Designer Depression: 8 Important Tips for Helping When Hope Has Died

The recent deaths of fashion icon and trendsetter Kate Spade and beloved international chef Anthony Bourdain remind us of the complicated beauty and frailty of the human spirit and the suffering caused by mental illness. For the past week, I have been haunted by these tragedies and considering, as many probably are, how we truly help a loved one, friend, patient, or even a stranger before or at the point when life has become utterly unbearable. Below I have compiled a list of important thoughts to consider if you are trying to support someone who is struggling with severe depression and suicidal ideation. I hope they offer some insight, hope, and guidance.

1. First, it is important to understand that the thoughts of a someone with suicidal depression go beyond being dark and into the depths of the proverbial “rabbit hole”. In this abyss, there is absolutely no light, nor direction to find one’s way out, and no bridge or entry point for supportive others. When you recognize someone is very depressed, do not falsely believe that your efforts can magically change how a person in this dark emotional space thinks or feels. This will lead to your own self-doubt, guilt, shame, and anxiety; all of which are the wrong focus in the moment. Keep your focus on doing everything you can to help, love, and support the person, while remembering that you ultimately can’t “make” someone with severe depression instantly better. All you can do is get the resources they need and be there to provide company, support, and when necessary, monitoring until professional help arrives.

2. Severe depression is dangerous and insidious, but the sufferer may often resist help; claiming that they are “fine”. However, when you know someone is severely depressed and potentially suicidal, all efforts to help should be immediate and intensive EVEN though they verbally express their strong resistance, attempt to isolate, or threaten to end your relationship or otherwise shut you out. This is the dark seduction of depression NOT your loved one nor the small part within them which knows they desperately need help. They will thank you later. But they have to be alive to do so.  Don’t give up!

3. Don’t be fooled by flights into health. If your loved one suddenly seems brighter, happier, less depressed, active, this does NOT mean they are “better”. Unfortunately, this often means they feel less burdened because they have finally resolved to end things and to obtain the “ultimate solution”. Be suspicious and, again, move forward with any plans to help even if they “seem fine” soon after being very depressed.

4.  Relatedly, keep in mind that antidepressant treatment has been linked to “medication madness” and a higher risk for suicidality in patients with severe depression (Bielefeldt, Danborg, & Gøtzsche,  2016 ; FDA, 2007).  The “lift” caused by chemical changes in the brain can increase agitation, make an individual less immobilized, and may provide just enough energy for someone to follow through on persistent suicidal thoughts. Consequently, the benefits of psychopharmacological intervention must be weighed against the risks and, in some cases, the risks are just too great. Careful psychiatric evaluation and monitoring are essential for interventions involving medication and we should not assume that drugs make it “all better”.

5. A very experienced teacher of mine once said, “Suicide is a permanent solution to temporary problems”. This means that a person experiencing depression needs you (and the professionals helping) to hold hope for them and provide support until they get to higher emotional ground. This could take a day, a week, a year, or several years. Keep close and stay aware for an indefinite period of time.

6. Be empathetic, supportive, and NEVER give up on helping care for someone until they are out of the darkness. However, keep in mind the following:

   • Find ways (and someone) who can take care of you so you can take care of your sick loved one. We all need support and helping a suicidal loved one can be overwhelming and frightening. Don’t do it alone.

   •  Find support in new places such as support groups for loved ones with depression, suicidal hot or “warm lines”, on-line or community supports. You’d be surprised how talking with professionals or strangers experiencing similar struggles can be freeing, helpful, encouraging, and soothing to the soul.

7.  A word must be said about perceived selfishness on the part of the individual who commits suicide. Loved ones, including spouses and children, are left in the wake of a loved one’s death by suicide and struggle with feelings of anger, confusion, grief, and an overwhelming sense of abandonment. These are obviously valid emotions and objectivity is an unreasonable expectation of those left to deal with life post-suicide. However, objectively speaking, similar to those in the throws of an addiction, when brain chemistry, emotions, and environmental circumstances coalesce in a perfect storm, love is simply not a consideration.  In the years, months, days, or moments preceding suicide, the brain, mind, and heart have been literally hijacked. Those unfortunate enough to be immersed in the dark waters of depression sink to a depth where love and connection no longer exist. Unremitting emotional pain and the consequent search for relief are the only driving forces.  Suicide is never personal (not intended to personally hurt loved ones) and it’s always personal (solely involving the emotional torment of the person who commits it). With time, it may be possible to view suicide as a poignant, tragic example of the old adage, “You can’t love others if you don’t love yourself”. Of course, this realization does not make suicide less devastating for those mourning the loss. But compassion for the deceased as well as for those left behind are key ingredients in the long-term recipe for healing.

8. One final thing: Remember. Life is hard. Period. Life is also great but, the hard parts can REALLY get someone down and keep them down. Keep in mind that everyone is doing the best they can with whatever resources they have at the time. Suicide happens when an individual becomes ultimately exhausted from battling their demons and hope figuratively and literally dies. People experiencing severe depression need supportive others to take the baton when they can no longer run and to hold the hope for them until they are strong enough to find it again. Do your best to provide this kind of support. Be strong. Be kind. Be loving. Be there. Be aware.

If you or someone you know is struggling with depression or suicidal thoughts, call 911 or the Suicide Prevention Hotline at 1-800-273-8255.