what do I do for a friend who has suicidal thoughts who is already in therapy?

November 7, 2009 2:24 PM

what do I do for a friend who has suicidal thoughts who is already in therapy?

A close friend of mine has battled depression for many years now. She has been in therapy for a year or so and has made some progress, but now and then we will go out for a few drinks and she will express suicidal thoughts.

Normally, if someone came to me with thoughts of suicide, I would tell them to seek therapy. What do you tell someone if they are already in therapy?

posted by anonymous to health & fitness (22 comments total)

"Call your therapist."
posted by Brandon Blatcher at 2:26 PM on November 7

"Are you talking about this with your therapist?"
posted by amethysts at 2:34 PM on November 7

Encourage them to tell their therapist; mention specifically to your friend that the therapist can adjust medication that may be causing increased suicidal thoughts.
posted by motsque at 2:39 PM on November 7

Perhaps don't tell them anything. Maybe try to talk through how they're feeling and why they see suicide as the only option?
posted by 4eyes at 2:43 PM on November 7

From Ms. Vegetable:

If you are out with said friend and she expresses suicidal thoughts, you can always take her to the ER.
posted by a robot made out of meat at 2:46 PM on November 7

While it's not something to say, I would suggest switching to non-alcoholic drinks. The only reason I say this is because depression and alcohol do not mix well at all, and it really can bring out the dark suicidal thoughts.
posted by Saydur at 2:52 PM on November 7 [5 favorites has favorites]

Seconding that you switch to something that doesn't involve alcohol. It's very likely that drinking is bringing out things that she can successfully handle when she's sober. (Speaking from personal experience, being depressed and drunk can lead to some pretty bad times.) And if she's on medication, drinking isn't recommended with most antidepressants anyway.

The fact that she's able to admit suicidal thoughts to you is a very good thing: she trusts you, and it's a good sign that she wants to get better. You might want to let her know that if she ever gets these thoughts when she's alone, or if she feels like she's in danger, you're available to take her to the hospital.
posted by Metroid Baby at 3:17 PM on November 7 [1 favorite has favorites]

There's a big difference between suicidal thoughts of the "I don't feel that life is worth living, but don't really plan to do anything about it" type and the "I am planning to end my life" type. Are you clear on which type of thoughts your friend is having?

If your friend is expressing the first type of thought, it's probably helpful just to listen & spend time with her. I agree with the idea of cutting down or eliminating alcohol - maybe meet for dinner instead, or have a single drink then move on to dinner? Unfortunately, there's not much you can actually DO for someone in a deep depression - it's something she'll need to work through with her therapist & at her own pace.

If, however, your friend is actively suicidal or you think she might be, it is appropriate to take action to ensure she does not hurt herself. This could mean taking your friend to the ER; asking her to call a suicide hotline or calling it yourself to ask for advice; or asking your friend to call her therapist while you are together.
posted by insectosaurus at 3:31 PM on November 7 [4 favorites has favorites]

Suicidal ideation is not really so rare when you're depressed. Most people maybe don't talk about it when they go out for drinks, but it's there.

In yesterday's "my friend is mentally ill" askme, theora555 said, "It's okay to be honest about suicide, to ask "Do you think you might hurt yourself?" Which is a really good point. Expressing suicidal thoughts is not the same has having a plan to hurt yourself and talking about it does help.
posted by dchrssyr at 4:32 PM on November 7

Definitely ask if the suicidal thoughts are backed by any kind of concrete plan. Lack of will to live is frequently an indicator of general hopelessness. Suicidal planning or actions are the scary red flags where an ER visit is a good idea. Her doctor should be aware of what's going on - if she is experiencing even suicidal ideation her meds may need to be tweaked.

With that said: agreeing with the sentiments on alcohol. It doesn't take much at all to interfere with the delicate balance of the depressive's brain chemistry - I find that 2 drinks a week pretty much renders my antidepressants moot. I find this intensely frustrating: I have fought it, negotiated it, tried to sneak around it, tried to ignore it and it doesn't matter. Drinks are few and far between.

