“I’m really worried about my friend Amy, I think she is getting more and more depressed and doesn’t seem to realise what’s going on.”, said Gwen.
Her school counsellor, Mrs. Wright looked at her with some concern and asked, “What makes you think that she is depressed Gwen? Have you noticed something different about her lately?”
“Well, she used to be very outgoing and social. She would come to all the school parties and loved going out on the weekends but lately she just says she doesn’t feel like it and is staying at home a lot”.
“Ok, that is a possible sign of depression, but is there anything else you have noticed?” Mrs. Wright asked, sitting forward in her armchair and writing down a few notes from the conversation.
Gwen was a very intelligent sixteen year old girl with ginger hair and bright green eyes. She had a kind and caring nature and was quite sensitive to the behaviours and emotions of others and so had come to see Mrs. Wright originally because she was suffering from some social anxiety. She had a propensity to really worry about what other people thought about her and spent hours agonising over whether she had said the wrong thing or looked or sounded stupid in front of her friends at school.
It always amazed Mrs. Wright over the past 16 years that she had worked in counselling how many people would do this – both teenagers and adults – and never question the validity of their own assumptions about what other people were thinking. It so often led to feelings of poor self-esteem and disengagement with people socially when there was no real reason for it. So many people at the core of their psychological issues seemed to her to have the underlying negative belief that somehow they aren’t good enough.
Mrs. Wright had been teaching Gwen some CBT (Cognitive Behaviour Therapy) to help her challenge her thinking and to engage with people without worrying about what they thought about her too much. This had allowed Gwen to express herself more and she had begun to enjoy socialising again and had indeed developed some close friendships in the school.
“Well, you know last year when I was feeling quite depressed about my social circle and you told me about some of the signs of depression?”, Gwen asked.
“Yes, I remember us talking briefly about it”, replied Mrs. Wright.
“Well, Amy has lost a lot of weight lately, I hardly ever see her eat at school. She brings lunch but takes a few bites and that’s about it. I think she has lost about 5 kilograms at least. And it isn’t from exercising or netball because she has pulled away from that too. She used to run two or three times a week and I asked her the other day how the running is going and she said that she hadn’t been feeling up to it lately”, said Gwen, her concern for her friend showed clearly on her face.
“Yes, another possible sign of depression. As we discussed last year, generally people’s weight can fluctuate up or down with depression but when it gets to be moderate or close to severe it tends to lean more towards people losing weight because they start to not bother and that can be very concerning. You also mentioned a loss of interest in activities that she used to enjoy and this is another major sign of depression. When people withdraw from life and that withdrawal can be from exercise, social activities and very importantly from things that they usually gain enjoyment from then this is a sign that something is wrong and we need to be on the alert for the possibility of depression. Has anything happened in her life recently that could have caused her to feel this way?” asked Mrs. Wright.
“Well, she broke up with her boyfriend last year but she seemed to be recovering okay from that but then her grandfather passed away quite suddenly a few months ago. I know she was very close to him, they would talk on the phone almost every day and she confided everything to him about her life, he was a big support to her”. Gwen looked down at her hands, a tear began to roll down her cheek.
“I guess you know how that feels Gwen and I can see how much you empathise with her,” said Mrs. Wright moving the box of Kleenex closer to Gwen who took a few tissues and wiped her eyes.
Gwen had lost her mother when she was 9 years old and although that was now 7 years ago, she would still struggle with the loss from time to time and be triggered by certain events or situations. They had discussed this as part of the counselling process over the previous few months and although Gwen had had some previous counselling before she had still needed some more closure as part of her counselling. This had also helped Gwen with some of her social fears as she came further out of her introverted shell and began to engage with the people around her without fear of judgement. She was now becoming quite popular with her school friends and building a strong social circle.
Gwen continued, “Yes, it does touch on that place of sadness inside me but I feel I am handling that better now and I want to reach out to Amy and help her. I can see that she is spiraling and it’s really hard to see her going through this. I have suggested to her that she come and see you but she won’t do it. She says counselling is for crazy people and she’s not crazy. I did laugh at that and say ‘thanks for that’. When she realised and remembered I had come to see you she laughed a little and apologized but still won’t come”.
“You know Gwen, as hard as it is sometimes to accept, you can lead a horse to water but you can’t make it drink”, said Mrs. Wright with a look of understanding and concern for Gwen but also for Amy.
“What do you mean?” asked Gwen, not quite sure what the saying actually meant or how it applied to this situation.
