5 Signs That Someone Might Be Struggling With Depression

Depression is one of the most common mental disorders in the country, according to the National Institute of Mental Health. The most recent numbers in 2017 show that around 17.3 million adults, about 7.1% of all adults in the United States, had at least one depressive episode in the past year. (A depressive episode is a time of two weeks or more when a person feels depressed, has lost interest in everyday tasks, or has other symptoms, including issues with sleep, eating, and energy, according to the agency.) And due to the COVID-19 pandemic, those numbers are increasing. According to a 2020 survey of 5,470 people by The Centers for Disease Control and Prevention, 40.9% reported a mental or behavioral health condition, including anxiety, depression, and substance abuse, because of the pandemic.

Although depression is prevalent in the United States, there's still a stigma around mental illnesses that prevents many people from seeking help. If you know someone who has been struggling recently or even have a feeling that a loved one might need help, you're in a perfect position to be a supportive and encouraging place of comfort. For the person who's having a difficult time, speaking about their struggles can be difficult; they might feel a mix of emotions, including fear, frustration, or worry that they might be overreacting. But it's important to push those feelings aside and tell someone you need help, says Valerie Cordero, Ph.D., co-executive director of Families for Depression Awareness. "Listen to your gut. If you sense something is wrong, it probably is."

Most importantly: People who are experiencing depression want to feel listened to, understood, and accepted. Here are a few signs that someone you know might be struggling. Plus, how you can help them out.

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1. They Might Not Seem Depressed

Although a hallmark sign is a persistent blue mood, depression can show up in several other ways. Sometimes depression looks like afternoon naps, or putting off chores, or needing space. One way to spot depression: Look for changing behavioral patterns. "Maybe your always-energetic friend is tired and cancels plans. Maybe they have always liked jogging but spend more time curled up on the couch," says Dania March, M.P.H., L.C.S.W., a psychotherapist in Oakland, California. "These patterns can take weeks or months to appear." Symptoms can also intensify in winter; shorter days can trigger a type of depression called seasonal affective disorder.

2. Major Life Events Can Trigger Depression

Depression can come on the heels of a significant disruption, such as a divorce, serious illness, job loss, or the death of a loved one or pet. Even presumably happy changes, like marriage, a promotion, and pregnancy, can lead to depression. "Positive transitions can trigger self-doubt," March explains. "And if that self-doubt grows deep enough, it can lead you down the road to depression."

New moms can be especially at risk for depression due to a constellation of reasons, such as fluctuating hormone levels, poor sleep, and lack of support. Keep checking in on friends and family during times of flux, remind them that whatever they may be feeling is valid, and offer to assist in exploring treatment options.

3. It's OK To Be Direct

If you suspect a loved one is struggling with depression, ask how she's feeling. Sometimes, the person pulls away to process their emotions, but this can quickly escalate to loneliness and isolation.

The language you use is essential. Try something like, "You seem bummed lately. Your energy feels different. I'm not upset, but I want to check in." If they open up about their depression, simply listen. "Avoid saying things like 'Stop being so negative' or 'It will pass.' This can be dismissive and imply that depression is a choice, which isn't true," says Don Mordecai, M.D., national leader for mental health and wellness at Kaiser Permanente.

Try offering concrete help like, "Can I order you something to be delivered for dinner?" A general, "Do you need help?" puts the burden on the person with depression to think of an answer, adding more to her overflowing plate.

4. They Could Say They Don't Want Help

When your mind is flooded with negative thoughts, it's easy to feel like a burden, says Theresa Nguyen, L.C.S.W., vice president of policy and programs for Mental Health America. This makes it more likely that you'll isolate yourself. When a friend does reach out, your brain is in such a fog that you may not even understand what the person is saying, let alone think you need to get better.

Getting help can be arduous. "There can be a wait for an appointment, therapists who don't take insurance, and medications that take a while to work or don't work," Nguyen says. "It can feel defeating."

If a loved one balks at seeing a mental health professional, she might be open to other resources. "You can read articles, explore other people's experiences with depression, or even take an online depression screening," Nguyen says. It doesn't replace a diagnosis, but it can make seeking support less threatening. "It's painful to unpack what's making you sad."

5. Sometimes They're Hesitant to Seek Out Medication

Antidepressants can be a lifesaver for those with depression. But sometimes, people are hesitant to try them. "A common concern is that antidepressants will alter your personality," says Mordecai. "They affect certain brain chemicals, but what I often hear from people who do well on meds is that they feel more like themselves after taking them." Personality changes, for the worse, mean that you should check with your doctor about switching dosages or drugs.

Types of meds used to treat depression include selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs). "You may need to try a few before finding one that works," says Louann Brizendine, M.D., founder of The Women's Mood and Hormone Clinic at the University of California, San Francisco. Most who get better on meds see a difference within three to six weeks.