Depression - How do you tell someone that you think they need help?

The story is a pretty simple one.

I'm living with my girlfriend. This is the real thing, we've discussed marriage and starting a family. But the last few months have been pretty tough. We are both late twenties (28 + 29) and pretty set in out ways, so we expected some of our habits to cause issues as we learned to fit together.

But the clashes have been a lot worse than expected. She used to be very carefree and happy. But she has been suffering with mood swings, inconsistent appetite and sleeping and all sorts of issues.

I have nearly packed my bags and moved out twice, even making plans to move to another city, but I'm determined to make this work.

Besides our moving in together she has had her support network of friends disintegrate, a huge fight with her mother and grandmother, her father moved away, her brothers are in trouble due to drinking and drugs and she has a new job with a lot of extra unexpected stress.

So it isn't surprising that she isn't herself. What really worries me is that she keeps saying she needs time in her bubble before she can think about trying to move on from our most recent fight. But I worry that she is pushing herself into a dark place.

I have had a few friends with depression, so I'm shocked that I didn't consider the possibility until one of them said that my girlfriend sounds exactly like this she did before she started going to therapy.

But I'm not sure how to bring it up. We are barely speaking at the moment. Well, I speak but she doesn't.speak to me, except that she doesn't know what to say.

I think the best strategy may be to sit her down, gently go through the issues in her life, and suggest that these may be driving her to depression.

I'm not sure if anyone else would have a better suggestion, but I'm really worried about the love of my life and I don't know what to do. I'm open to suggestions.

Apologies for any incoherence, I've typed this in a bit of a rush.

I would recommend talking with other people who are important in her life. This will help you determine if this is really a problem with her or if it might be a problem with your own perception. It is often difficult to know when you are so intrinsically involved yourself. Be open to that possibility because the next step is drastic.

If they see the same change in her and think it is serious enough that something ought to be done, consider an intervention. I know that sounds harsh, but depression is a very serious thing and can have extraordinarily negative impact on one's life. It is often difficult for the individual to seek help when they have lost the perspective one can only have from the outside of depression and it is really up to others that care to provide that perspective for them.

Follow the rules though and seek the guidance of a professional before doing it. Nothing sabotages an effort as much as well-intentioned, but overly personal interventions. Concentrate on affirming that you all love her, really want her to be happy and productive, and would like to have the person you fell in love with back.

Good points Paleo.

The problem though is that she doesn't speak to many of her other friends and family. The only nearby family member is a sister who is totally self-absorbed. The rest of The family is far away and she puts on a very effective mask with her remaining friends.

I think I'm in this on my own.

It's hard to say, some people don't think they have a problem or get used to it and accept it. When they are confronted about it, they might say "it's hard to explain" (hard=painful). As a person/walking time bomb who is under treatment and diagnosed, it was always difficult for me to ask for help when I needed it. In my case, it was pointed out that it's affecting other people, and has in the past, and it's even pushed friends away without knowing it. It was more destructive than I thought, and I did tons of damage to almost everything I touched.

Anyhow it may be difficult for her to ask for help or accept the fact she needs help, I hope you guys can get things rolling in the right direction. There are mental health offices in many towns, maybe you can set an appointment for yourself and talk to a therapist about your girlfriend, ask the proper way to approach a person about their mental health and/or how it's affecting your mental health. They deal with people who don't think they have problems all the time, they could have the right advice for you in your situation.

.. Zoloft.. it's what's for dinner.

I'd start out by researching depression. Look at what it actually is, and be ready with that knowledge. There's still a pretty big stigma attached to it for many people, as they view it as a thing that can be overcome by willpower, rather than the chemical medical condition that it is.

In successfully dealing with a similar situation in the past, I'd recommend learning about the symptoms and treatments, being very very patient, and respecting the fact that ultimately, there's nothing you can do for someone until they want to help them self. All you can really do is give them information and try and show them how their depression is effecting themselves and those around them. It can be tough, because part of being depressed includes the sort of feelings and emotions that keep a person from seeking help, or feeling like there's a way out.

I wish you the best of luck. Dealing with a depressed partner can be very trying, and can be a life long struggle. I can say with certainty that things can improve, but it will take strength and patience for both of you.

MaxShrek makes some very good points. I was in the same boat as him for a good portion of my life. I never realized I had such a problem until all the relationships in my life started falling apart. One of my friends just made a casual suggestion one day. It got the gears in my head turning. Possibly "greasing the skids" isn't a bad way to go.

