What to Do When Our Friend is Feeling Down?

Written by: Parapat Jootrakul, Team Content www.thaihealth.or.th and image archive

Interviewed by: Dr. Pravej Tantipiwatnasakul, Former Senior Physician, Department of Mental Health

Some information from: The People's Doctor Foundation and Rajanakarin Institute of Child and Adolescent Mental Health, Department of Mental Health, Ministry of Public Health

Illustration by: Natthaporn Chumlu, Team Content www.thaihealth.or.th and image archive

From someone who loves to talk, go out with friends, watch movies, and listen to music, everything can slowly change. For some, this change may happen quickly, but once it does, it can be a complete transformation. These symptoms should not be ignored by close friends, as they may be signs of depression.

'Depression' is a silent health threat caused by abnormalities in neurotransmitters in the brain. It can affect anyone, regardless of profession or age. The observable symptoms include: 1. Persistent feelings of sadness, hopelessness, and gloominess, noticeable both to oneself and others, and 2. Loss of interest in activities that were once enjoyable, accompanied by other symptoms such as changes in appetite, sleep disturbances, slowed thinking and speech, irritability, fatigue, feelings of worthlessness, and thoughts of self-harm.

“Each patient will have different details and treatment methods, but there are common points that can help those around them understand and support the patient to feel better,” says Dr. Pravej Tantipiwatnasakul, Former Senior Physician, Department of Mental Health, outlining ways to interact with patients at different levels:

• Mild depression should focus on adjusting daily routines, especially if there are chronic feelings of sadness that have persisted for a long time, often stemming from anxiety and a lack of emotional management skills. Skills in proactive problem-solving, emotional regulation, and communication should be developed to foster good relationships and build self-esteem.
• Moderate depression can benefit significantly from medication and routine adjustments, particularly through healthy eating, adequate sleep, regular exercise, and relaxation activities. If possible, practicing mindfulness to be aware of one’s thoughts and applying mindfulness to manage emotions is recommended. It’s important to view negative emotions, whether anger or sadness, as a natural part of life, as they reveal what is in our hearts.
• Severe depression requires consistent medication and encouragement that symptoms will improve. If possible, encourage light exercise in the sunlight and engage in relaxing activities as much as the patient is willing to participate.
• In cases where the patient has suicidal thoughts, do not dismiss it by assuming that someone who talks about suicide is merely seeking attention and won’t act on it. In reality, expressing suicidal thoughts reflects deep despair and is a warning sign to seek help immediately. A psychiatrist or mental health professional should assess the risk and collaboratively determine a support plan.

Depression can be treated, but the first step is understanding the condition, not just for the patient but also for those around them, especially family members who are closest to the patient, as they can provide significant support through understanding and proper care. Depression can become severe enough to impact daily life and may even lead to the patient deciding to end their life.

Many people often think they understand depression because they have felt 'sad' at times or have experienced something that made them feel upset and managed to cope. Dr. Pravej continues to explain that patients with depression may lack the energy and belief that they can improve, feeling too fatigued to exercise or engage in activities. Therefore, interactions should be based on an understanding of the nature of the illness. Avoid judging that their inability to act means they are lazy, lack discipline, or are seeking attention, as such thoughts can lead to critical and coercive treatment, worsening their condition.

How to Support Someone with Depression includes offering encouragement, inviting them to participate in activities together, and listening without judgment. If you’re a family member unsure of what to say, use touch and express love and concern through actions, such as scheduling time for enjoyable activities together.

• Would you like a hug?
• You’re not alone.
• You are always important to me.
• I will be by your side.
• I may not understand, but I care about you.
• I love you.

Phrases to avoid when encouraging someone with depression:

• Just forget about it.
• If you don’t want to feel this way, just stop thinking about it.
• It’s okay, it will pass.
• How long will you be sad?
• I understand how you feel; I’ve been there too.
• Stop being sad.

Some words can uplift and create positive feelings, while many others can deeply hurt. For patients with depression, words to avoid include critical or judgmental phrases and overly positive encouragement that pressures them to think positively, as this can exacerbate feelings of failure.

When physical health is good, mental health will follow. Encouraging patients to exercise is an integral part of healing for those with depression. The Health Promotion Fund (ThaiHealth) supports the Thai population in achieving good physical health through various projects, such as running events organized nationwide, as running helps release endorphins. Runners often feel relief from fatigue after running continuously for over 20 minutes, and upon finishing, regardless of winning a prize or not, they feel refreshed and mentally lighter.

Additionally, Dr. Fred Goodwin from the U.S. National Institute of Mental Health emphasizes that exercising requires time management and self-discipline. Those who achieve their goals will quietly feel proud, as any positive feelings towards oneself can help brighten mood and mental state.

In addition to regular medication, adjusting daily routines by incorporating physical activities and inviting patients to exercise can significantly improve their mental health. It is recommended that those experiencing depression consult a doctor, psychiatrist, or local health worker nationwide, or call the mental health hotline at 1323 or 1667 for free assistance 24/7. And don’t forget to check in on the feelings of those around you.

Thank you for the information from www.thaihealth.or.th