How to Help Someone With Depression

If they are not safe, or you cannot tell: in the UK, 999, or 111 and choose the mental health option (in England, Scotland and Wales). In Northern Ireland, Lifeline on 0808 808 8000. In the US, 911, or call or text 988. Stay with them if you safely can.

If they have stopped replying: the charity Mind suggests a text or an email to let them know you are thinking of them, without pressure to reply. If the silence frightens you, call a line for yourself.

None of four reviews of the research found that asking plants the idea. But the authors of one, Polihronis and colleagues, say more well-run trials are needed before that can be stated firmly.

Dazzi and colleagues reviewed 13 studies covering adolescents and adults, in general and high-risk populations. Not one found a statistically significant increase in suicidal thinking after someone was asked, meaning an increase bigger than chance alone might produce.

Blades and colleagues then pooled 18 studies and found a small decrease in suicidal thinking, and lower odds of subsequent suicidal behaviour. DeCou and Schumann pooled 13 prospective studies, which followed people up after asking them, and found no significant harmful effect. Polihronis and colleagues reviewed 17 studies and pooled the results of 8, and found no significant harm to later suicidal behaviour, self-harm or distress.

All of this evidence was measured in research and clinical settings, so it shows that the question did no measurable harm there, not that your asking tonight will reduce risk.

The guidance agrees that the question should be plain, not a plea with the answer built in. "You're not thinking of doing anything stupid, are you?" is easy to say no to, which is why trainers warn against it. No trial has compared the wordings, so "are you thinking about suicide" and "are you having thoughts of ending your life" are recommended on consensus rather than evidence of superiority.

Do not promise secrecy you may have to break.

If suicidal thoughts are present, the thing with evidence behind it is a written safety plan the person makes with a clinician. The plan covers:

• the warning signs they notice first
• what they can do alone
• the people and places that distract them
• who to tell
• which professionals and lines to call
• a step on making their surroundings safer

Stanley and Brown's version was compared with usual care across nine Veterans Health Administration emergency departments. Over six months, suicidal behaviour occurred in 3.03% of the 1,186 patients offered the plan plus structured follow-up. It occurred in 5.29% of the 454 who got usual care. So the plan's rate was a little over half. It is a cohort comparison: patients were grouped by hospital, not by chance as in a randomised trial. It was in a mostly male veteran population, so the size of the effect elsewhere is not established.

Your role is to be one of the named contacts, to help them find the plan when they need it, and to help with the step about their surroundings.

Mind and the US National Institute of Mental Health advise making the surroundings safer, and so does the safety-plan format itself. That means reducing access to the things the person could use, particularly anything they have named themselves. How to do that in a particular house is a question for their clinician or a crisis line.

None of what follows has been tested as wording. It comes from what charities recommend. Beyond Blue says its list came from asking people who had been through anxiety and depression what helped them most. That is real evidence but weaker than a trial.

Lines the charities suggest:

• "I'm sorry you're feeling like this, and I'm here for you." (Mind)
• "How are things? I've noticed you don't seem quite yourself." (Samaritans)
• "I can see this is a really hard time for you." (Beyond Blue)
• "What can I do to help you today?" (Mind)

Mind suggests asking something more specific if you can, such as "Would you like me to come over and keep you company?" Beyond Blue's reason for taking the initiative is that someone may be too overwhelmed to know what help to ask for. Nobody has tested a specific offer against an open one.

Samaritans warn against "I'll be so upset if you die." They want the person told that they matter without being made to feel guilty. Rethink's page for supporters goes the other way. It suggests focusing on the people they care about and who care about them, and on who they might hurt by leaving them behind. Nobody has tested either approach.

Listen before you solve. That instruction is unanimous across the guidance and it is consensus rather than a tested comparison. Samaritans and Rethink warn against giving advice, while Mind and Samaritans recommend helping with practical things, and Mind names taking them to appointments. Driving them to an appointment is not advice.

The guidance here is not to argue. Do not start listing reasons to live on their behalf. Rethink suggests instead asking about their reasons for living and for dying, and listening to the answers. It also suggests encouraging them to focus on getting through the day rather than the future.

A sequence built on that advice, in this page's own words and not a tested protocol: "That sounds unbearable. I'm glad you told me." Then the direct question about suicide. Then, if the answer is yes, "Thank you for telling me. I want you to stay safe. Can we get help together right now?"

Fernandez y Garcia and colleagues sorted what family and friends had said into four themes: feeling labelled, judged, lectured and rejected. They ran 15 focus groups in three US cities. The groups took in 116 people who had been depressed themselves or had a close friend or relative who had. They were about what stops people seeking care, and those remarks came up unprompted.

The authors read the lecturing messages, such as "snap out of it" and "it's all in my head", as telling people their symptoms were under their control. They read messages about life circumstances, such as "you've got so much to be glad for", as judging them for having no reason to be depressed. Mind and Rethink warn against both kinds, from "just think positively" to comparing someone with people who have it worse.