MaxShrek wrote:

There are mental health offices in many towns, maybe you can set an appointment for yourself and talk to a therapist about your girlfriend, ask the proper way to approach a person about their mental health and/or how it's affecting your mental health. They deal with people who don't think they have problems all the time, they could have the right advice for you in your situation.

This is a great idea IMHO

Dammit. Just wrote up a huge post and got auto-logged out. Let me see how much I can remember.

This is something I wrote up 5 years ago after I was first diagnosed with chronic clinical depression. At the time I wrote it I found it useful to get it off my chest and in the intervening years I've found it's been invaluable in helping my friends understand what I've been going through, and as a result helping me to understand how I'd been affecting them. I'm now in a place where I'm managing the symptoms day to day and, even in the middle of a major depressive episode at the moment, I can hold it together.

Anyway - here's a letter from the me of 5 years ago:

--------

Depression seems to be one of those things that even if people don't want to sweep it under the mat, they certainly don't know how to deal with it. When a friend is depressed, you might try a lot of things to cheer them up, and when you can't, or if they're unresponsive to it, you may feel bad about that and you may blame them for not trying. I've had that a lot.

Lesson one: people suffering from depression aren't just sad, or in a bad mood. They're incapable of feeling happy. You can't cheer up a depressed person any more than you can cure someone's dysentery by feeding them a meal.

Things I've found that can help:

Let them know you get what they're dealing with, that you can't know exactly how they feel but you know that it's hurting them. It wasn't until I starting talking about this stuff that I discovered how many people suffer or have suffered from this. It really does make you feel like you're alone.

Reinforce good things about them, let them know they're valued. Depressed people judge themselves harshly and find it hard to think of good things about themselves; the depression steers your thoughts away from happy memories and good self esteem until you're left with all the worst things. Reminding your friend they're not worthless like they think they are helps stop them spiraling down.

Encourage them to do things. One of the symptoms of depression is an inability to get things done to help yourself, mostly through fear and anxiety. I even have trouble getting to the shops to buy milk when I'm in the grip of the Marvins, much less socialize and be the life of the party. Gentle nudges to go out and do things that aren't stressful, like meet up for a meal or catch a movie help people get over that fear hurdle, and they'll feel better for doing something.
Don't pressure them into it, they'll feel worse. Just put the offer on the table and say you'd like them to come along. They have to get up and do it themselves, ultimately, but the encouragement helps a lot.

Don't blame yourself. It's highly unlikely it's anything you've done that's triggered it. Look after yourself, don't get dragged down with them. It's not your job to drag someone out of depression, it's something they have to do for themselves. Let them know you'll always be around to help, that you're not going to abandon them, and that you'll give them all the support they need. You can prop them up, you can stop them falling, but you can't carry them.

--------

Shortly after I wrote that I met the woman who has since become my wife. I was in the middle of an episode when I met her and we've lived through several in between but are still happily together.

A few thoughts as relate to your situation:

Firstly, I'd avoid suggesting there has been anything that has "driven" her to depression. Most people understand there are things that make you depressed but in the case of serious depression it's more than likely not something obvious and on the surface. Stresses in your life can push you into a situation where you can't cope but there's almost always something else underneath that makes you unable to cope with those stresses. Therapy can help unravel what it is causing you pain; in my case, being able to identify my own psychological weak points has been invaluable in dealing with my own depression. In some cases it comes down to plain old unlucky brain chemistry. In my case it's a bit of both.

Secondly, be prepared for the fact she will probably not be happy or grateful to be confronted with the idea she's suffering depression; even if she suspects it herself. Facing up to depression is hard. Really hard. The brain seems to me to be hard-wired to go looking for external causes for interior pain. It's why depressives are so good at hurting themselves and pushing away those around them: you want to find a simple explanation for the pain you're feeling. I've had several long-term relationships in the past where my partner had suggested I seek help for depression and I'd reacted aggressively. To admit it's depression you're suffering from is to put yourself at the bottom of a very long, steep hill, and you fervently believe there's no way you're ever going to climb it.

In your case I would make it clear to your girlfriend that you see how much she's hurting and let her know you want to help. Don't tell her what's going on, offer to help find out. Don't find the solution for her, assist her in finding it for herself. And don't expect her to jump straight into fixing the problem - depression's sickest trick is that it makes you believe you can't achieve anything, least of all overcoming it.

Max's idea is a great one and I cannot recommend enough getting professional help where you can.

Not sure what else to add, but if you want to ask me anything offline feel free to send me a PM.

Be patient, look after your girlfriend, but above all look after yourself.

