All of a sudden your best friend stops calling. She no longer wants to join you for yoga on Saturday mornings. The last time you saw her she looked fragile and sad, like someone else was living in her body. Her husband doesn’t know what to do so he solicits your help in cheering her up.

Or maybe it’s your sister. She has been struggling with depression for a few months now. She’s been to a psychiatrist and is on an antidepressant, but she doesn’t seem to be making much progress.

What do you do?

I’ve been on the giving and the receiving end of kind-hearted attempts to lift depression more times than I’d like to count. While every case of this maddening mood disorder is unique and responds to different treatments, there are a few universal things you can try to guide your depressed friend or family member down the path of healing and recovery.

1. Educate yourself.

Although people are better educated on depression and anxiety today than they were two decades ago, we still have a long ways to go on understanding how the brain operates: why some people smile as they get run over by a truck, and others cry uncontrollably at the mere thought of that. It turns out that more is going on in our noggin than just a bunch of lazy neurotransmitters that can’t deliver messages to certain neurons.

You don’t have to be a neuroscientist to help a friend or a family member with a mood disorder, but some basic knowledge on depression and anxiety is going to keep you from saying well-intended but hurtful things. It’s just hard to help someone if you don’t understand what she is going through.

2. Ask lots of questions.

Whenever one of my kids gets sick or injured, I start in with a series of questions: Where does it hurt? How long have you felt bad? Does anything make it worse (besides school)? Does anything make it better (besides ice-cream)? Just by asking a few basic questions, I can usually get enough information to determine a plan of action.

With depression and anxiety, questions are crucial because the terrain is so vast and each person’s experience is so different. Your friend may be so desperate that she’s had a suicide plan in action for weeks, or she could just be under a lot of stress at work. She could be having a severe episode of major depression, or just need a little more vitamin D. You won’t know until you start asking some questions.

Here are a few to consider:

  • When did you first start to feel bad?
  • Can you think of anything that may have triggered it?
  • Do you have suicidal thoughts?
  • Is there anything that makes you feel better?
  • What makes you feel worse?
  • Do you think you could be deficient in Vitamin D?
  • Have you made any changes lately to your diet?
  • Are you under more pressure at work?
  • Have you had your thyroid levels checked?

3. Help her learn what she needs to know.

I used to rely on my doctors to tell me everything I needed to know about my health. I don’t do that anymore, because they don’t know me as well as my family and friends. Psychiatrists and psychologists have expertise in some areas, which can be critical feedback as a person begins to tackle the monster of depression; however, there is so much other valuable information tucked away in memories with friends and families that could guide a person out of despair.

For example, during this most recent relapse of mine, my older sister kept insisting that I probe into my hormonal imbalances. “You haven’t been well since you’ve had your kids,” she said. “Part of this depression has to be hormonal.”

My mom reminded me that thyroid disease runs in our family and suggested I get my thyroid checked out. Initially, I was annoyed with their opinions since it required more work on my part. When I couldn’t take the pain anymore, I sought out a holistic physician who could piece together my problems with my thyroid and pituitary glands and address the hormonal imbalances that contribute so heavily to my depression.

You know your sister, friend, brother, or father better than most mental health professionals, so help him solve the riddle of his symptoms. Together consider what could be at the root of his depression: physiologically, emotionally, or spiritually. Where is the disconnect?

4. Talk about stress.

You can be drinking kale and pineapple smoothies for breakfast, lunch, and dinner; meditating with Tibetan monks for eight hours a day; sleeping like a baby at night — and yet, if you are under stress, your veins are flooded with poison and your mind is under fire.

About five pages into every psychology book there is a paragraph that says that stress causes depression. I think it should be on page one. There is just no way around it.

Stress is bad, bad stuff, and as long as it’s pouring cortisol into your bloodstream, you aren’t going to get well. So one of the biggest jobs of a friend or relative of someone who is struggling with depression is to help the person construct strategies to reduce stress.