The US National Institute of Mental Health advises walks together, and Australia's healthdirect advises gratitude journaling. Both assume someone who can still do them. The NHS page itself notes that people who are depressed may find it difficult to leave their home. For someone who has stopped getting out of bed, what these pages offer comes down to safety, keeping in contact, food and a route to a doctor.

In England and Wales an adult can refuse treatment if they have capacity, meaning they can understand the information and use it to decide. The exception is the Mental Health Act. Someone can be assessed and detained in hospital if they are a serious risk to themselves or others because of their mental health. A detained patient can be given most treatment for their mental disorder without consent, whether or not they have capacity. But someone with capacity can refuse electroconvulsive therapy except in an emergency.

In the US, each state sets its own rules for involuntary commitment, a court order for psychiatric treatment in hospital or outside it. They turn mainly on danger to self or others, or in most states on being unable to meet basic needs, rather than on capacity.

No trial in depression has compared asking again with backing off. Rethink's advice is to try to be persistent, because people change their minds over time. But that is advice, and anyone who tells you the research says keep pushing, or says back off, is extrapolating.

Put together from Rethink's, Mind's and Samaritans' pages, and untested as a package: stop arguing about the label, find a problem they will accept help for instead, offer to go with them to that appointment, keep making contact, and set your own limit. Rethink's own example is sleep. Someone who will not see a doctor about depression may agree to see one about not sleeping, and that may give the doctor a way to ask more.

If safety is the concern, you can call a crisis line about someone else. Samaritans will speak to you, and if you ask, a volunteer will call the person to see if they want to talk. In England, NHS 111's mental health option takes calls about another person, and so do Lifeline in Northern Ireland and 988 in the US.

A 2023 study of 956 older Korean couples counted milder depression as well as major depression. Among the spouses of people with depression, 27% were depressed themselves, against 8% of the other spouses. Earlier studies of couples of all ages found a smaller increase in risk, the study notes. About a third of the link ran through things the couples shared, such as support and chronic illness. The study could not say how much of the rest is emotional contagion, one spouse catching the other's mood, rather than other shared circumstances or people choosing partners like themselves.

The 2018 Cochrane review of couple therapy covered 14 studies and 651 participants; Cochrane is a global network that reviews health research. Against individual psychotherapy it found no difference in depressive symptoms, at end of treatment or at six months. It appeared to reduce relationship distress more than individual therapy did. Quality was low to very low throughout. So it is a reasonable thing to ask a clinician for when the relationship is part of the problem, and it is not a better depression treatment.

In England, once they are in treatment, staff must respect their wish to keep details from you, while you remain the person who gets the call at 2am. You can still be told about support for carers and about your right to a carer's assessment, and confidentiality can be set aside where someone is at serious risk.

England's National Institute for Health and Care Excellence (NICE) has guidance on people's experience of adult mental health services. It says that if the person wants their family involved, staff should negotiate what is shared and keep revisiting it. That is worth asking for by name at an appointment they agree to take you to.

NICE's self-harm guideline covers children and young people as well as adults. For a teenager who has self-harmed, it tells staff to share information with family members or carers as appropriate. That includes what care plans and safety plans involve and what to do in an emergency. The guideline also tells staff to offer the family information and support of its own.

Weissman and colleagues followed 276 offspring of depressed and non-depressed parents for up to 38 years. In their words, the higher rate of depression in children of depressed parents is one of the best replicated findings in psychiatry. By the last interview, 65% of those with a depressed parent had experienced major depression, against 33% of the others.

In a study by Belgian researchers, 21 young adults who grew up with a depressed parent recalled childhoods spent mainly on keeping the family going. They rarely thought about their own experience until adolescence. When the supporter is a child, the step this research points to, on this page's reading of it, is for an adult to take that role back.

In England, a child caring for a parent has a right to a young carer's needs assessment from the council. The council must consider whether it is appropriate for the child to be providing that care. Local young carers' services also exist to help.

The same confidentiality rules apply to friends as to family.

Mental Health First Aid is a course that teaches community members to support people with mental health problems.

Morgan, Ross and Reavley pooled 18 controlled trials and 5,936 participants. People who took the course ended up knowing more, better at recognising mental illness, more confident about helping and with firmer stated intentions to help than the comparison groups. The gains were generally small to moderate, and most were measured within six months; only two of the trials went further. The help trainees went on to give changed less: slightly more of it by six months, and no clear sign that it was better help.

A 2022 review of nine controlled studies found mixed effects on trainees using the skills. It found no effect on how helpful their actions were or on the mental health of the people they helped. The 2023 Cochrane review, covering 21 studies and 22,604 participants, could not draw conclusions about the people around trainees. In the three trials that measured those people's mental health six to twelve months later, the course may have made little or no difference compared with no training. The evidence is very uncertain.

Take the course to know more and to recognise mental illness better. None of the three reviews found a benefit to the mental health of the people trainees help.