Good luck.

she puts on a very effective mask with her remaining friends.

You'll be hard-pressed to find someone suffering from a depression who doesn't know how to put up a mask. Being unable to reach out is usually a big part of the problem. When my best friend told me about his depression seven years ago I was flabbergasted.

This doesn't mean you're on your own though.

Depression is extremely difficult to deal with. I've dealt with it in my own family. The best thing you can do is be patient, and understand that when a person is in a depressive phase, they may be incapable of seeking help.

I strongly urge you to read The Noonday Demon. It provides some profound insights into depression.

My advice...

The more you try to "fix" someone's mental illness the worse you will make it.

Have you considered couples counseling? Since the ultimate goal is to fix your relationship then you might simply stick to that for the time being. If you can find a good counselor they should be able to determine whether or not she is suffering from depression or if this really is just a problem between the two of you.

Kehama wrote:

Have you considered couples counseling? Since the ultimate goal is to fix your relationship then you might simply stick to that for the time being. If you can find a good counselor they should be able to determine whether or not she is suffering from depression or if this really is just a problem between the two of you.

While there is a lot of good advice so far, this one seems really great.

As Maq points out, it's risky to jump someone and say, 'you're depressed, get in therapy' but a counselor can assess the situation and make the recommendation without fear of backlash. Or hell, maybe there is another problem and it isn't depression.

Thanks for the advice so far folks, keep it coming. And I will try get hold of some form of professional help.

Maq's words are great.

My wife went through a multi-year phase of depression when we moved to the UK. It was rough as all hell, and stands out as the least happy time of my life, by a country mile.

I can't remember how we got to the point of her going to see a doctor about it, but that was when things started to improve. If nothing else, having an authority figure validate how she was feeling was the first step for her, and then having a treatment plan went a long towards alleviating the feeling of helplessness and lack of a way to move past it that we were both sufferring from.

She tried a few different meds before finding one that both helped with the depression and anxiety and also didn't turn her into a zombie. Took a couple of years of meds, a move to a much cooler city in the UK, and ultimately moving back to the US for it to go away. Translated, it was a case of fixing the things that were making her depressed, most of which were related to us living in the armpit of England with very little social network aside from each other.

The recurrence of it is still something I worry about from time to time, it's really a place I don't want to go back to. The silver lining is that I'm far more self-aware about our quality of life, mainly to ensure it stays good to avoid another slide back into depression.

Let me just mod some of the suggestions and note that sometimes it's better to have a friend approach the person. Because you are really emotionally tied together, doing it yourself could carry excess baggage. A friend might be able to plant the seed without your being the source, necessarily.

It could still blow up six different ways, but sometimes the baggage is piled so high you yourself can't walk around it. Find someone she trusts and talk to them, see what they think. Note that it might not be depression as such; anxiety has overlapping symptoms. Both can be carried at a functional baseline until things blow up, and then the person starts to fall apart from the stress. Don't assume it's depression.

In fact, that's a good start - maybe treat it as "honey, you seem really [stressed/anxious] lately, I know I am. Maybe we could talk to someone together, see if they have any insights into all this stuff that's gone on? Because if I keep on like this I'm going to fall apart. Would you keep me company when I go?" Something like that. If you involve yourself and let her know you are affected too, maybe that will make it easier for her to accept help from a doctor.

Get your GP or a very respected friend to recommend a good psychiatrist or psychologist.

As a person who at one point was depressed -and at another point had a depressed girlfriend- I know how difficult this can be. There's some great advice posted here (Kehama; Jonman; Robear), all of it centered on getting a professional involved, and I'd echo that.

Also, to build on something Jonman said; for me, depression was an opportunity to realize that some parts of my life were unhealthy and out-of-balance. I didn't live in England's armpit, but I had disconnected myself from my social network during what was already a difficult time. Thinking of it as a normal reaction to a bad life-situation had helped me move past some of the stigma baggage, and if that's a concern of yours, maybe that can help.

-Here's wishing you the best.

dejanzie wrote:
she puts on a very effective mask with her remaining friends.

You'll be hard-pressed to find someone suffering from a depression who doesn't know how to put up a mask. Being unable to reach out is usually a big part of the problem. When my best friend told me about his depression seven years ago I was flabbergasted.

dejanzie speaks the truth. I managed to hide my depression from everyone around me for nearly 15 years: family, friends, co-workers, etc. I'd fabricate entire stories about what I did over the weekend rather than admit that I spent it on my couch with the curtains drawn shut.

