Nearly one in 25 American adults has serious mental illness, which means odds are someone in your life is coping with anxiety, depression, OCD, bipolar disorder or another debilitating condition. Still, shame about mental illness — likely a holdover from when people wrongly believed such conditions were character flaws or a mother’s fault — can make it hard to seek help or even know what to say to those who struggle. To shine a light on the daily realities of mental illness, Good Housekeeping and the National Alliance on Mental Illness (NAMI) surveyed more than 4,000 people, and found that over a third had a close friend or relative with mental illness. In our special package on how to support loved ones with mental illness, women who live with these widely misunderstood psychological issues share what it feels like, and how you can make a difference.
The word depression is often thrown around in everyday conversation, which makes sense — depression is one of the most ubiquitous mental health conditions, and it doesn't discriminate. According to the National Alliance on Mental Illness, more than 17 million adults in the United States (just about 7% of the population) have suffered through a depressive episode in the past year, including people of all ages, ethnicities, and socioeconomic backgrounds. That doesn't mean, of course, that every "I'm really depressed" you hear from a friend or family is cause for concern — the word has become synonymous with any feelings of sadness or inertia, which are completely normal (and unavoidable) if you're a human.
That said, because symptoms of clinical depression and a more ordinary case of the blues can sometimes be a matter of degree, it's common for well-meaning loved ones to dismiss the signs of depression as a mood that will pass on its own, says Judy Ho, Ph.D., a California-based clinical psychologist and an associate professor within Pepperdine University's Graduate School of Education and Psychology. The fact is, helping a someone suffering through a depressive episode can be quite tricky — and empathy and distraction are not enough.
That's why we asked women living with depression, as well as medical specialists and researchers, to help us understand what it feels like to be depressed, and to share what they wish people knew about what they're going through.
For Rachel, 55, from East Lyme, CT, she could tell when her feelings of sadness escalated into a suffocating sensation that overwhelmed her entire routine. At first, she sought help through a naturopath. "I told her, I feel so down and I don't know why. I have my family, my home, and I love my job. Still, I couldn't shake it off."
That last part — not being able to shake it off — is key: Depression is characterized by a persistent hopeless mood that affects appetite, sleep, energy levels, and can make it hard to focus or maintain interest in activities you once enjoyed, says Diana Samuel, M.D., an assistant professor of clinical psychiatry at the Columbia University Irving Medical Center. To be diagnosed with clinical depression and be recommended for treatment, a person normally has to show all five of these symptoms, Dr. Samuel explains. A doctor might also diagnose depression if you have fewer than five, but the symptoms you have last a really long time and affect your functioning on a day-to-day basis.
There are generally two kinds of clinical depression, Ho explains. "One is a very major depressive disorder, when people feel sad, have no motivation, have low self-esteem that's very severe, and may be considering taking their own life," she says. Another person may have low-grade depressive symptoms that last a really long time, otherwise known as dysthymia. They feel sad or have no energy, aren't motivated or interested, but this kind of depression doesn't come with suicidal ideation or more severe tendencies. Unfortunately, the same person can have both types. "In between severe episodes, some can have the milder form of depression that can be long lasting if left untreated," adds Ho.
If you're thinking about suicide or are worried about a friend or loved one, call the National Suicide Prevention Lifeline at 1-800-273-8255.
Rachel says she struggled with depression for almost two years before she was diagnosed. "It's almost like I was down a hole, or down a well, and I wasn't able to climb up," she shares. "You can't turn those feelings off." Doing yoga, exercising, and gardening gave her a little temporary relief, but the depression would wash over her afterwards, for which she'd blame herself. "I didn't feel the joy and the natural good feeling you get when you love something. It was scary. I thought there was something wrong with me," Rachel says, explaining that she believed she was somehow choosing to feel bad.
Angie, 22, from Los Angeles, CA, says that her depression can color everything. "On bad days, sometimes, it feels like there's a cloudiness — this haziness throughout the day. Usually it can be things are going well or I'm going about my normal routine, but for some reason it's harder to focus.
"It's not that I don't want to — I just can't. It can mean getting very stuck on one thing, which sometimes can cause me to be immobile. If I wake up and feel depressed, getting ready for work (which normally took 30 minutes) takes an hour and a half."
Rachel and Angie both sought out therapists, and Angie was also on an antidepressant for a time, which helped her get a leg up. "I've been pretty good, but I do still attend therapy regularly," Angie says. "I try to do my best to know my weak periods. It comes and goes in certain seasons."