Family psychoeducation means structured sessions for relatives, often with the patient in the room, on what depression is, how to talk about it, problem-solving and coping.

For the patient, there are signs it helps. A Japanese trial gave four sessions to the relatives of patients who had recovered enough to be out of the depressive episode, most with some symptoms left. Over nine months, 2 of 24 patients relapsed against 15 of 30 (8% against 50%). It was small and drawn from one medical school and its partner hospital. It also compared the sessions with no extra support at all, so its authors could not rule out that meeting a supportive group did the work.

A 2022 pooled analysis covered five other trials, with 301 patients and their families. It found an improvement in patients' symptoms that its authors call small, and graded the evidence very low certainty.

For you, the evidence is mixed. The pooled analysis found no significant effect on family members' distress, but only one of its trials measured that. That trial was built to test it, in 49 families of patients whose depression had lasted more than a year, with the relatives' distress measured at 16 weeks. It found no significant difference in distress or in the relatives' sense of burden. The authors put that result down partly to relatives who were only mildly distressed to begin with and a trial too small for the effect.

A larger US trial randomised 318 relatives of adults with a mental illness. Each was assigned to the 12-week Family-to-Family course of the National Alliance on Mental Illness (NAMI) or to a wait for the next one. By the end of the course, those who took it reported less distress, though only in exploratory analyses, and no less sense of burden. The trial's authors said the drop in distress needs repeating in another study.

The largest trial, published in 2025, tested an online course. In Germany, 1,640 relatives of people with depression were randomised to four self-help modules, with emails from a psychologist or automated messages, or to information leaflets. The relatives started at about 23 on a distress scale scored from 10 to 50. In four weeks, the course groups' scores fell by about 1.7 to 2.3 points. With the leaflets, they fell by about 0.8, and the gap held at three months.

The relatives rated themselves and knew which group they were in, and about a third did not report the four-week score. So one large trial found that an online course eased relatives' distress a little.

A 2026 analysis pooled 11 studies and 1,366 caregivers. On the Zarit Burden Interview, a burden scale scored from 0 to 88, it put their average score at 38.15. Its authors read that as approaching moderate burden. The studies differed so much that a new study's average could plausibly fall anywhere from about 20 to 57.

In focus groups in six Australian cities, 37 carers and family members of people with depression described caring as intense and persistent. They described a constant watch over the person's safety, never being off duty and not knowing what each day would bring. Friends and relatives, they said, backed away from them as well as from the person they cared for. Beyond Blue's guidance for supporters says the role may bring resentment, frustration and anger.

Mind tells supporters to set boundaries, not to take too much on, and to share the caring role with others if they can. Beyond Blue tells them to decide what support they can provide and for how long, and to ask other people to help as well.

If you are the only person holding safety, safety needs more than one holder, though that is reasoning rather than a trial result. Recruiting a clinician, a crisis team or another relative is not withdrawal. Stepping back from being the treatment is different from stepping back from the relationship, and stepping back from the relationship hurts. A review of 19 qualitative studies, which collect people's own accounts rather than numbers, found people with depression describing feeling alone or abandoned within their own families.

1. Ask directly whether they are thinking about suicide. Four reviews found no sign that asking raises the risk.

2. If there are suicidal thoughts, help them make a written safety plan with a clinician, and be one of the names on it. Do not settle for a promise instead.

3. Make specific offers rather than open ones, as Mind suggests.

4. Listen before suggesting. Doing a concrete task, such as driving them to an appointment, is not advice.

5. Do not tell anyone to snap out of it, think positively or count their blessings.

6. Nobody has tested whether to ask again after a refusal. Rethink advises trying again, since people change their minds, but that is advice.

7. Mental Health First Aid improves what you know more than what you do. No review has found that it helps the mental health of the person you are worried about. Family psychoeducation may help them, and one large trial found that an online course eased relatives' distress a little.

8. Carers of people with depression report a substantial burden and describe exhaustion, and Beyond Blue names resentment too. You need other people holding this with you, and that is different from leaving.

Asking someone directly whether they are thinking about suicide has not been found to raise their risk. Four reviews of the research found no significant increase in suicidal thinking or behaviour after people were asked. But all of that evidence was measured in research and clinical settings rather than at home. A written safety plan has more behind it than a promise, on one small trial and a larger study in veterans' emergency departments that was not randomised.

Most of the everyday advice has not been tested. No trial has tested what to say to someone who is depressed, whether to press after a refusal, or a specific offer against an open one. That guidance comes from charities and from what people who have been depressed say helped.

Mental Health First Aid raises knowledge and confidence, but no review has found a benefit to the mental health of the people trainees help. Family courses may help the patient, and one large trial of an online course found a small drop in carers' own distress.

Download the conclusion

The verdict above as one image, with the one published trial that compared a crisis response plan with a promise. In it, about 5% of the soldiers given a plan attempted suicide within six months, against about 19% of those asked for a contract for safety. It is 1,080 by 1,350 pixels, and anyone may download it and post it.

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