Dear Rachel,

I am worried about my friend and fear that she is depressed. She has a few kids fairly close in age, and since her second child was born, her whole personality has changed. Life has become one big burden for her. She never goes anywhere. She is always tired, and lies on the couch all day. We grew up together, and it hurts me so much to see how she has changed. It seems like she doesn't enjoy her life anymore; she just endures it. The question is whether I should say something. I love her too much to say nothing, and yet I am afraid that she will just be insulted, and feel criticized. I don't want to do anything to make her feel worse. Please help.

Worried Friend

Dear Worried Friend,

Fatigue, even exhaustion, is a common phenomenon among mothers of small children, especially those that have several children close together, as your friend does. Yet the situation you are describing seems to be more extreme than ordinary exhaustion. Exhaustion shouldn't interfere with a mother's life to the point that she loses the capacity to enjoy it. When exhaustion becomes crippling, as it appears to be for your friend, it is appropriate to question whether it is actually a symptom of depression. Postpartum depression is much more common than most people realize, and if left untreated, it can fester for years, interfering with a mother's basic ability to take care of herself and her family. Long-term chronic depression is known as maternal depression, and it can have negative effects on the next generation as well.

Have you spoken with your friend's husband to see whether he shares your concerns? I imagine he has also noticed changes in her personality. It could be that he is equally worried, and will appreciate an opportunity to discuss his worries with you.

Approach your friend, and tell her that you have noticed how exhausted she is. Ask if there is something you can do to help her recharge her batteries. Would she like you to take the kids for a day, or even overnight, so that she could go away with her husband? Does she think that a cleaning lady will make a difference? Listen carefully to her responses. If she welcomes the extra help joyfully, it may be that she is not as depressed as you believe. Yet if she negates each and every suggestion, if she expresses the belief that her situation is hopeless and overwhelming, and simply cannot be improved, than this is a clear sign that the root cause of her exhaustion is depression.

Encourage your friend to discuss her feelings with her doctor or a counselor. If she is willing to take this step, and go speak to a professional qualified to make an assessment for postpartum depression, then you can remain a concerned and sympathetic ear. However, if she refuses, and stubbornly clings to the illusion that it is all just exhaustion, then you may need to speak more firmly with her about how you see that she has changed, and how you love her too much to watch her give up on herself.

Good Luck,