness or guilt, fixating on past failures 
  • Loss of interest in daily activities 
  • Sleep disturbances including sleeping too much or too little 
  • Fatigue 
  • Changes in appetite 
  • Trouble with concentrating, memory, and making decisions 
  • Physical problems like 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 symptoms in your friend, he may benefit from getting help. Depression is treatable and he may find that talk therapy, medication, or a combination of treatments may support him in feeling more like himself. 

With this knowledge in mind, you may decide to have another conversation with your friend, approaching your next chat from a slightly different angle. As a friend who has noticed a concerning pattern, you might want to think about how you’d like to discuss your concerns with your friend. First, you may start by finding a time and space to talk that maximizes privacy and comfort and minimizes disruptions for both of you. When you find time to talk, let your friend know you care about him and that you’re coming from a place of concern because you value your friendship. This may help reassure your friend that you’re on his side and want to be helpful. 

Next, you might discuss the pattern of what your friend has shared with you and what you have observed him do or say. Reflecting on what you have directly experienced that has been cause for concern. You may spend some time considering what that means to you—is it that it’s caused you to be worried about your friend? In what ways has this affected your relationship with him? Then, you may ask your friend if he understands where you’re coming from with what you shared. This may help you both get on the same page. You may not be sure how he’ll react to what you've shared, but considering how you might respond if he agrees or disagrees may be a part of your preparation. 

If your friend agrees with what you’ve shared, you might ask him if he’d like support with finding help. If he does, it’s key to be ready with some resources to share. You mention that your friend can’t afford counseling and doesn’t have health insurance. Perhaps there are low or no-cost mental health services in your community. Another option is checking out a site like Psychology Today, which could help him find a mental health professional that accommodates no coverage. You might also think about what other ways you can support him in his decision. If he’s open to it, and you’re comfortable, you might offer to go with him to a mental health professional’s office or perhaps you could just sit with him while calling a helpline. It’s key to think creatively, but it’s just as critical to let your friend guide any course of action. 

If your friend responds that he doesn’t want to do anything about it or if he doesn’t agree with your observations, being supportive often means respecting his decision. The choice to address (or not address) what he’s experiencing must be left up to him. However, if he isn’t ready to address it now, one positive takeaway is that he’ll likely have a better idea of who he may reach out to in the future if he does decide to take action—you! 

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 friend 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. In fact, it may be time to involve other people, such as a member of your friend's family, or a mutual friend. It may be particularly helpful if you feel like he isn't heeding your concerns, or you feel that he’s at serious risk of harming himself. No matter what happens or how the conversation goes, it’s key to make sure your needs are also met in the process. You might also consider speaking with a mental health professional yourself to address how you may be feeling and to talk further about how you might help your friend. 

Best of luck, 

Last updated Sep 08, 2023
Originally published May 01, 1994

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