Helping a Friend in Despair

Source: Youssef Naddam/Unsplash

The New York Times article that David Brooks wrote about the death of his close friend to suicide after a long battle with depression ("How Do You Serve a Friend in Despair?") was tremendously poignant but, unfortunately, gives those suffering from depression the dangerous misperception that depression is difficult if not impossible to treat and that the best a friend can do is hang in there with them.

Brooks doesn't say which treatments his friend tried to no avail. We have no idea if his friend stuck with a medication regimen long enough for it to take therapeutic effect, if psychotropic drugs were mixed and matched to achieve an optimal targeting of specific symptoms, or if he pursued an integrative approach that combines psychopharmacological, psychotherapeutic, social, spiritual, and body-mind modalities. Nor do we know if newer adjunct treatments, like Transcranial Magnetic Stimulation (TCM), Ketamine, or Electroconvulsive Therapy (ECT), were tried.

A misleading and hopeless message is a disservice.

It is true that for some people, it can take a bit of trial and error as well as persistence to find the right treatment formula. But to declare, as Brooks does, "how little the medical community knows about what will work" regarding the successful treatment of depression is a misleading message that promotes anxiety and hopelessness. No one suffering from depression should be dissuaded from seeking help. There is every reason to be confident that one can be successfully treated for depression, but you wouldn't know it from Brooks's noble but despairing piece.

The good news about depression.

Depression is a treatable illness. Psychopharmacologically, we have dozens of agents in a variety of categories: antidepressants, mood stabilizers, antipsychotics, sedative-hypnotics, anxiolytics, and psychostimulants, which can be mixed and matched to target specific symptoms with impressive results. Anxiety often accompanies depression, and that can—and should—be addressed to prevent a depressed patient from panicking and quitting treatment before it becomes effective. There are also excellent psychotherapeutic approaches, including Dialectical Behavior Therapy (DBT) and Cognitive Behavior Therapy (CBT), that can augment the effect of psychopharmacology, as well as alternative treatments, including Transcranial Magnetic Stimulation, Ketamine, Vagus Nerve Stimulation, and Electroconvulsive Therapy (which is much advanced from its infamous portrayal in One Flew Over the Cuckoo's Nest).

How to help your loved one

In answer to the question Brooks poses—"How to serve a friend in despair?"—I recommend becoming acquainted with the range of effective treatments for depression, helping your friend find them, and not letting them give up. Recognize that depressed thinking makes one feel nihilistic about treatment. That is the nature of the condition; it is not an objective or accurate evaluation. When your friend or relative feels hopeless, remind them that it is their depression "talking."

Help your loved one who is depressed find a healthcare professional who provides psychoeducation, reassurance, and a roadmap. Understanding the nature of depression, the possible treatment approaches, how they work, and how long they will take to become effective are essential ingredients in achieving a successful outcome. Knowing what to expect along the treatment route will relieve anxiety and prevent your loved one from panicking and stopping treatment before it becomes effective.

Depression can be contagious. It has a ripple effect on friends and family. Like Brooks, loved ones may become frustrated, despairing, and worried that their friend can't be helped. But no one should lose hope. The treatment of depression requires a trusting relationship with a healthcare professional with whom you can collaborate on a treatment plan, who prepares you for the road ahead, and who monitors your journey so they can help you over the speed bumps that may arise.

As Brooks discovered, when someone is in the midst of despair, they lack the energy or faith to follow the well-intentioned advice of loved ones. They don't respond to efforts made to lift their mood. But they do need to know that recovery from depression is attainable. Support your loved one by reminding them of that… over and over and over.