Depression no support

SAMHSA’s National Helpline | SAMHSA

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

  • Suggested Resources

    What Is Substance Abuse Treatment? A Booklet for Families
    Created for family members of people with alcohol abuse or drug abuse problems. Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.

    It's Not Your Fault (NACoA) (PDF | 12 KB)
    Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

    After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
    Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.

    Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
    Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

    For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

Recovery and Recovery Support | SAMHSA

Recovery and Resilience

Resilience refers to an individual’s ability to cope with change and adversity. Resilience develops over time and gives an individual the capacity not only to cope with life’s challenges but also to be better prepared for the next stressful situation. Psychological resilience, the ability to cope with adversity and to adapt to stressful life events, varies widely from person to person and depends on environmental as well as personal factors. It refers to positive adaptation, or the ability to maintain mental and physical health despite participating in stressful situations. Resilience is playing up those protective factors so they can outweigh the risk factors. Optimism and the ability to remain hopeful are essential to resilience and the process of recovery.

Because recovery is a highly individualized process, recovery services and supports must be age appropriate and offered over the life course and flexible enough to ensure cultural relevancy. What may work for adults in recovery may be very different for youth or older adults in recovery. For example, the promotion of resiliency in young people, and the nature of social supports, peer mentors, and recovery coaching for adolescents and transitional age youth are different than recovery support services for adults and older adults.

Recovery and Relationships

The process of recovery is supported through relationships and social networks. This often involves family members who become the champions of their loved one’s recovery. They provide essential support to their family member’s journey of recovery and similarly experience the moments of positive healing as well as the difficult challenges. Families of people in recovery may experience adversities in their social, occupational, and financial lives, as well as in their overall quality of family life.

These experiences can lead to increased family stress, guilt, shame, anger, fear, anxiety, loss, grief, and isolation. The concept of resilience in recovery is also vital for family members who need access to intentional supports that promote their health and well-being. The support of peers and friends is also crucial in engaging and supporting individuals in recovery.

Peer support assists individuals to engage or stay connected to the recovery process through a shared understanding, respect, and mutual empowerment. Peer support extends beyond the reach of clinical treatment into the everyday environment providing non-clinical, strengths-based support. This relationship can help lay the foundation for SAMHSA’s four dimensions of recovery.

Recovery Support

SAMHSA advanced recovery support systems to promote partnering with people in recovery from mental and substance use disorders and their family members to guide the behavioral health system and promote individual, program, and system-level approaches that foster health and resilience; increase housing to support recovery; reduce barriers to employment, education, and other life goals; and secure necessary social supports in their chosen community.

Recovery support is provided in various settings. Recovery support services help people enter into and navigate systems of care, remove barriers to recovery, stay engaged in the recovery process, and live full lives in communities of their choice.

Recovery support services include culturally and linguistically appropriate services that assist individuals and families working toward recovery from mental and/or substance use problems. They incorporate a full range of social, legal, and other services (PDF | 409 KB). that facilitate recovery, wellness, and linkage to and coordination among service providers, and other supports shown to improve quality of life for people (and their families) in and seeking recovery.

Recovery support services may be provided before, during, or after clinical treatment, or may be provided to individuals who are not in treatment but seek support services.

These services, provided by professionals and peers, are delivered through a variety of community and faith-based groups, treatment providers, schools, and other specialized services.  The broad range of service delivery options ensures the life experiences of all people are valued and represented.

For example, in the United States there are 34 recovery high schools that help reduce the risk in high school environments for youth with substance use disorders. These schools typically have high retention rates and low rates of students returning to substance use.

Additionally, SAMHSA's Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) advances effective recovery supports and services for people with mental or substance use disorders and their families.

Find more Publications and Resources on Recovery and Recovery Support.

Save me carefully - Such things

  • Psychology
  • Context
  • Monologues
  • 04. 03. 2019

What to do if a loved one has depression? What if a person does not want help, does not want to be seen, how not to drown himself, trying to save another?

The author of this text is not a journalist, but a business analyst. That is why she hid her real name, but could not help but share her pain.

Finding reliable statistics on depression in Russia is difficult. As of the beginning of 2017, in Russia, the disease was detected in 5.5 percent of the population. This is a lot, consider every twentieth. These statistics include my father and not me: the statistics do not take into account those who did not apply to state institutions.

By the time my dad showed visible symptoms of depression, I was already in treatment. But even understanding what I needed to do with myself, I had no idea how to react to what my mother described on the phone.