She doesn’t need to quit her job. She can keep her kids. However, she may need to make some significant lifestyle changes and be sure to introduce self-care into every day. What is that? Five-minute breaks here and there to take some deep breaths, or an hour massage once in awhile, or maybe a day off here and there to sit by the water, golf, or go for a hike.

5. Talk about support.

It doesn’t matter what the illness is — cardiovascular disease, colon cancer, fibromyalgia — a person needs support in her life to fully recover: people with whom she can vent and swap horror stories, folks who can remind her that she is not alone even though her symptoms make her feel that way.

Research shows that support groups aid the recovery of persons struggling with depression and decrease chances of relapse. The New England Journal of Medicine published a study in December 2001 in which 158 women with metastatic breast cancer were assigned to a supportive-expressive therapy. These women showed greater improvement in psychological symptoms and reported less pain than the women with breast cancer who were assigned to the control group with no supportive therapy.

Brainstorm with your friend on ways that she can get more support. Research and share with her various groups (online — like the Facebook group I started — or in town) that she might benefit from.

6. Remind her of her strengths.

Just yesterday morning I was having suicidal thoughts during yoga. It was one of those painful hours when I couldn’t stop thinking about how soon I could die. Instead of being gentle with myself, I started comparing myself with a few incredibly accomplished people I swim with — the kind of people who swim across the English Channel for giggles — and tend to make the average person feel pathetic.

Later in the day, I went for a walk with my husband, still fighting the death thoughts as we strolled along the rocks bordering the Severn River at the Naval Academy, our favorite route. We were talking about how jealous we were of couples who didn’t have kids (in some ways, not all), how damaged we feel after 13 years of parenting, but how much we’ve evolved as human beings because of all the struggles we’ve endured in that time.

“You’re strong,” he said.

I balked. “No, no I’m not,” I said. I was thinking strong meant swimming the English Channel, not fighting suicidal thoughts in yoga.

“Yes, you are,” he insisted. “You have a 200-pound gorilla on your back constantly. Most people would roll over and give up, coping with booze, pot, and sedatives. Not you. You get up and fight it each day.”

I needed to hear that. In my head, I categorize myself as weak because of the constant death thoughts, when, in reality, the fact that I can accomplish stuff in spite of them means I’m strong.

Remind your friend, sister, brother, or dad of his strengths. Bolster his confidence by recalling specific accomplishments he’s made and victories he’s won.

7. Make her laugh.

As I mentioned in my post “10 Things I Do Every Day to Beat Depression,” research says that laughing is one of the best things we can do for our health. Humor can help us heal from a number of illnesses.

When I was hospitalized for severe depression in 2005, one of the psychiatric nurses on duty decided that one session of group therapy would consist of watching a comedian (on tape) poke fun at depression. For an hour, we all exchanged glances like “Is it okay to laugh? I sort of want to die, but this woman is kind of funny.” The effect was surprisingly powerful. Whenever the “black dog” (as Winston Churchill called depression) has gotten hold of a friend, I try to make her laugh, because in laughing, some of her fear and panic disappears.

8. Pass on some hope.

If I had to name one thing a person (or persons) said to me when I was severely depressed that made me feel better, it would be this: “You won’t always feel this way.” It is a simple statement of truth that holds the most powerful healing element of all: hope. As a friend or family member, your hardest job is to get your friend or brother or dad or sister to have hope again: to believe that he or she will get better. Once his or her heart is there, his or her mind and body will follow shortly.

9. Listen.

You could disregard everything I’ve have written and just do this: listen. Suspend all judgments, save all interjections — do nothing more than make excellent eye contact and open your ears. In her bestselling book, “Kitchen Table Wisdom,” Rachel Naomi Remen writes:

I suspect that the most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention. And especially if it’s given from the heart. When people are talking, there’s no need to do anything but receive them. Just take them in. Listen to what they’re saying. Care about it. Most times caring about it is even more important than understanding it.

Originally posted on Sanity Break at Everyday Health.