“Well, it’s a saying that has been around a long time and like most of those simple sayings we’ve heard so many times before, there is a power in them. If we take the time to really understand what they mean and apply them to our lives they can help us cope better with some of the events and situations that life can throw at us sometimes. I can’t tell you how many people have come into counselling and told me about a friend or a relative who really needs help and support but who for some reason or another won’t go and get that support. Men are usually worse than women when it comes to this as they think counselling is for sissies, or they have grown up being told real men don’t cry. But we know that it’s the opposite and that real men can access and understand their emotions and know when to reach out for help before it’s too late. Unfortunately it seems women are not immune to this either as you have seen with your friend Amy”.
“I am still a little unsure about the saying though” Gwen smiled as she brought her counsellor back on track. This could happen from time to time with Mrs. Wright but she liked her quirkiness.
“Oh yes! Well, it is absolutely true of course that you can literally lead a horse to water that is thirsty and needs to drink in order to stay alive, but you can’t make it drink. Imagine trying to grab a horse by the mouth or neck and pushing its head to the water. No matter how hard you push, if that horse doesn’t want to drink, you aren’t going to achieve anything aside from maybe straining your muscles and being incredibly frustrated!” said Mrs. Wright.
Gwen couldn’t help but smile at the image of someone trying to force a horse to drink water.
“And so it is with people too Gwen. We can tell them what we know is good for them. We can give them information and material to read and explain how others have been helped by doing certain things but all the best intentions and efforts in the world will amount to nothing if the person is not ready to get help. If the person is not ready to admit they need help and then seek that help, there is not much we can do but just be a gentle reminder to them and keep reaffirming the message that help is available when they are ready”.
Mrs. Wright thought of another client she had helped a few years before who had come to see her only after he had been driving drunk and had ‘wrapped his car around a tree’ and miraculously survived. It was only then that the young twenty-three year old had decided that he needed to do something about his depression before it took his life. Mrs. Wright chose not to share this story with Gwen as she didn’t want her to worry unnecessarily about her friend.
“Do her parents know what is going on?” she asked.
“I’m not a hundred percent sure but I think they must know as they would have seen her withdrawing from netball and social outings. I guess I could try to talk to her mother if I get a chance when I am at her house?” Gwen asked.
“That may be a good idea, you may know things that are happening with Amy at school that they don’t but be prepared for Amy to not be happy about it. However, if you feel it will be in her best interests then go ahead”, Mrs. Wright suggested.
“The other thing I noticed is that she is sleeping a lot and always seems exhausted even though she tells me she has more than 8 hours of sleep a night and will often sleep in on the weekends” said Gwen.
“Yes, another major sign of moderate to severe depression Gwen. The problem with that being that unfortunately lethargy breeds lethargy. The depressed person has lost energy, pulled back from physical and enjoyable activities and thus feels less active and less energetic and so wrongly feels that more rest or sleep will help. Sometimes they don’t want to face the world and sleeping is a way of escaping. But this is what I call one of the major traps of depression. You must keep trying to encourage Amy to get out and do something, anything to get her out of the house. Unfortunately, what happens when people get depressed is their friends and family don’t know how to handle it so they stay away and that is the worst thing that you can do as a friend. This only increases their sense of isolation”.
“What if she gets suicidal?” Gwen asked, frightened by the prospect of this or even having to broach the subject with Amy.
“I know it may seem a very hard thing to do Gwen, but as a close friend, if you feel there is any possibility that she may be thinking about it, you must ask her. Just ask her if she has had any thoughts of self-harm. We call these thoughts ideation. They are very common with moderate to severe depression and while alarming to the people around the depressed person and sometimes quite alarming to the depressed person themselves, it is not unusual. It’s a cry for help. The time to get worried is if you ask the next question which is if they have a plan to carry out their ideation and you know they have the means to do it. If the answer is yes you need to get them immediate help from a doctor and psychologist. It doesn’t sound like Amy is at that stage of things but it doesn’t hurt to check. This is what you can do as a concerned friend if she is not yet willing to get help.”
“What if she doesn’t get help?” asked Gwen
“Another saying I like Gwen is: ‘When the student is ready, the teacher will appear’. She needs to be ready. She may need to hit bottom before she realises that she is the only one who can change her life by getting the help and support she needs. You can certainly reaffirm how counselling has helped you and that it has made a difference to you and helped you get on with your life. Sometimes a bit of self-disclosure can help because people realise they are not alone and that plenty of people go for counselling. Everyone needs to talk to someone who is not emotionally involved in their lives and that includes us psychologists! Someone who they can tell their deepest darkest secrets to or just say anything they need to say and express their feelings without fear of being judged or preached to”.
Gwen noticed Mrs. Wright was getting a little worked up on this point.
Mrs. Wright realised too and said, “Sorry, that’s my little soap box speech for the day” and smiled.
Gwen smiled too. “You’re right though, Mrs. Wright”. They both laughed at that.
“Okay, so how about you have a talk to her…” said Mrs. Wright.
“But I don’t know what to say to her, I don’t want to set her off” Gwen cut in.