My father committed suicide. The family fell apart after that: it is difficult to avoid the questions “why?” and mutual accusations, it is difficult to listen to “what if…” and not delete people from your life. In moments when you want to die and think that everyone will be better off without you, you can’t imagine what hell will come for your loved ones later (although it’s still very hard for them now). For me, everything ended differently: I was lucky. I came to the doctor on time, in my environment it was not considered shameful to seek help, I had a permanent job and support, I, in the end, was younger and did not have time to acquire some of the hard memories and regrets.

Now, after the second year of remission, I have tried to compile a list of things that, in my opinion, help to understand what is happening, seek help and organize life so that it is as less painful as possible for a person in depression.

The first signals

Depressive-specific signals can be seen in what a person says and how he organizes his life. I have never told my relatives that I do not want to live and I carefully look at the rails in the subway. But the number of "funny" pictures sent to friends, showing how useless and out of place I am in this world and how fun it would be to disappear, is comparable to the collection of a small museum.

See also How to help a person with depression What to say to a depressed friend and what not to say

Sometimes there are obvious physiological symptoms, such as trouble sleeping. If a person constantly (more than three days in a row) sleeps less than five hours a day due to the fact that he cannot fall asleep or often wakes up at night, this is a serious reason to see a doctor. The situation is similar with changes in eating habits: if a person constantly forgets to eat or regularly overeats, this may be a sign of a disorder.

Depressive states can last for a very long time, so you should not focus only on recent changes in behavior. If a person "has always been like this", then perhaps he has just been ill for a long time. For example, I did not remember myself different, and then it suddenly turned out that it was not necessary to wade through pain and meaninglessness every day.

How to start treatment

The most helpful thing you can do is help the person see a doctor. If the situation is severe (the symptoms described above are persistent and last more than two weeks), go to a psychiatrist first. More precisely, to an ordinary therapist for a referral, and then to a psychiatrist. It is he who makes the diagnosis and can pick up medicines if they are needed.

Before you go to the doctor, it is important to make a list of observations that concern you: sleep and eating disorders, tremors, anxiety, depression, panic attacks, apathy, aggression, constant fatigue, and so on. A doctor's appointment is an unusual event, you need to get together and prepare for it: have a factual base with you that will show what and how long is happening behind the doors of the office.

If the specialist devalues ​​the problem, intimidates or, in the case of the therapist, the person is uncomfortable with him, go to another.

It was about the normal, calm course of things. If the situation is such that hospitalization is needed, you can come to a neuropsychiatric dispensary or a psychiatric hospital and directly ask. It’s good if you know what kind of hospital this is, whether it has additional services (paid wards, over-the-counter psychotherapy, and so on). And do a fluorography in advance - they won't accept it without it. Remember: if there was a suicide attempt, but it was not recorded, then you may be denied hospitalization and, possibly, treatment that is critical at this moment. Therefore, if you consciously decide not to call an ambulance, you are not doing the person a favor.

And if he is not ready to go to the doctor

It is necessary to tell that this condition is being treated. Of course, you have no idea what the person feels, but you see that it is hard for him: he has insomnia, anxiety, he drinks pills without a prescription (substitute the necessary symptoms).

You are worried and want to help. Because he is dear to you. You may know stories when people with similar symptoms got better. This is not easy, not fast, it often requires the help of a doctor, but sometimes such persuasion works.

Be prepared to talk about problems. Take it seriously, even if they seem funny to you. For me, for example, for a long time it was a problem to call a stranger. Even to the help desk. And the phrases: “Lord, what’s so difficult about this?”, “I would like your problems” and “Well, look at Vasya, he generally stutters, but he can” - they didn’t help me at all. Just because a person shared a problem with you doesn't mean you should be looking for a solution right now. The fact that you listened to a person and agreed that it is hard for him is very valuable in itself.

Get ready to talk about something else, like how koalas can swim, how scientists got new pictures of Mars, or Marvel is releasing a new movie. It is important for a person to be distracted - he already spends a lot of time alone with himself and his problems. Talk about something abstract, unexpected and fun. You should not provoke conversations about the patient - the psychotherapist will cope with this.

Do not interfere with treatment unless absolutely necessary. If a person contacts a psychotherapist via Skype from your shared apartment, go for a walk for this time. It's not even that something very personal is being discussed at such moments, but that then you don't look your best: tired, desperate, sad and you don't want anyone to see you in this state.

If you don't like what is happening to the person, you can discuss it with him or your doctor. But please, you don't need to ask a person to stop drinking pills if you don't like something that is not critical for his condition. I was asked, begged and threatened with health problems in the future. And it was scary, because before the pills I didn’t have a “future” and I didn’t understand how to explain this to my relatives.

