In the wake of Kate Spade and Anthony Bourdain’s recent suicides, the New York Times published a piece with the headline, “What to Do When a Loved One Is Severely Depressed.” The writer, Heather Murphy, noticed that the people commenting on these stories were struggling with the same question: “What do you do when a friend is depressed for such a long time that you’ve started to feel that nothing you can do will make a difference, and your empathy reserves are tapped out?”

Here is a difficult truth: If your loved one has not yet come to terms with accepting help from a professional, there is very little you can do for their sickness.

But I phrased that carefully for a reason. There is very little you can do for their sickness. There is plenty you can do for them — without exhausting yourself. The Times story leads with one of the most effective options: “Don’t underestimate the power of showing up.”

One of the great blessings in my life is my roommate. She doesn’t have depression, but for some wonderful reason, she understands how it warps people, and she has incredible depths of gentleness, understanding, and compassion — three things depressed people can rarely offer themselves.  I never feel judged by her, even when it’s been days since I’ve left my bed.

During a recent dark period, she came into my room and asked how I was doing. I mumbled that I wasn’t great, but said I’d be fine. She sat on my bed and asked if there was anything she could help with. I started describing all the things that were overwhelming me. I started to cry. I felt helpless. I hated myself. None of the things I had to do were that difficult, objectively, but when I thought about doing them, I felt like I was made of lead. At one point I said something about how messy my room was; how it was making me feel so bad and like I couldn’t do anything.

She brightened. “What if we clean it together, tonight?” she asked. I felt so silly for how much hope that gave me. I asked if she was sure she didn’t mind and she assured me she was, and said having a messy room made her feel overwhelmed, too. I nervously admitted that  I didn’t know where to start. “Your desk,” she said immediately, her brain unencumbered by the mud of depression.

I ended up doing most of the cleaning and organizing myself while she sat on my bed. At one point, she said she felt like she wasn’t really helping. But her presence was the greatest help I could ask for. With her there, I felt less alone and intimidated by the task in front of me. Without her, I would’ve felt hopeless and crawled back into bed. With her, I not only got a break from being submerged in my lonely darkness, but I got to feel capable for the first time in what felt like such a long while. I was able to accomplish something.

It’s difficult feeling like it’s on you to fix your  depressed friend, especially if your friend isn’t ready to get professional help. The best I think any of us can do is express love for our friends when and how we can.

If your friend is already getting professional treatment, it might help to know that what they’re doing is really hard work. They are clawing their way out of the belly of an unfathomable beast, and it takes tremendous strength. You might feel inclined to give advice or suggest something like exercise or a social activity, always with the best of intentions, but your friend might be exhausted, and beyond any more effort. Sometimes the best thing you can do is just be there. Watch TV with them, or a movie. Lie on the floor with them and hold their hand. Bring work over and just hang out. It might feel like nothing, like it did to my roommate. But to your friend, it’s everything.

What if your friend is ready and willing to get professional help? Another helpful item in the Times piece comes near the end: “Make getting to that first appointment as easy as possible.”

If you are someone who finds making phone calls and doing research easy, and even enjoyable, helping a friend find a doctor on their insurance could be huge. If you’re not that kind of person, maybe you know someone who is. Ask other people for help! You don’t have to be in this alone, just the same way your friend doesn’t have to be in his depression alone.

A friend of mine had a traumatic experience with reproductive health and avoided the gynecologist for years. When she finally decided she was ready to try again, one of her friends dealt with finding a doctor and scheduling an appointment. (That sort of thing is not my strong suit, even on my best days.) I took on the responsibility of accompanying her to the appointment; showing up is something I can do, at least when I’m well. Between the two of us, we helped her surmount this obstacle. A year later, she scheduled a checkup and went to the appointment, all on her own.


What if you’re the one who is depressed?

When I’m very low, I get very avoidant. I become consumed with the fear of people — editors, friends, anyone — giving up on me, because I want so badly to give up on myself. I am so frustrated and annoyed to be depressed once again, and I can’t imagine that they would feel any different. I think about sending an email telling them I’m back in that dark space, and I imagine them rolling their eyes and wondering why they put up with me, with someone who keeps getting worse instead of better.

But it’s not true that I keep getting worse. I relapse, but I also get better. And people seem to think I’m worth it, even if I don’t. That’s a hard thing to remember when you’re in the darkness. But it’s an important truth, one maybe worth writing down somewhere to revisit when you need to. Here is what I would say to you in those moments, if I could:

You are the only one who wants to give up on you, and that is just because of your illness. No one else sees you the way that your illness is making you see yourself. Try to trust that. No matter what, there is always someone who desperately doesn’t want you to give up.

