Depression: What You Say vs. What They Hear

 It could happen to anyone: You mean to offer your loved one some advice or encouragement, but your words upset them instead. Well-meant missteps like this are common when talking to a loved one about their depression. Things that sound caring or motivational to you may sound negative or hurtful to them. Below, Paul Nestadt, MD, the James Wah professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine in Baltimore, offers advice on phrases to avoid and what to say instead.

Either statement might sound dismissive of what your loved one is going through. Depression is an ongoing mental health condition, not an ordinary sad mood. What's more, telling them to be happy might sound like you're blaming them, as if they're choosing to be depressed rather than content. That couldn't be further from the truth. Instead, think about saying something like: "I'm really sorry you're going through this. What can I do to help?" Do your best not to compare their depression to a sad mood or tell them what you've done in the past when you felt down or had the blues.

Your loved one may feel like you're calling them ungrateful for being depressed rather than content. They may think you're moralizing and minimizing their pain. Instead, you might want to just offer yourself as a listener. You could say: "Are there things you'd like to talk about that are going on with you right now? If you don't want to talk about those things, we don't have to." This basically conveys that you're here for them and you're ready to listen. If they want to talk, you can let them guide the conversation to some degree.

Giving your loved one this advice may accidentally put pressure on them, and they may feel shame and resistance as a result. Even though exercise is good for everyone, it can be hard to do with clinical depression, and it's not a simple fix for the condition. Instead of telling your loved one to exercise more, you could rephrase it as an offer: "Would a short walk with me help right now?" Or, "Is there one activity that you've found helps you that maybe we can think about doing?" Just being available as a sounding board for them may help.

Comparing your experiences with your loved one's may come across as dismissive or even competitive. Another statement along these lines to avoid is, "When I was feeling depressed, I did X, Y, and Z." Just be aware that different things help different people with depression. So instead, you might say something like: "What's helped you before?" Or, "I wonder if there are other people who've dealt with this and we can maybe find out what's helped." Or, "I haven't lived your life, but I'm here for you. I want to understand what you're going through."

In general, saying this doesn't help, and there's really no good way to rephrase it. Instead, just be aware that your loved one with depression may not always convey their emotions on their face. One possible symptom of the condition is being less emotive in that way. They might be less animated, might make less eye contact, and they might just express less. What's more, people with depression often put a lot of effort into not looking depressed – and trying to keep that mask on can be draining.

This comment doesn't help at all, since no one can "just snap out of" depression. If you've said something like this, recognize that it might be coming from a place of frustration in yourself, and try to address it. Being a caregiver or supporting person for a loved one with depression can be very hard and draining. It's important to make time for yourself and give yourself a break. Share your caregiving responsibilities with other family members or loved ones when possible.

If your loved one seems deeply depressed, ask them if they've had suicidal thoughts. Ask in private when you both have time, and be direct. (Don't worry that you'll plant the idea of suicide in their head – that's a myth.) If they tell you they've considered suicide, you can help them get professional care. You can also ask if they have a gun or stored-up medications at home and whether they'd be willing to let you remove these while waiting for medical help. Also, be aware that the national crisis line, 988, can offer support to people with suicidal thoughts as well as their caregivers.