Gaining normal weight is not a reason to quit pills. Lack of sexual interest is not a reason to quit pills. The person decided to undergo treatment not because he wanted the sky in diamonds, but because the state of the brain makes his life unbearable. Don't force the person to choose between the treatment they need and your approval.

From the project “Into the Void” Photo: Svetlana Sofyina

One of the exciting questions: "How to understand that the treatment helps?" I still don't know how to answer it. Much depends on the symptoms. In my case, after a month, sleep and nutrition more or less recovered. The effect on the internal state became visible after about a year: I caught myself thinking that I was not afraid to go to the store, that I was not tormented by thoughts of the iron not being turned off, I laughed louder and sobbed less at night. In any case, this is not a quick process and you should not expect results tomorrow, neither from pills, nor from therapy.

How to organize your life

Good sleep, healthy eating, movement and bright lighting during the day contribute to recovery. It is also important not to run elementary household items.

Everything that promotes good sleep: a routine, thick curtains, a comfortable mattress and pillow, avoiding gadgets an hour before bedtime will help you recover better. A bonus can be a heavy blanket - weighing from 10 to 17 kilograms, filled with plastic balls or buckwheat. It has a soothing "hugging" effect and is supposed to help with anxiety, but research doesn't show how true this is. I feel more comfortable with him, but perhaps this is a placebo effect.

Of course, it is difficult to influence nutrition if you do not live together. You can try to start a tradition of joint lunches or dinners, offer to subscribe to food services. One of my colleagues directly approached and asked if I had dinner today, and if not, he brought me food. It was wonderful: the feeling that you were taken care of.

Physical activity is very important, it naturally increases serotonin levels. Both a gym membership (swimming pool, yoga classes, dancing) and just walks will help here. If possible, go together - this way there will be less temptation to miss. Well, if a person can be in the sun more often, and the lighting in the rooms is bright, this also helps to recover.

Ask if you can help with something - with treatment, with household chores. And help. Do not impose if the person refuses: you are unlikely to persuade him at this moment. From time to time, there may be a desire to do something for (and for) a person - after all, it will not be easier for anyone if they are evicted from an apartment or their water is turned off. But remember that it is important for your friend to make decisions and feel in control of what is happening in his life, even if it is just a sock that is not in its place.

And, of course, positive emotions will help. Ask him what he likes - food, activities, series, books. Try to remember what he liked before, perhaps even in childhood. Drawing, reading, concerts, meeting old friends, movies, animals, tea and pancakes on your favorite couch. Arrange a small holiday for your loved one (and yourself). Nevertheless, it is better not to offer something that will require a lot of effort from a person, such as a noisy party. And there is no need to insist if a person refuses. He understands better what he needs now.

From the project “Into the Void” Photo: Svetlana Sofyina

Two other things helped me a lot: meditation and pets. I learned to meditate through the app, I practiced every day for ten minutes. You can find meditation recordings on YouTube and yoga websites. Pets help organize, require constant interaction, and show they love you (or their food, but that doesn't matter). Therefore, if you live together and have long wanted to get a dog, do it. But please, don't drag the kitten to another person if he didn't ask you to.

Help someone who helps

Depression exhausts not only a person, but also his relatives. Remember the rule "first put the oxygen mask on yourself, and then on the child. " Find a psychologist or psychotherapist for yourself. Find someone you can tell what's going on without fear of the information falling into the wrong hands. Ask him for help - it is very difficult to support a person in depression, you do not need to try to survive it alone. Create a safe space for yourself, where there is no sick person and his problems. Make your life more enjoyable.

It is not worth making the recovery of a person the meaning of your life - this will not help either him or you. In addition, when you try too hard to help, and the person does not feel better, then he begins to feel guilty.

What to do if a loved one is depressed: a psychologist explains

Reason and feelings

How to behave if a loved one is depressed? Psychologist explains

Adriana Imzh

14 December 2016 14:31

Afisha Daily continues to seek advice from psychotherapist Adriana Imzh. This time we figure out how to behave if your friend, relative or loved one is depressed: is it worth feeling guilty for what is happening, will support and participation help him, and what to do if you are angry with him.

Writer Ella Derzai, when reading psychological materials on this topic, suggested replacing the word "depression" with the word "leprosy" - simply because many journalists do not try to figure out the meaning of this word. It seems to me that this approach well illustrates the difficulties of getting the name of the disease beyond the boundaries of psychiatry (when the word begins to denote a number of things that have nothing to do with the original problem). Imagine materials like "Ten Hot Drinks for Leprosy" or "How to Avoid Winter Leprosy?"

So what is depression? Depression is very different.

