How to support someone with depression and anxiety

If someone in your life is suffering from anxiety or depression it can be hard to know how to help. Health reporter Catherine Milford explains how to spot the symptoms and how best to support your loved one.

How do you know when someone is depressed? The people who tell you they are depressed – they’ve had the worst day, the alarm didn’t go off, then they had a row with their partner, they were late for work, the heel just broke off their shoe and it’s not even 10am yet… – they are certainly having a bad day. But what about those people who don’t shout or complain – about anything really – but you’re pretty sure that something isn’t right?

Thanks to strong Kiwi figureheads such as former All Black John Kirwan and comedian and mental health advocate Mike King, we have gone some way towards destigmatising mental health conditions such as depression and anxiety. However, for those suffering from anxiety or depression it’s still extremely difficult for them to tell anyone how they are feeling.

Admitting to friends, family and workmates that you’re struggling is still perceived by some as a sign of failure, despite it being so common.

And it is common, especially during puberty and adolescence, during menopause, and particularly in women (although these numbers may be skewed by fewer men admitting they’re struggling). Also, at high risk are people who struggle with stress or burnout at work, those with a genetic disposition to mood disorders, abuse victims and people who have, or have had, persistent or chronic illness. The list of triggers is long – but still people are hesitant to talk about it.

So, if they won’t tell you, how do you know if someone needs help?

“Depression and anxiety reveal themselves very differently in different people,” says Gwendoline Smith, a consultant psychologist, a campaigner against the stigma around mood disorders, the author of several books on depression, and a sufferer of depression herself.

“Age plays a big part, so how you’d approach a 15-year-old you suspect of self-harming would be very different to how you’d approach someone elderly. The elderly are often surrounded by grief, with spouses, friends and siblings dying, but their depression is often not picked up. An elderly person taking too many pills can be seen as just forgetfulness, when the reality could be quite different.”

While there is no such thing as a definitive guide to spotting and supporting someone who is struggling with anxiety or depression, there are always ways you can help. If you are seriously worried at any point, however, or you think there is a danger of someone doing imminent harm to themselves or others, call in professional help immediately.

Anxiety and depression: what’s the difference?

“Put simply, depression is worrying about what’s happened in the past; anxiety is worrying about what will happen in the future,” says Adele Saunders, St John New Zealand psychologist. “Someone suffering from depression will have more difficulty engaging, lowered moods and be over- or under-sleeping; while anxiety often presents itself by hyper-arousal, a tendency to panic, phobias, OCD behaviour and fear.”

Ms Smith believes depression and anxiety are under-diagnosed in several areas, including in alpha-type females, and men who are perceived as successful. “Men have traditionally evaluated anxiety as weakness,” she says. “They hide it under a cloak of adrenaline, so often men hide anxiety by always being busier, faster, louder…”
Although anxiety and depression are often lumped into the same sentence, they can present differently – although not always, which makes them harder to diagnose. “Anxiety and depression are separate conditions, but it’s now recognised that anxiety is a pathway to depression,” Ms Smith says. “Someone who is depressed is likely to have lived with some form of anxiety for at least two years prior.”

This is especially true following traumatic events such as the Christchurch earthquakes. “A constant low-grade anxiety is like leaving the parking lights on in the car,” she explains. “If you leave the headlights on, the battery will go flat very quickly; if you leave the parking lights on, the battery still drains, it just happens more slowly. Low-grade anxiety deteriorates the human engine until it crumbles and collapses.”

What can I do?