And I am sure that there are people that will disagree with this but: tell her that she matters to you. Make sure she knows how important she is in your life. More than once the only thing that kept me alive on particularly rough nights was the thought of how my best friend would hate me forever if I killed myself.
posted by 8dot3 at 5:00 PM on November 7

like 8dot3 says, I would stress to your friend that you care about her and that you want her to take care of herself. Speaking from my own experience during a depressive episode -- I found it very difficult to take any advice from my friends when I was depressed and suicidal. I knew that I should find help, but I just couldn't for some reason, and hearing again about the things I should do often made me feel even more inadequate. What did feel good was when people just told me that they cared about me, and stuck with me with enough tenacity and patience that I began to feel that, even though I was a mess and depressed, I wasn't totally a lost cause. As a friend you can't fix someone else, but you can be there for them and let them know that it's ok for them to feel what it is they're feeling.
posted by cubby at 5:38 PM on November 7

I'm 38, and I've had suicidal thoughts since I was 10. On the one hand, I don't usually talk about them to friends over drinks. On the other hand, when I befriend someone else who has had issues with depression etc., sometimes we tell all kinds of sordid stories to each other, because it's such a relief to know that we're in a conversation that is not going to lead to a thread like this.

Now, this doesn't mean that your friend isn't going to commit suicide. But please consider: To someone who never has suicidal thoughts, hearing them from someone else might seem so strange and wrong that you feel you'd be a terrible person if you didn't take steps to save their life. But to someone who has... well, sometimes they are just thoughts that occur in the natural course of things. I've learned to censor my interaction with friends who think the way that you do.
posted by bingo at 5:48 PM on November 7 [6 favorites has favorites]

Most often, a person who comes into the therapy office with suicidal thoughts just plain needs friends they can talk to and be with, for the other 166 or 167 hours of their week. Part of a therapist's plan for a client who is suicidal is to help the person build up a support network outside of therapy, for the everyday type of support that they'll need. Start by asking your friend what you can do to help, and make sure she is discussing the thoughts with her therapist.
posted by so_gracefully at 5:55 PM on November 7

There are some really great thoughts here already. "Call your therapist" might not be among the best, however.

If your friend is dropping her suicidal thoughts into conversation, she might be putting up a flag that says, "I need you to be my friend right now." Being her friend means that, like insectosaurus, dchrssyr and cubby mentioned above, you ask if she's inclined to hurt herself, talk to her, let her know she matters to you.

Getting angry at her could work, too: "You're thinking of offing yourself? Really? How dare you!? How dare you threaten to take yourself away from me?" That tactic worked with a friend of mine. YMMV.
posted by LOLAttorney2009 at 6:12 PM on November 7

I agree that their drinking is just letting their guard down. Perhaps they are just talking about it to get it off their chest because they trust you? Just from experience there were times I needed to say I was feeling that bad just to say it. Did I mean it to the point of you needed to call 911? No. But you can't tell psychiatrists, "I just feel so bad that I want to kill myself." because off to in-patient you go.

Encourage them to stick with therapy. Probe to see if their current psychologist is really helping them (do they feel like they're getting anywhere? Maybe they should switch). And tell them it's ok to feel that way at times and you're there for them. Depression is incredibly frustrating because it never seems to go away. Have them know that you truly care about them.
posted by stormpooper at 6:38 PM on November 7

This response is not for when things are going very good or very bad; it's more for those times in-between. It's something I would have been receptive to in my darker times; YMMV.

Ask her if she could talk about the supports and tools she's learning. Some of these may be things that she could use some help in using.

An example:

Self-care is one of the first things mentioned in helping people manage their depression. In the program I went through I was given a sheet with dozens of self-care suggestions - things like taking a walk, being around positive people, journaling, trying new creative things, beginning a daily stretching program, expressing appreciation, playing an instrument, reading, playing a board game, etc.; the lists are long.

A problem that I faced (and others in my group) was that for some activities an extra push is needed to get started. Offer to be a part of some of the self-care activities she is interested in but hasn't done; e.g. as taking walks or trying new creative outlets.

