Providing Social Support To Overcome Depression

Humans are social animals by nature. But modern life has disrupted many of the traditional social norms that people have relied on for millennia, to the detriment of our overall health. The American Psychological Association reports that loneliness has been linked to health problems including “high blood pressure, diminished immunity, cardiovascular disease and cognitive decline” and that “low levels of social support have even been linked to increased risk of death from cardiovascular disease, infectious diseases and cancer.” Social support plays a big role in depression, as well.

Individuals with poor social support have a higher probability of developing depression, according to a study in the Journal of Clinical Nursing. And many Americans today don’t feel like they have a social network they can count on. The APA reports that 55 percent of survey respondents said they could use “at least a little more emotional support” when talking about problems or making difficult decisions. Strong social support can help people cope with problems and improve self-esteem and a sense of autonomy, the APA says. But not everyone has the skills to be socially connected, while many others find that maintaining those connections are harder these days.

“At its worst, depression is a disease of isolation,” says Dr. Drew Ramsey, assistant clinical professor of psychiatry at Columbia University and chair of the American Psychiatric Association’s Council on Communications. “People generally tend to be social creatures. We feel best when we are connected to others and to our community. That is a huge part of the human identity.” It also provides us with important psychological benefits. “It’s like the keel on the ship,” Ramsey says. “You can have an awful day, but if you can lean on social support, be that your regular Tuesday basketball game, your church choir or whatever you use, the bumps in life are digested much better.”

Breaking Out of the Cycle

While social support is one of the most powerful protections against depression, it’s also one of its most challenging treatments. “In the depths of depression, someone’s self-esteem is awful,” Ramsey says. “They know they are not their best selves, and so they don’t want other people to see them that way. They are alone in the darkness, which perpetuates the depression and is also dangerous. Our biggest fear is that they end up isolated and disconnected, which leads to the worst outcome, which is suicide.”

Carl Tishler, a psychologist and adjunct associate professor of psychiatry and psychology at The Ohio State University, adds that trying to help depressed people back into the world when they don’t want to go can be difficult for those trying to help them. “The ‘alone’ feeling is something they don’t know what to do about. The friend or relative or significant other who is trying to help the person gets frustrated and throws her hands up and walks away,” he says. “That causes frustration for support-givers, who can feel overburdened, and then the depressed person feels increased guilt and becomes more withdrawn. It’s a viscous circle.”

How can depressed individuals escape this circle? Psychotherapy can help patients reframe their view of the world, making it less scary for them to re-enter. “Depression is a distortion in the mirror we evaluate ourselves in,” Ramsey says. “When we see or more importantly feel our role in others’ lives, that is very protective from the worst of depression.” Mental health professionals screen suicide risk by asking patients what keeps them alive. “We are reassured when people look you in the eye and say, ‘I know I need to be here for my children’ or ‘I need to show up to work because my employees depend on me,’” Ramsey says.

He also reminds patients that, even in the depths of depression, “their light can still shine and people can enjoy them. I spend a lot of time with people who are depressed, and I often find them making me laugh. I remind them that, in the midst of feeling horrible, they are still themselves.”

Start Small

Someone who is depressed isn’t likely to go to a big party. But he may be convinced to make baby steps back into society. That may be a small community function without much social interaction, or going to a movie instead of dinner with a friend to limit conversation, or simply taking a walk in a park, Ramsey says. “I want to chip away at their isolation,” he says. “One of the tips I learned from patients is that it is easier to socialize if there is something other than yourself to focus on.”

He also tries to add structure to their lives by creating commitments they need to meet. “It’s hard to go work out when you’re depressed, but it’s easier if you have a commitment of a class to go to.” He might also suggest less stressful ways to revisit activities patients usually enjoy. “If they used to like dinner parties, they might take a cooking class or go to a tasting menu, or simply go to a farmers’ market,” he says. “The goal is to get them out of the home and with other individuals. What makes you feel good is being with other people mutually enjoying an activity. Getting out of your head and into your life is one of the things I try to engage people in.”

Tishler adds that taking care of another living thing is also helpful. “[Caring] for plants or animals makes them feel they have some responsibility for another life, not just their own,” he says. “I have had a number of patients who, were it not for their dog, wouldn’t get out of the house. The dog forces them to meet the neighbors, say hello, go to the vet or to buy dog food. It forces interaction.”

Ramsey provides one more caution. “The word ‘social’ has changed because of social media,” he says. “Socializing online doesn’t count.” Indeed, data suggest that social media networks lead to more depression, he says. “Social media provides the potential for connecting us, but is real human connection really happening? When we spend hours online comparing ourselves to others, counting ‘likes,’ that is horrible for the human psyche. Make sure social media is actually social in that it is making you feel good and connecting you with friend outside the house. That is what feels best as humans, and I don’t need any research to support that.”