Try to remember your sickness is not you. Remember that it has lifted before and try — I know how hard this is, but please try — to remember it will lift again. It really will, because it has before.

This can be a tricky thing to believe because if we’re being honest, the opposite is then true as well. You have been brought low before, so history says you will be again. Sometimes that colors my periods in the light with gratitude, with appreciation for being out of the darkness. Sometimes it shadows them in apprehension, fear of the inevitable slump stalking me.

I’ll be honest: At first, I didn’t really know what advice to give you. I  can’t tell you that if you just work really hard, if you take your medication correctly, if you try to exercise when you’re feeling up to it, if you leave the house to get some sunlight on your skin, then the darkness will be kept at bay forever. I can’t lie to you.

But I can tell you this: There are people in your life who want to love you even when you are in the darkness, and who can manage that. Appreciate them. Try not to push them away or shut them out, even though I know it can be frightening to let them see you when you feel so deeply detestable.

It can be terrifying to risk scaring them away.

The last time I had a really major depression, this was my great fear. Who will  I lose this time? The depression before, I had lost people. I was young and so were they; I was exhausting to them. It was painful to have them tell me that. So I worked hard to be able to take care of myself, to not need anyone. To rely only on paid professionals. And when I got sick again, I was certain I would lose more people. I tried to shut my friends out, but they didn’t let me. And the truth was, I didn’t want to.

Part of how I coped was telling them about my fear: I asked them to tell me if I was becoming overwhelming before just giving up on me. Over and over, my friends told me they were fine, that they were willing and able and happy to do what they could.

And most of them understood that often what I needed was just their presence, and their perspective. I would drag myself sobbing over to their apartments, and they would let me cry myself into a nap on their couch. These are the things I love about you, they would say. But I don’t have those things anymore, I would cry; I’m not funny, I can’t think, I can’t write, I can’t be a good friend. You are, you can, you can, you are, they would respond. I would try hard to believe these people, because I loved them.

One more important thing you can do for your loved ones when you are in the darkness is seek professional help. A big reason my friends were not exhausted by me is because they didn’t have the pressure of feeling like my survival rested entirely on them. I was in therapy; I was working on finding the right medication with the help of a psychiatrist. They could simply love and care about me, without feeling like they had to fix me.

There are always resources, no matter where you — or your friends — are. A commonly shared one is Lifeline, a national hotline: 1-800-273-8255. The Center for Disease Control has a whole page with other suggestions. If affording medication is difficult, apps like GoodRx can be hugely helpful. links to a whole spreadsheet of resources available nationwide and in various localities.

* * *

If practice makes perfect, I should be an Olympic champion at being depressed. I’ve been at it for almost two decades now.

This is one of the dark jokes I tell myself in an effort to make light of the darkness that sometimes consumes me. Haha, I joke, the only thing I’m good at is being depressed. My depression sneers back that it’s certainly true that I’m not good at anything else.  

But the joke made me realize something I have gotten better at, with practice: Surviving depression. I’ve fought my way through three major depressions so far, and countless smaller slumps. It was thanks to lessons I learned from my second depression that I was able to recognize my third one, and get help.

It was also thanks to the people in my life who showed up. Their refusal to allow this isolating disease to succeed in rendering me totally and completely alone has saved my life over and over. The boss-turned-friend who told me it was okay if it took months before I got better, and said the only thing he expected of me was to answer my phone when he called me every morning. I didn’t need to have pitches or have left my house; I just needed to let him know I was alive. The friend who got me a job hostessing, then collaborated with my mother on an array of outfits I could use as uniforms because my brain couldn’t handle the decision-making required to get dressed. The friend who rented a car, picked me up and took me to a Japanese mall in New Jersey, sharing a comforting tradition her dad had created with her as a kid. The friend who let me come over when I messaged her in the middle of a panic attack, gave me half a Klonopin, and tucked me into her bed, gently telling me that if I didn’t feel better when I woke up, we would go to the hospital and she would stay with me the whole time and everything would be okay.

That’s the biggest lesson I’ve learned in wrestling with this illness for nearly 20 years. You can’t get out of it alone. It is also, confusingly, true that no one can save you — you’re always the one who has to do the work, who has to slog through the muddy darkness — but the eminently human kindnesses of friends and family along the way are what make the slog even remotely possible. And the truth is, you don’t have to do much of anything most of the time. Just be there.

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Having survived it before doesn’t make it any easier to do so again. It doesn’t make the relapses any less scary. Depression has its own logic, and once it takes you, you are trapped in it. You may know, intellectually, that it’s depression, but it weighs your whole being down; you cannot think your way out of it. Depression is a beast that swallows you whole and forces you to live inside it until you fight your way out — always with help, always with the others safely outside the beast who can pull you back.