• “At St John, we teach the saying ‘Look, Listen, Link’”, Ms Saunders says. “Look for signs and symptoms; see if something is different to their ‘normal’. Listen to them if they want to talk, so they know there is someone to touch base with in the first instance. Then link them up to the right people who can help them move forward.”
• Check in with them. Whether you’re a work colleague, friend, family member or neighbour, just ask how they are doing. Often people will bottle it up until someone just asks the question.
• Don’t try to ‘solve’ the problem. Recovery from a mood disorder takes time, patience and a lot of help and support. While encouraging words are a great way of connecting with someone, you won’t be able to fix a longer-term issue.
• Be patient. This is their journey, not yours, so what worked for you, or your sister, uncle etc, might not be appropriate for them.
• Try to encourage them to join in. Whether it’s an after-work netball match, a trip to the movies or a walk in the bush, anything that gets them involved will help. Be wary of the temptation to take them for a drink – drugs and alcohol don’t mix well with anxiety and depression.
• Young people and teenagers are more likely to respond to a direct enquiry about their depression or anxiety – they are often interested in genetic or hereditary anxiety and want to know why they are how they are. Leaving a book about depression open on a specific page in a room, or showing them a website, is often a good way to give teenagers information.
• Suggest they talk to their GP or contact a help centre if things are looking more serious.
• Think carefully about who else you might tell. If someone is feeling low, it could cause more harm than good to talk to someone else at work unless your work has a confidential counsellor service. However, if someone is suicidal, get help immediately.

What not to do

• Don’t try to ‘assess’ or diagnose them unless you’re a medical doctor or psychologist. Listen to them, and encourage them to talk, or to seek help – just making a connection with them is helpful.
• Don’t encourage maladaptive coping. Suggesting they go and get drunk, or indulge in a day of retail therapy if financial issues are a contributing factor, may only compound the issue.
• Don’t minimise their situation. Everyone can name someone who’s been worse than someone else, or who had a more traumatic situation. Coming up with a counter argument for someone who is anxious or depressed is unhelpful, and is likely to make the person feel even more disconnected.
• Don’t go racing in and overwhelm someone who is already feeling anxious. That person is already worrying about many things; take care your concern isn’t interpreted as being something else for them to worry about.

The facts

Often described as ‘the common cold of mental illness’, depression statistics are worsening worldwide. The World Health Organization predicts that, by 2020, depression will be the second-highest cause of death and disability in the world. One in five Kiwi women, and one in 10 men, will suffer some form of depression in their lifetime.

Anxiety and depression can occur for many reasons and at any time in life. Research has shown the existence of a genetic predisposition towards depression; however, that doesn’t mean if you have a parent with a depressive disorder, you will automatically have the same. Depression can often accompany physical illness, especially if it has been life-threatening. Poor nutrition and deficiencies in key nutrients are associated with depressive symptoms, as are changes in the seasons (Seasonal Affective Disorder), alcohol and/or drug abuse and life stages, eg, adolescence and menopause.

The symptoms

•  Loss of interest or withdrawal from activities they once enjoyed
• Changes in weight (either dramatic loss or gain)
• Lack of energy or lethargy
• Loss of libido
• Inability to concentrate
• Irritability or feelings of sadness
• Changes in physical appearance: less attention to the way they dress,
  slouching, or a lack of expression or ‘light in their eyes’ when talking
• Gut problems often arise in conjunction with depression. Irritable bowel syndrome, indigestion and digestive issues are common in people with depression.

Resources

Gwendoline Smith is the author of several books on depression, including Sharing the Load: What to do when someone you love is depressed (RRP $35.99) and The Book of Knowing: Know how you think, change how you feel (RRP $20.00), available in selected bookshops and online.

St John New Zealand now provides a one-day Mental First Aid course giving non-professionals strategies to manage or support people struggling with mental illness. It includes information on key symptoms to look out for in others, and how to link them to the correct resources, as well as advice on dealing with self-harming and suicidal feelings. For more information visit stjohn.org.nz

1737 (1737.org.nz) is a 24/7 support space for anyone wishing to talk. A registered counsellor on the other end of the phone can provide you with help, and link you to someone else if required.

Youthline (youthline.co.nz) provides support for young people, their families and those supporting young people. Freecall 0800 376 633 or free text 234.