It took a very good friend of mine to finally get me to admit that I needed to ask for help. And she got me to that point only after gently (and lovingly) nagging me for months. Depression makes you unable to help yourself, partially because you can't see outside of the mental hole you're in and partially because, deep down, you don't feel you're worthy of getting help, of getting better.

I'd encourage you to help her re-connect with her friends, even if you have get in touch with them and ask them to call or email her. That personal contact with people who care about you helps a great deal in working through the dark times, even if it just makes you put on that mask for a period of time.

The suggestions to get her to her doctor are spot on. The stigma of depression, like any mental disease, is strong. I purposefully didn't talk to my doctor about what I was going through for years because of embarrassment and then over an irrational fear that drugs would somehow make me, well, not me.

All of those concerns I had were completely overblown. It really helped to understand that depression wasn't a judgment against me as a person or a result of some deep flaw in my character, but a medical condition. A treatable chemical imbalance.

Getting medicated (go Lexapro!) has really helped me crawl out of the hole that I was in. Now I'm moving on to the talking doctor portion of my treatment, dealing with the issues that would trigger the deep depressive bouts and deal with the things that I don't like about myself and my behavior. Some of that was coping mechanism that I developed over years that I now have to unlearn.

Have patience with her, but don't let up on the encouraging her to talk to a medical professional about what she's going through.

Robear wrote:

Good stuff

I don't have much (any?) experience with depression, but my experience of getting into arguments with girlfriends tells me Robear has a good point here. It's probably obvious, but be very careful about how you approach this. About here:

MrDeVil909 wrote:

I think the best strategy may be to sit her down, gently go through the issues in her life, and suggest that these may be driving her to depression.

I could almost hear a woman's voice saying "Oh, so now I'm crazy, am I? Well isn't it great that I have you around so I know what's wrong with me!".

That said, I do have a tendency to be a patronising jackass, so you may be better at heading off that sort of thing than I am. Good luck, anyway! It's a tough situation.

Finger -> Butt

MrDeVil909 wrote:

I'm really worried about the love of my life and I don't know what to do. I'm open to suggestions.

This is a very good line to open up with. I'd use it.

Like Paleo said, I wouldn't plan a big, scripted intervention with her though. She may not be able to handle much right now and that might just overwhelm her and shut her down.

I'd just kind of gradually introduce things, perhaps even taking a few days of gently rehashing a point to get it to sink in before progressing to the next step:

1. Remind her how much you love her and are committed to her.
2. Admit that you're very worried about her.
3. Tell her you're not sure what to do and ask for suggestions.
4. Start subtly making suggestions of your own. Suggesting couples therapy is a good first move, because that places the burden on both of you and not just her. Then you can move on to suggesting individual therapy or medications for her.

Repeat step 1 liberally of course.

Whenever I felt really bad, something that did help push me was the part in that silly Good Will Hunting movie where Sean keeps repeating to Will that "it's not your fault".

Along with the advice above, I would like to add that you should encourage her to do something physical like take a walk. The endorphins can help to make her feel a little less.... bleah. Also, try to encourage her to reconnect to something, i always felt that was too afraid or apathetic to do anything, which led me to keep my self "safe" in my own apartment. Does she like sports or some other activity? Something that she can do while feeling safe? If there is something she always wanted to do but didn't feel like she had the time, try that....

Also, keep away from the "Im so sad I wanna blow my own head off music"... nothing like mood music to reinforce a bad mood. I did this waaaaay too much

Strange, the mood music always calmed me. Well, except for that one special song. That song destroyed me for a few days several years ago, especially the line "first time I'd seen him smile in years". It's a beautiful song though.

Thank you so much for making this post, as I am also in your shoes. Thanks for the contributions everyone has made to this conversation so far, as well. Lots of good advice here to take into consideration.

Ego Man wrote:

Also, keep away from the "Im so sad I wanna blow my own head off music"... nothing like mood music to reinforce a bad mood. I did this waaaaay too much

I know what you mean. The temptation to go wallowing in self pity is so overwhelming sometimes I have to remind myself not to do it. Reminds me of John Nash in the film of A Beautiful Mind where he says his mind has too much of a fondness for patterns and he must be careful not to indulge them.

For me the biggest thing has been making myself aware that depression passes. It can be managed, it can be lived through, and you will come out the other side. When it comes now I treat it like I would any other illness: I do what it takes to manage the symptoms (light therapy, healthy diet, and exercise alleviates the worst of it for me), and make sure I give myself a chance to recover from it. I avoid unnecessary stress, put off major life changing things for a little while, and cut myself some slack. I still feel the symptoms of it, but the knowledge that I've beaten it before arms me with the confidence not to slip into despair.