Another example:

Meditation and relaxation are powerful tools, but for some people (myself too, initially) they aren't that accessible; for different reasons.

If she feels that there might be some benefit to meditating but has yet to take it up, offer to help find a place (e.g. a local wellness centre, university or Buddhist organization) that offers classes or lunchtime sessions, and if you're both so inclined, offer to check it out together.

Or, if those suggestions don't fly, simply offer to help her review any support materials that she has with her.
posted by Hardcore Poser at 9:14 PM on November 7

Are they taking anti-depressants? Because all other issues with alcohol and depression aside, many anti-depressants either stop working when you drink alcohol or have possibly dangerous interactions with it.
posted by Target Practice at 10:25 PM on November 7

Keep this number and pass it on to your friend: 1-800-273-TALK (8255). It is a national suicide prevention/crisis intervention hotline. It's free, confidential and staffed by people who are trained in exactly this kind of problem. They can help you differentiate normal suicidal thoughts that attend depression from subtle expressions of actual intent. They can help you learn to respond to both. If you don't like the person/response you get, call later and talk to someone else.

Ask her how you can help.

Stay calm, don't freak out. Don't get angry. Offer suggestions only if she wants them, but don't try to fix her or her problem. If she shoots down every idea you offer, it's a good indication that she wants something other than 'solutions'. Just listen, tell her you care about her and ask her what you can do. See if she's willing to come up with a list of trusted people she can call if things get dicey. Tell her what she means to you as a friend - often that feels more meaningful to someone than a just ticking off a list of their good qualities.

Use 911/ER services sparingly and only if she's in imminent danger. The above hotline can help you decide what is and is not an emergency. Also, poke around online and see if your county/city has a mental health crisis line. They might be able to tell you what ER policy is in your area is regarding mental health crises.

Understand that even with therapy and medication, depression is an ongoing struggle for many people.
posted by space_cookie at 12:32 AM on November 8 [1 favorite has favorites]

Listening is absolutely the best thing you can do. Telling her to call her therapist is, to me at least, pretty much the same as telling her to go call someone who cares. Listen to her, don't try to fix it, don't belittle what she's saying. Ask her what she thinks about this, what she thinks is going on in her mind. She may well just be trying to work on the self care stuff her therapist is talking her through.

Depending on how close you are, if you're really worried, offer to stay the night with her, or invite her to sleep over at your place, so she doesn't have to be alone while these thoughts are in her head. That would have meant a lot to me when I was in her situation.
posted by Jilder at 2:51 AM on November 8

Nthing listening. Listen, listen, listen. Just be there for her, and in the most humble, simple and uncomplicated way make it clear that you won't give up on her as a friend.

Don't do anything "drastic" or out of the ordinary unless there is a clear and present reason for it; the main thing is simply to let her know that at least one other person simply likes the fact that she exists.

If you want to do something more "active" try getting one of the many excellent books out there like "depression for dummies" or something a bit more biographical by some famous person who suffered depression, and just work on understanding it for yourself. Emphasis on "for yourself", the main thing is just to be there (don't be her therapist, just be there).
posted by KMH at 9:05 AM on November 8

I find that 2 drinks a week pretty much renders my antidepressants moot.

This.
posted by small_ruminant at 9:57 AM on November 8

I don't have the stats to hand, but a high percentage of potential suicides talked down from the Golden Gate bridge went on to live long and happy[ish, one presumes] lives.

Among the best advice I've heard is that if you kill yourself, you may be killing the wrong person - the depressed person of today, not the future you of tomorrow or next year.

While that sounds glib, the underlying point is true - be there for your friend, but above all remind her that she does have a future - and quite possibly a really happy one. Many suicides lose sight of that future because they feel either that the present is unbearably shitty or that nothing could change. The first is almost always manageable and the second is a guess - and often a poor guess.

So, among the other good advice others have given about defusing the short term impulse to kill herself: focus your friend on the future - create goals to achieve together that involve no more burden of expectation than her being alive. A trip to the park, a holiday, a meal out, a book club with a reading list, a shared resolution etc etc.
posted by MuffinMan at 3:47 AM on November 9