“Well, it may be best to approach it by saying that you are concerned about her and that you have noticed some changes in her behaviour and any other changes you want to acknowledge. She may not even realise that people have noticed some of the changes. Then you could tell her again that you found counselling to be really helpful and how it has helped you get through a difficult time in your life. Tell her that you care about her and maybe offer to talk to her whenever she wants and encourage her to take up some running or netball sessions again. Explain to her how this will improve her mood because it will increase her serotonin levels which could possibly be part of why she is feeling depressed”.
“What are serotonin levels?” Gwen asked
“Serotonin is one of the chemicals in our brain and body that is involved in the creation of feelings of peace, happiness and enjoyment in life. Another important one is called Dopamine.”, explained Mrs. Wright.
“So are you saying Amy may have a chemical imbalance?” asked Gwen.
“Goodness no! This is a big issue in the field of psychology and psychiatry at the moment Gwen and it is so important to understand that depression and anxiety can be healed through natural means. And just because someone may have lower levels of serotonin does not mean they have a chemical imbalance that requires correcting through drugs. There are so many more options available to people before they should consider taking something like an anti-depressant” said Mrs. Wright, clearly showing this an issue she had some fairly strong views on.
“Like what?” asked Gwen.
“Well, there are so many things really. Most doctors and psychiatrists would not think of suggesting these things to people but I really recommend that you do mention them to Amy. She may feel more comfortable trying these natural ways first anyway and it is certainly the better way to go. We know through scientific evidence that cardiovascular exercise, something like jogging, swimming, cycling or anything that gets the heart rate up and works up a sweat will help to combat depression by increasing serotonin levels. Most people know this but it can be hard, as I said before, for depressed people to get going and do this. But it’s still very important and they only need to do this for 15-20 minutes, two or three times a week. This has been scientifically proven to increase serotonin levels so that’s always a good start. There are a few nutritional things that people don’t usually know about that can also contribute to depression. When we have been under stress for a long period due to any number of stressful life events, our levels of serotonin can be lowered. Stress releases cortisol into our bodies and this chemical can lower serotonin levels over time. The stress reaction can also deplete our levels of the essential B vitamins, especially Vitamin B6 and B12. These are essential for healthy brain function and are actually involved in the body and brain’s process of creating serotonin out of protein. So you could definitely recommend that she start taking a high potency Vitamin B complex” said Mrs. Wright.
“Oh okay, wow I didn’t know that. Maybe I should start taking Vitamin B too?” Gwen asked.
“Absolutely, it’s important for all of us. I take it every day without fail,”, said Mrs. Wright. “the other thing that is essential for effective brain function and mood regulation is getting enough Omega 3. The best way is through high quality fish oils and people who are depressed need to take about 600-800mg of EPA everyday”.
“I feel like I’m in biology class! This is a lot of information,” Gwen laughed.
“Yes, I know. I will write it down for you if you like.” Mrs. Wright offered.
“If you could that would be great. What is EPA?”
“Each capsule of fish oil has both EPA and DHA in it which are both types of fatty acids our brain and bodies need. It’s not really important what it stands for – I couldn’t pronounce it even if I wanted to! – but most of the commercially available ones have only about 180 EPA per capsule. People with moderate to severe depression need 600-800mg a day so they need to take about 4 capsules a day. There are higher potency ones with more EPA in them so you don’t have to take so many capsules. I take them each day at mid-morning with a fruit and then again after lunch. Best to take them with some food in the stomach”.
“Right. Well, that’s another one I will think about trying myself too” said Gwen.
“She should begin to see some results within a week or two but if not, she may need to add in exercise and counselling too. But again, you can take her to the water, you can tell her what will help her but unless she recognizes the need for help or trying something to help herself, it may not work. But Gwen, I want you to really get this. You can only do your best to help her. You can even go and buy her some fish oil capsules and Vitamin B but you can’t force them down her throat, just as you can’t force the horse to drink”
“Yes, I guess I can just try be there for her as you say and make sure she knows I am there to talk to whenever she needs”, said Gwen – looking a little more encouraged about what she could do to help her friend.
“That’s all you can really do and that may make all the difference in the world to her too. Never underestimate the power of having even one person show kindness, interest and caring towards someone who is suffering in order to help them heal and recover from emotional difficulties”, said Mrs. Wright.
“Absolutely. Once again Mrs. Wright, you are so right”. They both laughed again.
Gwen got up, stretched and thanked Mrs. Wright. She spontaneously gave Mrs. Wright a hug on the way out of the counselling office. Mrs. Wright blushed a little but was very touched and thought once again how lucky she was to do the work she did every day. As tough as it could be at times, making a difference to someone’s life always made it all worthwhile.
David Fox is a psychologist and the author of Change your Life! Hope and Healing for Anxiety and Depression.