Three to 17 percent of the world’s population suffers from depression, but trying to explain it to the other 83 percent can be difficult. Normal people have bad days and sad moods, but “normal” means they’re actually able to deal with those bad days, whereas depressed people can’t — not in an adequate manner. Explaining why “Cheer up!” doesn’t work is impossible because they just don’t get it.

I can’t speak for everyone, but for me, depression is like a quicksand trap. Your foot has been caught, so you pull it out, but you need to step with the other foot, and since you do that, it sinks too. Then, you’re in with both feet, up to the knees, and as you kick, you’re up to the waist. Eventually, there comes a moment when you realize it is inevitable — you’re about to get sucked down, so you just allow it. You relax for a second, and then it’s already enveloped you. You’re in the dark.

Sometimes, it’s like a hole in my chest that some vermin inside me has gnawed into laboriously and persistently. It comes on slowly, expanding and expanding until I start to feel it all the time. There is a physical sensation, an itch; but it doesn’t go away, even with the deepest breaths of fresh air.

It’s like being in a vise or a Chinese finger trap. The more you move, the tighter they crank it. You think, this will have to stop eventually, but you just don’t know when, and you have no choice but to stay still in the vise. Your life is bidirectional, but there’s a screw on either end, and you have no control of the tightness setting.

All of this sounds very melodramatic — even to me. So, of course, it’s impossible to explain to people who have never experienced it. Maybe simpler is better: this whole thing is disgusting.

Having a family member or friend with depression isn’t easy. So, friends and family, this is what you need to realize:

1. It’s an imbalance, and people can’t help it. Depression is a neurotransmitter deficiency. You’ll protest: “But it’s only because (insert stressor here) …” Look. It doesn’t matter how it got started. If it’s short-lived, it might be situational or an adjustment reaction. But if it lingers, regardless of what triggered it, it is an imbalance of serotonin and dopamine. It is no different than, say, diabetes, or hypothyroidism. So, please please, please, don’t tell people to “snap out of it.” They can’t snap out of it any more than they can will their pancreas to make insulin or get their neurotransmitter production back on track.

2. Your friend is not depressed for lack of trying not to be. “You just need more positive energy!” “Eat clean and exercise!” “You lead an unhealthy lifestyle!” “You need a vacation!” All suggestions for a cure. And I am not knocking the benefits of healthy living, rest or positive energy. But for a person who might already be feeling worthless, hearing that they’re just not doing life right exacerbates the problem. Along the same vein, please don’t remind them that they “have no reason to be depressed.” A reason would make it so much easier; a reason can be dealt with! However, pointing out there is none invalidates the struggle and evokes shame. I suggest a simple, “I know, this really sucks.” It’s applicable in so many situations.

3. You can’t always fix it, and that doesn’t reflect on you. Most people are generally kind to their friends and family, and they honestly want to help. They truly believe that once the problem is identified, it can be fixed. So, they try to provide help by encouraging talking or an active lifestyle, or trying to eliminate sources of stress as possible triggers, or whatever — they try, at least at first. After a while, when it doesn’t work (and it won’t), they get annoyed and possibly bored, or worse, angry with the depressed person. At least some of that must be due to inability to accept that they can’t help. Remember, you cannot fix depression with your bare hands, and it doesn’t mean you failed. It means this shit is for real.

4. Just be. If you really want to be supportive of your friend or family member, this is the best you can do. Seriously. Just be. Sit there with the person and accept the fact that they are currently in a hole. Hug them when indicated. Get them tissues and tea, if they want it. Don’t try to offer easy solutions. Don’t get angry. Don’t tell them to man up. And most importantly, don’t take it personally.

5. Get medical help. I cannot stress this enough. Contrary to popular belief, doctors aren’t just going to plop you on an antidepressant and send you on your way. They will do a careful history and a physical to rule out any reversible organic causes. They might recommend therapy first. And yes, sometimes, your friend may not be able to do without a medication. And please don’t tell people who are trying to get help and get on medication, “Do you really want to be numb to all emotion?” That is not what medication does. Medication helps that person get to a normal place; they need the medication so they can feel like you feel every day. You wouldn’t dream of telling a diabetic to “get a grip,” right? This is no different. If it is determined that a person needs medication, they need it; they cannot do it on their own. Get them the help: an impartial, experienced professional who can recognize signs and will know what to do. Because depression is a frequently fatal condition.

If you are concerned that a friend or family member may be succumbing to depression, please take them to the emergency room. Send an ambulance to their house if they’re talking suicidal. If it’s you, you are not alone. If you feel yourself circling the drain, call the National Suicide Prevention Lifeline: 1-800-273-8255

Sasha Retana is a gastroenterologist.

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