I vote you go with the couples counseling suggestion. She will know you want to help her through this, not just "fix" her.

Does she want help?

Does she think she has a problem?

Is she, even reluctantly, able to consider the probability that the reason she has lost her friend and family are due to her own behavior?

You can't help someone that won't admit that they have a problem.

I hate to say it, but you're 29. If she won't accept help or seek it out, you need to move on with your life otherwise before you know it you'll be 40 and so wrapped up with caring for her and treating her gingerly, your best years are in the rear view mirror.

You also have to consider that if she can get this depressed when she essentially has little responsibility (sharing the bills with you, etc.), how would she react with a kid? Let me tell you something, my wife and I have a very strong relationship, communicate extremely well, and almost never fought. My wife is a very strong independent woman with a successful executive career. I'm 35, she's 33. We just had a child 4 months ago and it's been more difficult than I could ever have imagined. My wife had a short but fierce bout with postpartum depression. Caring for a small child and a wife who was pregnant was the toughest thing I've ever done in my life. Do you really think that she would be able to handle it? Could she deal with the added stress from the inevitable drop in self-esteem pregnant women get as a result of their expanding figure? Can you afford to possibly wait 4+ years or however long it would take to "get her mind right" should she even be willing to enter therapy in the first place? Then there's the scientific reality that a severely depressed mother who is pregnant can absolutely affect the fetus's health and development, even if the mother outwardly seems happy but is facing extreme inner turmoil.

I know as guys we tend to think short-term but I'm going a little against the grain here and advising you to think of the big picture and how this all factors into the life you envision for yourself. Because there is a distinct possibility that this could severely affect your plans to have a family.

FSeven wrote:

you'll be 40 and so wrapped up with caring for her and treating her gingerly, your best years are in the rear view mirror.

Best years? Please.

FSeven wrote:

Could she deal with the added stress from the inevitable drop in self-esteem pregnant women get as a result of their expanding figure?

This is not inevitable, in fact, some women feel a great deal of superiority when functioning as a vessel of new life.

Maybe she just doesn't want to move together and get married and stuff, and she's hiding it by becoming depressed and unattractive =P

I've been on the other end of things, having dealt with anxiety and depression for the last 7 years. I can say a couple things to this.

- It gets better. It does. If your SO goes into treatment, eventually she'll get better. Talk therapy works for some. Medicine works for some. But being depressed and anxious and having someone to talk to helps. It really does.

- On that note, you can start off by being that person for her. You say she isn't speaking to you, but what are you saying to her? My wife absolutely had the best approach with me. She talked to me in a way that reassured me she wasn't going anywhere. That she wasn't panicking. She would just ask me how I was doing, how I was feeling. "Are you okay with this?" if it was something I had anxiety about. She was very gentle and loving and amazing.

If possible, I think you need to try to become her biggest advocate. Not to "fix" her, but just to make RIGHT NOW better. If you can help make RIGHT NOW better, then all those right nows will eventually stack up and she'll see things more clearly and start to feel better. The worst thing you can do is to push her into therapy or medical treatment. You guys need to hunker down together as a team and take care of each other. It means you may have to live in her dark mood for a while. This is the price for loving someone who has depression, unfortunately. But if you do this, I promise you that eventually she'll open up. Eventually she'll start talking to her friends and family.

- Take care of yourself. My wife and I recently saw the musical "Next To Normal" when in New York. It's about Mental Illness and it's excellent. My wife cried and cried and cried. She felt at many points as if there wasn't oxygen in the room for her. As if we focused on me too much. She was right. She still has pain from this period of time. So I would say you should make sure to take care of yourself as well. That way when you're hunkered down in these dark places you don't grow to resent her or suffer yourself.

SillyRabbit wrote:
FSeven wrote:

you'll be 40 and so wrapped up with caring for her and treating her gingerly, your best years are in the rear view mirror.

Best years? Please.

No kidding. The best days of your life are the ones where you are happy, enjoy life and are surrounded by companionship. My 20s were a total waste. I don't regret it. The training wheels were on then. Now they're off and my 30s have been great and I'm excited for my 40s. Right now is all that matters.

MaxShrek wrote:

.. Zoloft.. it's what's for dinner.

"Next To Normal" has this funny line: "Valium is my favorite color." People with mental illness who have taken 4+ different medications, many at once, usually find that really funny. They all come in their own colors/shapes.

I've had the blues, greens, and yellows.