Therapy is the backbone of treatment for depression, Ho says, specifically cognitive behavior therapy (CBT), often paired with medication. The combination of the two have been shown to be more effective than either alone, Dr. Samuel adds, citing evidence from a 2014 World Psychiatry analysis.
Psychologists mainly focus on a form of CBT treatment known as behavioral activation, which helps patients increase their engagement in activities that may temporarily improve their mood. Ho says this helps them avoid the negativity that may snowball into bouts of depression.
Being around other people (even if they don't feel like it) also helps, says Ho. "Anybody who has ever cared for someone who is facing depression knows that sometimes, depressed people will actually push their loved ones away," Ho explains. "Behavior activation allows them to identify which kinds of activities leads to pleasant emotions, and it helps them get through depressive episodes to get connected with loved ones again."
It can take between three and six months of therapy for someone to move through depressive symptoms, but the person may feel some immediate relief as they begin to learn their first few coping mechanisms in therapy, Ho adds. "Research has shown that people can improve their symptoms within 8 to 12 weeks with appropriate help," she says. If medication is an option, patients may see relief as soon as 14 days after first treatment, according to the National Institute of Mental Health.
Patience is key, though, as Dr. Samuel stresses that people's needs change, and what works today might not work next month. "In some people, the first medication might not provide complete relief of their symptoms, and they might need to try another medication or a combination of medications to feel better," she explains. "It is also important to have realistic expectations, and know that treatment might need adjusting along the way."
If you know someone who is fighting depression, there are lots of things you can do to help:
- Help them research convenient treatment providers: Depression often saps motivation, Ho explains, which makes it hard to be proactive in finding help. Rachel's sister-in-law and her good friend both respectfully pushed her to consider therapy, for which she is grateful. Gently providing your friend or family member contact information or details about a nearby program might empower them to actually pick up the phone.
- Listen proactively: When someone tells you what's going on with them, summarize what you're hearing in a neutral, nonjudgmental way, which will help them feel heard, Dr. Samuel says. For example, if they were to say, "I feel like nothing really matters that much," you could reply, "It sounds like you're saying you're not energized to care about anything right now." And ask questions, suggests Dr. Samuel. "For example, if they are saying, 'I can't get out of bed in the morning,' they might be saying three different things. Maybe they don't have the physical energy to get up right now; maybe they didn't sleep well the night before; or they may be saying that they don't want to face their life or the world considering how they are feeling right now," she says. Knowing where the person is coming from will help you connect with them.
- Keep their confidence: Even if you really want your friend to get more social support from others, don't share what they're going through until you've asked for permission to loop someone else in, says Rachel. She explains that she has felt comfortable discussing her condition with family members and very close friends, but she would prefer to be the one to broach her health with colleagues or acquaintances. Just because you've discussed it previously doesn't mean it's okay to bring it up in casual settings, Rachel says. That said, you should always feel comfortable seeking professional medical help if you believe someone is a risk to themselves or others.
- Don't blame the person struggling: Angie says many people don't understand that depression isn't a choice — and that they can use hurtful language implying they should just snap out of it. With depression, that's not possible. "When someone tries to say, 'You're choosing to be sad' or 'You can just be happy, just be positive,' I think that's unhelpful because I consider myself to be a very positive person," she says. "I feel like that invalidates me." Depression is a medical condition that requires treatment — not a personal failure.
- Try not to take things personally: "People who are depressed may push people away with the way they act," says Dr. Ho. Irritability, for instance, is a common symptom. You don't need to be a doormat, but bear in mind that it's probably the depression coloring their behavior. "Try your best to move past this and support them in getting help: Don't abandon them entirely."
- Keep your mind open. You may not know the whole story. "Someone with severe depression can still be going to work, completing day-to-day tasks and appearing to be managing from the outside, but they might be suffering and in significant distress internally," Dr. Samuel says. Frequently check in on them if you can: Casual text messages throughout the day, or set up a routine where they can normally expect your call. "Just make sure they don't feel like they're alone for too long, as depression can manifest with hopelessness and being alone, it can be easy to feel hopeless," Ho adds.
The COVID-19 crisis has made life more challenging for everyone—especially those who are struggling with a mental illness. Visit NAMI’s COVID-19 Resource and Information Guide for additional advice. For more info on depression, visit the Anxiety and Depression Association of America.
Additional reporting by Lambeth Hochwald