When a friend is depressed

Dateline Portland, Oregon, Amelia J. Wilcox, Ph.D.: It is difficult enough as adults to know how to approach a depressed friend. Teenagers are often on the front lines with their peers, aware of a friend's depressed mood and wanting skills to help them through a difficult time, but unsure how to have such a challenging conversation. What do you do when you are a teen and your friend is depressed?

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A young friend of mine had tea with me a few months ago, and the conversation turned to an important question—how could she help her best friend, whom she thought was depressed. More and more teens struggle with depression these days. This reality means their close friends often end up on the front lines—the first to recognize that something might be wrong.

The first thing I did was ask some clarifying questions. Did my young friend, for example, understand the difference between a blue mood, depression that occurs in reaction to a stressor, and a major depression? Blue moods come and go for us all. They are, I explained, part of the human condition, and if we listen to them when they arrive they can tell us important and useful things about our stress and how we are managing life. An adjustment disorder, on the other hand, is a moderate depression that occurs in reaction to a stressor and may continue for a few months. Finally, a major depression is a more severe condition that can last for weeks to months and includes symptoms like sleep disruption, and sometimes suicidal thoughts. She explained that her friend had become increasingly sad in recent weeks, and that it didn’t seem to be getting better.

I asked her if there had been an unusual event or stress in her friend’s life. Were things okay at home? Had she experienced a disappointment in a relationship or problems with her applications to college?  I explained an adjustment disorder occurs in reaction to something that happens in life. For most people, even without treatment adjustment disorders will resolve within months of the stress going away. But just because something is likely to go away by itself eventually doesn’t mean you shouldn’t get some support. Support can help you learn what led to the stress and give you tools to better manage stress now, and in the future.  I also explained that for some vulnerable people an untreated adjustment disorder may not resolve, but instead evolves into a major depression, which can be very serious.

My young friend told me she wasn’t sure if there had been anything really recent, but explained a very specific stressor that had occurred a few months back, one that her friend’s family was still working to manage. That could, I mused, be a clue about what was going on. I asked my young friend what she was noticing that worried her.

She told me that at first she thought her friend was mad at her because she seemed angry all the time, and really touchy about everything. She asked if she’d done something wrong, and her friend promised she hadn’t, but acknowledged she’d been stressed and just didn’t feel like herself. Now, my young friend told me, her best friend just seems sad all the time. She’s not much fun to be around and she doesn’t go to games or other after school activities any more.

I told my young friend that it was a really good idea to talk to her own mom and maybe to the school counselor about her worries, and said that I had some difficult questions to ask, the answers to which would suggest whether those conversations should happen immediately or not. I explained why I was asking them, and assured her that it was okay if she didn’t know the answers. First, I asked if her friend had thought about harming herself. I also asked what she knew about her friend’s drugs or alcohol use, explaining that sometimes people use these things because they are depressed, but that it is also true that these things can cause or exacerbate depression.

My young friend and I finished our tea and she went home to talk to her mom. Her mom phoned me that evening to get some referrals to pass along. When my young friend and I met for tea recently, she told me her best friend had started going to psychotherapy and had also joined their group of girlfriends for a sleepover that weekend. I told her how impressed I was by her courage. It is a good friend who knows when to reach out for help, and does it even though it is hard.