First, there are three levels of depression—mild, moderate (clinical), and severe (chronic). Mild depression usually goes away on its own in 2-3 months, medium depression can go away on its own or turn into severe depression, if it goes away on its own, then in six months to a year. As a rule, mild and moderate depression can be treated with a psychologist without the use of drugs, but with the use they are faster and easier.

You can no longer confuse severe depression with spleen: a person has a difficult time when he takes great care of himself, including in the sense of hygiene, it is difficult for him to get up, wash dishes, brush his teeth, clean the apartment, leave the house . In very bad situations, he forgets to eat and may die of hunger.

There is a masked depression - this is a depression in which a person is overly cheerful and constantly busy with something so as not to feel how bad he is, how tired and sad he is. This usually leads to a breakdown and the transition of depression to a severe stage.

Depressions are also of different types according to sensations. For example, asthenic depression is a severe loss of a resource due to (usually) heavy workloads and stress. It is characterized by an unpleasant feeling of a weight hanging from you, an inability to rejoice (you wake up in the morning - and it feels like you just worked two shifts in the mine).

Anasthenic depression, or depression with derealization, is characterized by a feeling that the world is not real, the walls are cardboard, the view outside the window is drawn, feelings have died out forever, the world has frozen. This type of depression can also accompany more severe mental diagnoses, such as schizophrenia. Also, depression can be with bipolar disorder - and in the other pole, a person is cheerful and full of energy.

Depression can be caused by a hormonal imbalance after childbirth or due to menopause and aging (in a number of modern countries, antidepressants are automatically prescribed for older people). Such depressions include, for example, postpartum depression.

Endogenous depression is caused by internal biochemical processes in the body, usually leads to lifelong medication, because the body is simply not able (or has lost this ability) to produce the necessary substances on its own. Sometimes - very rarely - such depression leads to such severe conditions that it may be the basis for euthanasia in countries where this is possible.

Atypical depression is usually accompanied by a number of other symptoms that are uncharacteristic of ordinary depression, such as severe anxiety, increased appetite (usually, patients have a reduced appetite before taking antidepressants), and severe somatic pain.

Depression also differs in causes. Psychogenic depression is caused by severe stress, and psychotypical depression is caused by a predisposition of the nervous system and head injuries.

Also, depression can be childish and adolescent (in this category of patients, it usually occurs as a result of severe trauma - a terrible divorce of parents, school bullying, natural or man-made disasters, wars).

This is our set - quite diverse in terms of reasons, ages, statuses and manifestations.

Finding recommendations for relatives of all patients with depression is quite difficult. Therefore, it is probably worth starting with an understanding of what kind of depression your loved one has, how long it lasts and what is needed for it to pass.

For example, with asthenic and psychogenic, as well as with childhood and adolescent depression, rest and recovery, love and support of loved ones, hope - hope is very necessary - and faith in a brighter future. Over time, the body will recover itself. And while he is recovering, in general, the approach is the same as with a severe flu - remind him to take pills, hold his hand, stroke his head and sympathize with what is happening.

In more severe cases, care is very necessary: ​​people in this state really find it difficult to do even household chores, and when taking antidepressants, when the body begins to recover, drowsiness also increases (and, as a rule, libido is depressed). Therefore, such things as many hours of sex, extreme sports, a trip to Burma for a week, snowball fights and long shopping trips will not lead to the fact that Princess Nesmeyana will come to life, but to the fact that she will turn into the shadow of Hamlet's father, which can only cursing indistinctly. He will also get sick for sure with something - from a banal cold to some exotic inflammation of the Achilles tendon and neuralgia.

If you are not the cause of depression in a person (you have not betrayed, you have not divorced, you have not tried to drown yourself in acid in a Joker costume), do not blame yourself. Depression, like cancer, is caused by a complex combination of different factors, and you are probably not the most important person there.

On the contrary, the ability to stay with a person in depression without depreciation (are you completely lazy?) is a jewelry art that is far from accessible to every person, even if he has a special education.

And it seems to me that an important factor in being around a depressed person is taking care of yourself. Remember that living next to someone who is constantly worried, afraid, or crying is also not easy. Do not lock yourself at home with him, otherwise depression will defeat you too. Look for support in work, friends, trips to nature (if it makes you happy), shopping, skydiving, watching funny comedies - in general, do not forget about yourself. Your life goes on - as does the life of a person with depression.

Don't forget to respond to aggression. If you are an ordinary active person who is used to living and enjoying life, then a slow, whiny, tired and weak person, who at the same time has not lost either arms or legs, will cause you a lot of irritation.

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